Pub Date : 2021-01-01DOI: 10.35248/2167-0277.21.10.326
Stuart J. McFarlane, Jair E. Garcia, A. Dyer
The feeling of grogginess and lack of alertness one may experience upon, and post-awakening is a physiological phenomenon termed 'sleep inertia' [1-3]. Compared to wholly awake participants, individuals experiencing sleep inertia show decrements in performance which can be reflected in significantly poorer accuracy, memory, complex decision making, and slower reaction time (RT). The duration and severity of sleep inertia is variable and can be influenced by factors such as sleep stage at awakening, sleep deprivation, time of day, as well as a variety of reactive countermeasures [4] like caffeine [5-7] or lighting treatments [8-10]. Research suggests that a typical bout of sleep inertia may last for approximately 30 minutes, however, durations of up to 4 hours have also been reported [1,11-15]. Indeed, in many scenarios sleep inertia represents a multidimensional performance decrement that has the proven potential to negatively impact real-world situations and is frequently highlighted as a research field requiring improved understanding to allay such occurrences [16-23]. For example, in the 2010 Air India Express air crash disaster that resulted in 158 fatalities, it has been shown that the captain of the aircraft had recently woken from an in-flight nap prior to the accident. The poor decisions made by the pilot in the time-frame from awakening to crashing were attributed to the disaster and have been linked to the effects of sleep inertia [23]. Tragedies such as this highlight the importance of maintaining situational awareness in demanding and critical settings. In everyday scenarios, the impacts of sleep inertia cannot be underestimated. It is estimated that on a global economic scale the financial losses as a result of sleep deprivation (a known factor to enhance sleep inertia) amount to hundreds of billions of dollars annually [24,25]. Thus, countermeasure treatments for the reduction of sleep inertia are warranted to ensure safety among citizens in public space, domestic, and employment settings.
一个人可能会经历昏昏沉沉和缺乏警觉性的感觉，醒来后是一种被称为“睡眠惯性”的生理现象[1-3]。与完全清醒的参与者相比，经历睡眠惯性的个体表现出表现的下降，这可以反映在准确性、记忆力、复杂决策和反应时间(RT)的显著下降上。睡眠惯性的持续时间和严重程度是可变的，可能受到觉醒时的睡眠阶段、睡眠剥夺、一天中的时间以及各种反应性对策[4](如咖啡因[5-7]或光照治疗[8-10])等因素的影响。研究表明，一次典型的睡眠惯性发作可能持续约30分钟，然而，也有报道称持续时间长达4小时[1,11-15]。事实上，在许多情况下，睡眠惯性代表了一种多维度的性能下降，已被证明有可能对现实世界的情况产生负面影响，并且经常被强调为一个需要改进理解以减轻此类情况发生的研究领域[16-23]。例如，在2010年导致158人死亡的印度航空快运(Air India Express)空难中，有证据表明，该飞机的机长在事故发生前刚刚从空中小睡中醒来。飞行员在从醒来到坠毁的这段时间内做出的糟糕决定被归咎于这场灾难，并与睡眠惯性[23]的影响有关。诸如此类的悲剧突出了在苛刻和关键环境中保持态势感知的重要性。在日常生活中，睡眠惯性的影响不容小觑。据估计，在全球经济范围内，由于睡眠剥夺(一种已知的增强睡眠惯性的因素)造成的经济损失每年高达数千亿美元[24,25]。因此，减少睡眠惯性的对策治疗是必要的，以确保公民在公共空间、家庭和就业环境中的安全。
{"title":"The Awakening Futures Sound Positive! Commentary On The Efficacy For Audio To Counteract Sleep Inertia","authors":"Stuart J. McFarlane, Jair E. Garcia, A. Dyer","doi":"10.35248/2167-0277.21.10.326","DOIUrl":"https://doi.org/10.35248/2167-0277.21.10.326","url":null,"abstract":"The feeling of grogginess and lack of alertness one may experience upon, and post-awakening is a physiological phenomenon termed 'sleep inertia' [1-3]. Compared to wholly awake participants, individuals experiencing sleep inertia show decrements in performance which can be reflected in significantly poorer accuracy, memory, complex decision making, and slower reaction time (RT). The duration and severity of sleep inertia is variable and can be influenced by factors such as sleep stage at awakening, sleep deprivation, time of day, as well as a variety of reactive countermeasures [4] like caffeine [5-7] or lighting treatments [8-10]. Research suggests that a typical bout of sleep inertia may last for approximately 30 minutes, however, durations of up to 4 hours have also been reported [1,11-15]. Indeed, in many scenarios sleep inertia represents a multidimensional performance decrement that has the proven potential to negatively impact real-world situations and is frequently highlighted as a research field requiring improved understanding to allay such occurrences [16-23]. For example, in the 2010 Air India Express air crash disaster that resulted in 158 fatalities, it has been shown that the captain of the aircraft had recently woken from an in-flight nap prior to the accident. The poor decisions made by the pilot in the time-frame from awakening to crashing were attributed to the disaster and have been linked to the effects of sleep inertia [23]. Tragedies such as this highlight the importance of maintaining situational awareness in demanding and critical settings. In everyday scenarios, the impacts of sleep inertia cannot be underestimated. It is estimated that on a global economic scale the financial losses as a result of sleep deprivation (a known factor to enhance sleep inertia) amount to hundreds of billions of dollars annually [24,25]. Thus, countermeasure treatments for the reduction of sleep inertia are warranted to ensure safety among citizens in public space, domestic, and employment settings.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"10 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69990139","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 : 2021-01-01DOI: 10.35248/2167-0277.21.10.E114
Amedeo Xu
{"title":"Note on Psychosis and schizophrenia","authors":"Amedeo Xu","doi":"10.35248/2167-0277.21.10.E114","DOIUrl":"https://doi.org/10.35248/2167-0277.21.10.E114","url":null,"abstract":"","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"10 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69990977","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 : 2020-01-01DOI: 10.35248/2167-0277.20.9.323
Sim Es, Giovanna Caldeira, Soares, C. Paula
Sleep problems are an increasingly prevalent health condition in modern society and studies have shown that university period is a landmark for sleepiness and poor sleep quality. These sleep changes could be responsible not just for poor academic performance, but also be the cause of health issues, especially mental diseases. Sleep deprivation in university students arises from multiple factors. In this study we aimed to describe social aspects, academic workload and the correlation between daytime sleepiness and the quality of sleep between students of different academic degrees. This research analyzed the correlation between the levels of daytime sleepiness (Epworth Sleepiness Scale - ESS), sleep quality (Pittsburgh Sleep Quality Index - PSQI) and academic workload and applied a sociodemographic questionnaire to university students. The sample (mean age: 22.2 years, SD=4.4) was made up of 55 students of law, 107 of civil engineering and 167 of medicine. The results of the average daytime sleepiness, researched using the Epworth Sleepiness Scale was 11.5 points (SD= 4.8) in Law, 10.5 (SD= 4.1) in Civil Engineering and 11.1 (SD= 4.1) in Medicine, as the quality of sleep, investigated with the Pittsburgh Index, the results were 8.7 (SD=2.6), 7.1 (SD=2.8) and 8.6 (SD=3.1), respectively. There were no significant differences in sleepiness (f=1.1; p>0.05) between courses, but in sleep quality there were significant differences (f=8.1; p 0.05), Civil Engineering (r= 0.09; p>0.05) and Medicine (r=0.17; p>0.05). In our sample, we found poor sleep quality and daytime sleepiness, regardless of degree and the workload required by it. Besides the discrepancies of workload and work activities our findings reinforce the idea that the cause of somnolence, poor sleep and sleep deprivation is multifactorial and highly prevalent in undergraduate students.
{"title":"Why Are Undergraduate Students Sleepy and Sleep Deprived","authors":"Sim Es, Giovanna Caldeira, Soares, C. Paula","doi":"10.35248/2167-0277.20.9.323","DOIUrl":"https://doi.org/10.35248/2167-0277.20.9.323","url":null,"abstract":"Sleep problems are an increasingly prevalent health condition in modern society and studies have shown that university period is a landmark for sleepiness and poor sleep quality. These sleep changes could be responsible not just for poor academic performance, but also be the cause of health issues, especially mental diseases. Sleep deprivation in university students arises from multiple factors. In this study we aimed to describe social aspects, academic workload and the correlation between daytime sleepiness and the quality of sleep between students of different academic degrees. This research analyzed the correlation between the levels of daytime sleepiness (Epworth Sleepiness Scale - ESS), sleep quality (Pittsburgh Sleep Quality Index - PSQI) and academic workload and applied a sociodemographic questionnaire to university students. The sample (mean age: 22.2 years, SD=4.4) was made up of 55 students of law, 107 of civil engineering and 167 of medicine. The results of the average daytime sleepiness, researched using the Epworth Sleepiness Scale was 11.5 points (SD= 4.8) in Law, 10.5 (SD= 4.1) in Civil Engineering and 11.1 (SD= 4.1) in Medicine, as the quality of sleep, investigated with the Pittsburgh Index, the results were 8.7 (SD=2.6), 7.1 (SD=2.8) and 8.6 (SD=3.1), respectively. There were no significant differences in sleepiness (f=1.1; p>0.05) between courses, but in sleep quality there were significant differences (f=8.1; p 0.05), Civil Engineering (r= 0.09; p>0.05) and Medicine (r=0.17; p>0.05). In our sample, we found poor sleep quality and daytime sleepiness, regardless of degree and the workload required by it. Besides the discrepancies of workload and work activities our findings reinforce the idea that the cause of somnolence, poor sleep and sleep deprivation is multifactorial and highly prevalent in undergraduate students.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"9 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69989192","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 : 2020-01-01DOI: 10.35248/2167-0277.20.9.311
Daniel M. Beyerbach, Jill Fricke, Kristofer J. James, S. McKane, Karthikeyan Kanagarajan
Central sleep apnea (CSA) is a neurological breathing disorder resulting from intermittent disruptions in the neural drive to breath. CSA and obstructive sleep apnea (OSA), caused by partial or complete airway blockage, sometimes occur together. The remede System (Respicardia, Minnetonka, MN) is an implantable device that delivers transvenous phrenic nerve stimulation therapy (TPNS) to treat CSA. A patient who failed previous Positive Airway Pressure (PAP) therapies presented with severe CSA and OSA with a baseline Apnea Hypopnea Index (AHI) of 98.1 events/hour. The patient was implanted with a TPNS device and titrated to maximum effectiveness. His CSA improved, but still had persistent OSA. PAP therapy was added to supplement the TPNS. With TPNS off, PAP therapy treated obstructive events but not the central events. TPNS alone treated the central events but not the obstructive events. With both therapies on, CSA and OSA were controlled and breathing was normalized (AHI=3.8). ClinicalTrials.gov Identifier: NCT01816776.
{"title":"Transvenous Phrenic Nerve Stimulation and Automatic Positive Airway Pressure Therapy for Treating Central Sleep Apnea and Residual Obstructive Sleep Apnea","authors":"Daniel M. Beyerbach, Jill Fricke, Kristofer J. James, S. McKane, Karthikeyan Kanagarajan","doi":"10.35248/2167-0277.20.9.311","DOIUrl":"https://doi.org/10.35248/2167-0277.20.9.311","url":null,"abstract":"Central sleep apnea (CSA) is a neurological breathing disorder resulting from intermittent disruptions in the neural drive to breath. CSA and obstructive sleep apnea (OSA), caused by partial or complete airway blockage, sometimes occur together. The remede System (Respicardia, Minnetonka, MN) is an implantable device that delivers transvenous phrenic nerve stimulation therapy (TPNS) to treat CSA. A patient who failed previous Positive Airway Pressure (PAP) therapies presented with severe CSA and OSA with a baseline Apnea Hypopnea Index (AHI) of 98.1 events/hour. The patient was implanted with a TPNS device and titrated to maximum effectiveness. His CSA improved, but still had persistent OSA. PAP therapy was added to supplement the TPNS. With TPNS off, PAP therapy treated obstructive events but not the central events. TPNS alone treated the central events but not the obstructive events. With both therapies on, CSA and OSA were controlled and breathing was normalized (AHI=3.8). ClinicalTrials.gov Identifier: NCT01816776.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"33 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69988289","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 : 2020-01-01DOI: 10.35248/2167-0277.20.9.313
A. Scott, Akke Vellinga, Miriam Geehan, Mohammad Ahmed, E. Mulloy, Gilmartin Jj
Aims and objectives: A number of validated questionnaires are routinely used to screen specific populations for obstructive sleep apnea (OSA) including the STOP, STOP-Bang, Berlin and Epworth sleepiness scales. These questionnaires depend on subjective questions which cannot be independently confirmed. The subjective questions also result in high sensitivity and low specificity as they are generally resulting from OSA. The aim of the study was to identify verifiable and independently measurable risk factors and increase specificity to limit the number of polysomnography evaluations (PE) and lower healthcare cost. Methods: A retrospective data collection of patients (N=164) enrolled for PE was performed which included the results of STOP, STOP Bang, Berlin and Epworth questionnaires as well as demographic and health related variables. OSA was defined as an AHI>=15 obtained from an overnight PE. Sensitivity and specificity of each questionnaire as well as for combinations of other, independently verifiable factors (IVF) was calculated. A new questionnaire was devised including the IVFs and data was prospectively collected from patients undergoing PE (N=209). Results: The retrospective analysis identified age>50, male, BMI>30, alcohol consumption >21 per week, collar circumference>16 inches (40 cm), diabetes, use of antidepressants and high blood pressure as the most influential factors. Prospective data collection was performed and analysis resulted in a new scale with a cut off of 3 based on the following equation: OSA=(2*BMI>30)+(Age>50)+(Male)+(neck>16)+(diabetes)+(alcohol>21unit/week). For every 100 patients with OSA, the total number enrolled for PE based on each screening tool were respectively for STOP 92 enrolled of whom 41 were diagnosed and 1 patient missed, for STOP-Bang 94 enrolled, 42 identified and 1 missed, Berlin 83 enrolled, 36 identified and 7 missed, Epworth 46 enrolled, 22 identified and 20 missed and our new screening tool 65 enrolled, 35 identified and 8 missed. Conclusion: In a high risk population of patients referred for PE we identified independently verifiable factors associated with OSA and with only 2/3 of patients enrolled for PE, we identified most OSA cases while keeping the number of missed cases down.
{"title":"Improving the identification and triage of patients with Obstructive Sleep Apnea who require treatment: The Merlin tool for high risk populations","authors":"A. Scott, Akke Vellinga, Miriam Geehan, Mohammad Ahmed, E. Mulloy, Gilmartin Jj","doi":"10.35248/2167-0277.20.9.313","DOIUrl":"https://doi.org/10.35248/2167-0277.20.9.313","url":null,"abstract":"Aims and objectives: A number of validated questionnaires are routinely used to screen specific populations for obstructive sleep apnea (OSA) including the STOP, STOP-Bang, Berlin and Epworth sleepiness scales. These questionnaires depend on subjective questions which cannot be independently confirmed. The subjective questions also result in high sensitivity and low specificity as they are generally resulting from OSA. The aim of the study was to identify verifiable and independently measurable risk factors and increase specificity to limit the number of polysomnography evaluations (PE) and lower healthcare cost. Methods: A retrospective data collection of patients (N=164) enrolled for PE was performed which included the results of STOP, STOP Bang, Berlin and Epworth questionnaires as well as demographic and health related variables. OSA was defined as an AHI>=15 obtained from an overnight PE. Sensitivity and specificity of each questionnaire as well as for combinations of other, independently verifiable factors (IVF) was calculated. A new questionnaire was devised including the IVFs and data was prospectively collected from patients undergoing PE (N=209). Results: The retrospective analysis identified age>50, male, BMI>30, alcohol consumption >21 per week, collar circumference>16 inches (40 cm), diabetes, use of antidepressants and high blood pressure as the most influential factors. Prospective data collection was performed and analysis resulted in a new scale with a cut off of 3 based on the following equation: OSA=(2*BMI>30)+(Age>50)+(Male)+(neck>16)+(diabetes)+(alcohol>21unit/week). For every 100 patients with OSA, the total number enrolled for PE based on each screening tool were respectively for STOP 92 enrolled of whom 41 were diagnosed and 1 patient missed, for STOP-Bang 94 enrolled, 42 identified and 1 missed, Berlin 83 enrolled, 36 identified and 7 missed, Epworth 46 enrolled, 22 identified and 20 missed and our new screening tool 65 enrolled, 35 identified and 8 missed. Conclusion: In a high risk population of patients referred for PE we identified independently verifiable factors associated with OSA and with only 2/3 of patients enrolled for PE, we identified most OSA cases while keeping the number of missed cases down.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"9 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69988629","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 : 2020-01-01DOI: 10.35248/2167-0277.20.9.322
A. Reihani, J. VanHouten, Vivek Jain
Background: Menopause is associated with increases in sleep-related complaints, including insomnia and mood disorders with associated sleep disruption. Decreased sleep efficiency seen on the polysomnography (PSG) may be related to menopause, OSA, or aging. To identify and treat a new pattern of problems that present with the onset of menopause, sleep physicians should have a better understanding of the effect of OSA treatment with CPAP on quality of life among menopausal women. Therefore, in this study, we hypothesized that sleep architecture improvement with the treatment of OSA would result in subjective improvements in sleep quality in postmenopausal women as assessed by the Post PSG Sleep Assessment (PPSA). Method: In this study, we prospectively analyzed 49 menopausal women diagnosed with OSA presenting to the George Washington University’s Medical Faculty Associates, Center for Sleep Disorders. From 2012 to 2016, this sample of responders was invited to undergo in-laboratory polysomnography. Patients were treated with continuous positive airway pressure (CPAP). Pre-treatment SF-36, Hamilton rating scales (HAM-D) for depression, insomnia severity index, Epworth sleepiness scale (ESS), and MRS scores were compared with three-month post-treatment scores with Wilcoxon signed-rank test. Result: During the recruitment period, 60 women underwent polysomnography and were diagnosed with moderate to severe sleep apnea. During the initial follow up visit, 49 women met the eligibility criteria for the study. There was a trend for higher average Epworth Sleepiness Scale (ESS) in patients who were non-compliant to the CPAP treatment (Using the Medicare adherence criteria of ≥ 4 h of use on 70% of nights) than the individuals who adhere to the CPAP treatment. (7.29 versus 6.0 respectively, p< .849). Conclusion: Although findings show that compliance to Obstructive Sleep Apnea (as assessed by AHI) treatment with CPAP, was unrelated to the severity of menopausal symptoms, there is good evidence that treating OSA improves depression with OSA-related symptoms (i.e., daytime sleepiness, cognitive deficits, etc.). Overall, this study shows that sleep apnea symptoms are more severely expressed by OSA patients who are non-compliant with CPAP treatment.
{"title":"Evaluating the effect of Obstructive Sleep Apnea (OSA) Treatment with CPAP on Menopause Rating Scale (MRS) among post-menopausal women","authors":"A. Reihani, J. VanHouten, Vivek Jain","doi":"10.35248/2167-0277.20.9.322","DOIUrl":"https://doi.org/10.35248/2167-0277.20.9.322","url":null,"abstract":"Background: Menopause is associated with increases in sleep-related complaints, including insomnia and mood disorders with associated sleep disruption. Decreased sleep efficiency seen on the polysomnography (PSG) may be related to menopause, OSA, or aging. To identify and treat a new pattern of problems that present with the onset of menopause, sleep physicians should have a better understanding of the effect of OSA treatment with CPAP on quality of life among menopausal women. Therefore, in this study, we hypothesized that sleep architecture improvement with the treatment of OSA would result in subjective improvements in sleep quality in postmenopausal women as assessed by the Post PSG Sleep Assessment (PPSA). Method: In this study, we prospectively analyzed 49 menopausal women diagnosed with OSA presenting to the George Washington University’s Medical Faculty Associates, Center for Sleep Disorders. From 2012 to 2016, this sample of responders was invited to undergo in-laboratory polysomnography. Patients were treated with continuous positive airway pressure (CPAP). Pre-treatment SF-36, Hamilton rating scales (HAM-D) for depression, insomnia severity index, Epworth sleepiness scale (ESS), and MRS scores were compared with three-month post-treatment scores with Wilcoxon signed-rank test. Result: During the recruitment period, 60 women underwent polysomnography and were diagnosed with moderate to severe sleep apnea. During the initial follow up visit, 49 women met the eligibility criteria for the study. There was a trend for higher average Epworth Sleepiness Scale (ESS) in patients who were non-compliant to the CPAP treatment (Using the Medicare adherence criteria of ≥ 4 h of use on 70% of nights) than the individuals who adhere to the CPAP treatment. (7.29 versus 6.0 respectively, p< .849). Conclusion: Although findings show that compliance to Obstructive Sleep Apnea (as assessed by AHI) treatment with CPAP, was unrelated to the severity of menopausal symptoms, there is good evidence that treating OSA improves depression with OSA-related symptoms (i.e., daytime sleepiness, cognitive deficits, etc.). Overall, this study shows that sleep apnea symptoms are more severely expressed by OSA patients who are non-compliant with CPAP treatment.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"26 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69989141","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 : 2020-01-01DOI: 10.35248/2167-0277.19.9.308
Dong An, J. Selvanathan, J. Wong, C. Suen, S. Mir, Marina F Englesakis, F. Chung
There may be a bidirectional relationship between sleep and pain in patients with chronic pain. Actigraphy is increasingly being used as a non-invasive and objective method to assess sleep in chronic pain patients. This systematic review aimed to evaluate the utility of actigraphy in chronic pain patients. Additionally, meta-analyses were conducted to compare sleep parameters measured by actigraphy with those measured by sleep diary and polysomnography. Medline (1946-2019), Medline In-Process (May 2019), Embase (1947-2019), Cochrane Central Register of Controlled Trials (1991-2019), Cochrane Database of Systematic Reviews (2005-2019), and PubMed-NOTMedline (1946-2019) were searched for studies using actigraphy to measure sleep in chronic pain patients. Using the random effects model, meta-analyses were conducted to examine the concordance of actigraphy versus sleep diary and actigraphy versus polysomnography for commonly measured sleep parameters. Thirty-four studies with 3,590 patients were included. As an adjunct to sleep diary, actigraphy detected improvements in various sleep parameters after interventions in 10 studies and provided a useful objective sleep metric when comparing pain patients with healthy subjects in four studies; however, diary measurements were more “sensitive”. Comparing sleep diary versus actigraphy, sleep onset latency was significantly lower with actigraphy (mean difference of 22.7 minutes lower; 95% confidence interval: 13.2 to 32.2 minutes lower; p<0.01). No sleep parameters were significantly different between polysomnography and actigraphy; however, the confidence intervals were large. Actigraphy is an objective assessment tool that is being increasingly utilized to measure sleep in chronic pain patients. Based on studies that have measured sleep with both sleep diary and actigraphy, there are intrinsic differences between the two assessment methods as actigraphy lacks the cognitive component of subjective measures. Even though no differences in sleep parameters were detected between actigraphy and polysomnography, it cannot be established that the two are equivalent objective measures because of the limited number of studies and large variability.
慢性疼痛患者的睡眠与疼痛之间可能存在双向关系。作为一种非侵入性、客观的慢性疼痛患者睡眠评估方法，活动描记术正被越来越多地应用。本系统综述旨在评估活动描记术在慢性疼痛患者中的应用。此外，还进行了荟萃分析，比较活动描记仪测量的睡眠参数与睡眠日记和多导睡眠描记仪测量的睡眠参数。检索了Medline(1946-2019)、Medline in - process(2019年5月)、Embase(1947-2019年)、Cochrane中央对照试验登记册(1991-2019年)、Cochrane系统评价数据库(2005-2019年)和PubMed-NOTMedline(1946-2019年)，以检索使用活动描记法测量慢性疼痛患者睡眠的研究。采用随机效应模型，进行meta分析以检验活动描记术与睡眠日记、活动描记术与多导睡眠描记术在常用睡眠参数测量上的一致性。34项研究共纳入3590名患者。作为睡眠日记的辅助手段，活动描记术在10项研究中检测到干预后各种睡眠参数的改善，并在4项研究中将疼痛患者与健康受试者进行比较时提供了有用的客观睡眠指标;然而，日记测量更“敏感”。对比睡眠日记和活动描记术，活动描记术的睡眠发作潜伏期显著降低(平均差22.7分钟;95%置信区间:低13.2 ~ 32.2分钟;p < 0.01)。多导睡眠图与活动图的睡眠参数无显著差异;然而，置信区间很大。活动记录仪是一种客观的评估工具，越来越多地用于测量慢性疼痛患者的睡眠。根据同时使用睡眠日记和活动描记法测量睡眠的研究，两种评估方法存在内在差异，因为活动描记法缺乏主观测量的认知成分。尽管在活动描记仪和多导睡眠描记仪之间没有检测到睡眠参数的差异，但由于研究数量有限且变异性较大，因此不能确定两者是等效的客观测量。
{"title":"The Utility of Actigraphy to Measure Sleep in Chronic Pain Patients and Its Concordance with Other Sleep Measures: A Systematic Review and Meta-Analysis","authors":"Dong An, J. Selvanathan, J. Wong, C. Suen, S. Mir, Marina F Englesakis, F. Chung","doi":"10.35248/2167-0277.19.9.308","DOIUrl":"https://doi.org/10.35248/2167-0277.19.9.308","url":null,"abstract":"There may be a bidirectional relationship between sleep and pain in patients with chronic pain. Actigraphy is increasingly being used as a non-invasive and objective method to assess sleep in chronic pain patients. This systematic review aimed to evaluate the utility of actigraphy in chronic pain patients. Additionally, meta-analyses were conducted to compare sleep parameters measured by actigraphy with those measured by sleep diary and polysomnography. Medline (1946-2019), Medline In-Process (May 2019), Embase (1947-2019), Cochrane Central Register of Controlled Trials (1991-2019), Cochrane Database of Systematic Reviews (2005-2019), and PubMed-NOTMedline (1946-2019) were searched for studies using actigraphy to measure sleep in chronic pain patients. Using the random effects model, meta-analyses were conducted to examine the concordance of actigraphy versus sleep diary and actigraphy versus polysomnography for commonly measured sleep parameters. Thirty-four studies with 3,590 patients were included. As an adjunct to sleep diary, actigraphy detected improvements in various sleep parameters after interventions in 10 studies and provided a useful objective sleep metric when comparing pain patients with healthy subjects in four studies; however, diary measurements were more “sensitive”. Comparing sleep diary versus actigraphy, sleep onset latency was significantly lower with actigraphy (mean difference of 22.7 minutes lower; 95% confidence interval: 13.2 to 32.2 minutes lower; p<0.01). No sleep parameters were significantly different between polysomnography and actigraphy; however, the confidence intervals were large. Actigraphy is an objective assessment tool that is being increasingly utilized to measure sleep in chronic pain patients. Based on studies that have measured sleep with both sleep diary and actigraphy, there are intrinsic differences between the two assessment methods as actigraphy lacks the cognitive component of subjective measures. Even though no differences in sleep parameters were detected between actigraphy and polysomnography, it cannot be established that the two are equivalent objective measures because of the limited number of studies and large variability.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"9 1","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69988245","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 : 2020-01-01DOI: 10.35248/2167-0277.20.9.321
C. P. Dain, Joseph Thomas
Objective: Patients who underwent bilateral sagittal split osteotomy with mandibular setback had been evaluated using lateral cephalograms to identify sites of mechanical obstruction that predispose to airway obstruction. The bioadaptive changes that occur in the peri-airway structures in the post-operative period were evaluated. Methods: The hard and soft tissue landmarks used in cephalometry were used to trace and measure the pharyngeal airway space (PAS) and changes in position of hyoid. Amount of mandibular setback, PAS width, PAS area and changes in the hyoid position were recorded. The difference in pre- and post-operative values measured from cephalometric tracings were analyzed statistically using repeated measure ANOVA. Results: The results demonstrated a significant reduction in PAS width and area corresponding to the decrease in length of mandible after BSSO setback. The decrease in PAS width was found to be 41% of the amount of mandibular setback at 6 months. The mean mandibular setback recorded at 6 months was 8.2 mm. The mean reduction in PAS width registered at 3 and 6 months were 3.8 mm and 3.4 mm (p value 0.001),marginally reclaiming the PAS width at 6 months. The mean reduction in PAS area at 3 and 6 months were 1.6 cm2 and 2.1cm2 (p value 0.009) demonstrating no recovery in the PAS area. The hyoid was displaced posteriorly and inferiorly; the mean displacements in the posterior direction at 3 and 6 months were 2.6 mm and 2 mm (p value 0.013) and inferior direction were 3 mm and 4 mm. Conclusion: Mandibular setback surgery has the potential for narrowing the pharyngeal airway space with a significant reduction in PAS width and area, that could predispose to OSA. The results demonstrate that bioadaptive changes of the hyoid are greater post-surgery and tend to settle in the direction of its pre-surgical position in the anteroposterior plane and drift inferiorly in the supero-inferior plane in an attempt to restore the airway space.
目的:对接受双侧矢状面劈开截骨合并下颌后退的患者进行侧位头颅造影评估，以确定易导致气道阻塞的机械阻塞部位。评估术后气道周围结构发生的生物适应性变化。方法:利用头颅测量术中使用的软组织和硬组织标记来追踪和测量咽气道间隙(PAS)和舌骨位置的变化。记录下颌后退量、PAS宽度、PAS面积及舌骨位置变化。采用重复测量方差分析(repeated measure ANOVA)对术前和术后头颅测量值的差异进行统计学分析。结果:BSSO退缩后，下颌骨PAS宽度和面积明显减小，相应的下颌骨长度减小。在6个月时，PAS宽度的减少是下颌后退量的41%。6个月时记录的下颌后退平均为8.2 mm。在3个月和6个月时，PAS宽度平均减少3.8 mm和3.4 mm (p值0.001)，6个月时PAS宽度略有恢复。3个月和6个月时PAS面积的平均减少分别为1.6 cm2和2.1cm2 (p值0.009)，表明PAS面积没有恢复。舌骨向后下方移位;术后3个月和6个月后侧移位分别为2.6 mm和2 mm (p值为0.013)，下侧移位分别为3 mm和4 mm。结论:下颌骨后退手术有可能使咽气道间隙变窄，PAS宽度和面积明显减少，易发生OSA。结果表明，舌骨术后的生物适应性变化更大，并倾向于在手术前的前后平面上向其位置方向沉降，并在上下平面上向下漂移，以试图恢复气道空间。
{"title":"The Bioadaptive Changes in the Pharyngeal Airway and Hyoid Position Following Mandibular Setback Surgery: A Cephalometric Study","authors":"C. P. Dain, Joseph Thomas","doi":"10.35248/2167-0277.20.9.321","DOIUrl":"https://doi.org/10.35248/2167-0277.20.9.321","url":null,"abstract":"Objective: Patients who underwent bilateral sagittal split osteotomy with mandibular setback had been evaluated using lateral cephalograms to identify sites of mechanical obstruction that predispose to airway obstruction. The bioadaptive changes that occur in the peri-airway structures in the post-operative period were evaluated. Methods: The hard and soft tissue landmarks used in cephalometry were used to trace and measure the pharyngeal airway space (PAS) and changes in position of hyoid. Amount of mandibular setback, PAS width, PAS area and changes in the hyoid position were recorded. The difference in pre- and post-operative values measured from cephalometric tracings were analyzed statistically using repeated measure ANOVA. Results: The results demonstrated a significant reduction in PAS width and area corresponding to the decrease in length of mandible after BSSO setback. The decrease in PAS width was found to be 41% of the amount of mandibular setback at 6 months. The mean mandibular setback recorded at 6 months was 8.2 mm. The mean reduction in PAS width registered at 3 and 6 months were 3.8 mm and 3.4 mm (p value 0.001),marginally reclaiming the PAS width at 6 months. The mean reduction in PAS area at 3 and 6 months were 1.6 cm2 and 2.1cm2 (p value 0.009) demonstrating no recovery in the PAS area. The hyoid was displaced posteriorly and inferiorly; the mean displacements in the posterior direction at 3 and 6 months were 2.6 mm and 2 mm (p value 0.013) and inferior direction were 3 mm and 4 mm. Conclusion: Mandibular setback surgery has the potential for narrowing the pharyngeal airway space with a significant reduction in PAS width and area, that could predispose to OSA. The results demonstrate that bioadaptive changes of the hyoid are greater post-surgery and tend to settle in the direction of its pre-surgical position in the anteroposterior plane and drift inferiorly in the supero-inferior plane in an attempt to restore the airway space.","PeriodicalId":73946,"journal":{"name":"Journal of sleep disorders & therapy","volume":"9 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69988531","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：