Sleep is a universal biological function but remains poorly understood and a relatively new field of science and medicine. Over the past decade, there have been rapidly accumulating scientific and ...clinical data around sleep, including the effects of various sleep aspects on cardiovascular health. Much of the research in the field has focused on sleep-disordered breathing, particularly obstructive sleep apnea. However, other sleep pathologies including hypersomnolence disorders, sleep-related movement disorders, and parasomnia disorders have been linked with cardiovascular health. Other areas of sleep, such as sleep duration, timing, and circadian rhythms, also have a demonstrated association with heart health. In this review, we provide an updated summary of the literature connecting sleep and cardiovascular disease.
The global prevalence of PASC is estimated to be present in 0·43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing ...long COVID symptoms. Despite this, its clinical features are not well-defined.
We collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) phenotype.
The median age was 47 years, 59.0% were female; 49.3% White, 17.2% Hispanic, 14.9% Asian, and 6.7% Black. Only 12.7% required hospitalization. Seventy-two (53.5%) patients had no known comorbid conditions. Forty-five (33.9%) were significantly debilitated. The median duration of symptoms was 285.5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86.5%), post-exertional malaise (82.8%), brain fog (81.2%), unrefreshing sleep (76.7%), and lethargy (74.6%). Forty-three percent fit the criteria for ME/CFS, majority were female, and obesity (BMI > 30 Kg/m
) (
= 0.00377895) and worse functional status (
= 0.0110474) were significantly associated with ME/CFS.
Most PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype.
What Is Narcolepsy? Sum-Ping, Oliver; Mignot, Emmanuel
JAMA : the journal of the American Medical Association,
05/2023, Letnik:
329, Številka:
20
Journal Article
Abstract Introduction The Epworth Sleepiness Scale (ESS) is the gold standard measure subjective daytime sleepiness. Since the inception of the ESS 25 years ago, modern life has evolved considerably ...and the situations posed by the ESS have become dated. This interim analysis introduces the Situational Sleepiness Scale (SSS) which focuses on common activities occurring in the modern world. Methods A group of sleep physicians and staff between Stanford and the UK Biobank developed the questionnaire. An initial set of questions were distributed to subjects, and through multiple iterations of subject feedback and subsequent revision, were refined into its current form of eleven situations. To explore further the scale as a replacement for the ESS, the SSS and the eight situation ESS were given in tandem to patients and visitors of the Stanford Sleep Clinic. Results A correlation coefficient between the ESS and SSS was run on 121 completed questionnaires. Our result to date indicates a strong correlation between both scales (R2=0.74, p<.0001). The mean score for the SSS was 7.74 and 7.36 for the ESS. The standard deviation for the SSS was 5.11 compared to 4.74 for the ESS. A test of variance produced a value of 25.9 for the SSS and 22.3 for the ESS. Thirty-four subjects scored ≥ 10 in this sample using the ESS and 26 of these subjects had a value ≥ 10 for the SSS. Most of the subjects who scored ≥ 10 on the ESS scored ≥ 10 on the SSS and vice versa suggesting that a similar cutoff could be used for defining daytime sleepiness on the SSS. Conclusion In this interim analysis, we found the Situational Sleepiness Scale to be easily administered and to correlate well with the ESS. In future studies we will examine consistency of scores across item, stability over time/ repeatability, and explore psychometric properties. Additional studies aiming at gathering several hundred subjects with various diagnoses are ongoing. As the SSS goes up to 33, but has a similar cutoff of ten on the correlation, we believe the SSS could be more discriminative than the ESS for very sleepy patients such as narcoleptics. Support (if any)
Abstract Introduction This study aimed to identify novel markers of NT1 using between-nap and in-nap features of Multiple Sleep Latency Test (MSLT) recordings. We hypothesized that sleep-wake ...instability observed in NT1, alongside quantifiable patterns of sleepiness during wakefulness, may contain biomarkers for differentiating NT1 from other hypersomnia disorders between naps. Further, we wanted to explore if NT1 and NT2 MSLT could be distinguished beyond the common presence of a mean sleep latency below 8 minutes and multiple SOREMPs. Methods We analyzed in-between nap periods of MSLT recordings, extracting features describing sleepiness, microsleep patterns, and sleep-stage mixing, in three different sleep centers, based on the hypodensities obtained from U-sleep. 107 features were extracted from 178 patients diagnosed with NT1, NT2, Idiopathic Hypersomnia (IH), and Subjective IH (sIH), most with CSF hypocretin levels available. Second, we trained a model to distinguish NT1 from sIH and to differentiate NT1 from other hypersomnolence disorders, including IH plus NT2. A cross-cohort validation strategy was employed, involving training the model on combinations of two cohorts and validating on the third. Results Analysis indicated an increased probability of REM sleep during between-nap periods in the MSLT of NT1 patients, along with a greater prevalence of sleep stage mixing between REM and N1 sleep stages in microsleep episodes. In distinguishing NT1 from NT2, IH, and Subjective IH using features solely from between-nap periods of the MSLT, sensitivity was 0.72, specificity 0.70, and F1-score 0.62 across three validation cohorts. Distinguishing NT1 versus NT2 with between-nap features resulted in sensitivity 0.75, specificity 0.59 and F1-score 0.66 across three validation cohorts. When using features from the in-nap part of the MSLT, NT1 was distinguished from NT2 with sensitivity of 0.75, specificity of 0.82, and F1-score of 0.78 on average across the three validation cohorts. Conclusion The findings in this study support the hypothesis that NT1 patients exhibit increased sleepiness and sleep stage mixing during wake periods compared to other hypersomnolence disorders. Further, NT1 and NT2 could be partially distinguished using in-nap features, even so these two groups of subjects have positive MSLTs. This work supports the use of new analytical methods in MSLT. Support (if any)
Abstract Introduction Isolated Rapid Eye Movement (REM) Sleep Behavior Disorder (iRBD) is a marker of neurodegeneration and is currently diagnosed based on REM sleep without atonia (RSWA) and a ...history of dream enactment. However, even for sleep experts, scoring RSWA can be challenging and incidental RBD cases are easily missed. Previous research focused on the automatic identification of iRBD using 3D video analysis. This study aims at developing a machine learning classifier to detect iRBD using only conventional 2D cameras and evaluating its performance on an expanded cohort. Methods We used 2D video data from in-lab video-polysomnography recorded at the Stanford Sleep Center in 78 patients with definite iRBD per ICSD-3 TR criteria and 109 without RBD (41 OSA AHI > 15, 37 RLS/PLM PLMi>15, 9 non-RBD parasomnias, 5 insomnia, 2 narcolepsy, 39 with normal sleep). An automatic computer vision algorithm, i.e. optical flow, was applied on the recorded videos to detect periods of movements in REM sleep. Movement periods were divided based on their duration from very brief (0.1s) to extended (>30s) motor behaviors, 1 second of immobility separating each period. Features were movement frequency and proportion of movement periods in REM sleep. Different combinations of these features fed a logistic regression classifier, which was trained and tested in the 10-fold cross-validation scheme. Results On average, 58.13 and 42.53 movement periods were detected during REM sleep in cases and controls, respectively. The best performance was achieved using short movements (0.1-2s) with sensitivity of 0.921, specificity of 0.674, accuracy of 0.835 and F1 score of 0.847. With medium (2-15s) and long (15-300s) movements, accuracy was 0.845 and 0.672, sensitivity 0.743 and 0.147, specificity 0.901 and 1.0, and F1 score 0.808 and 0.256, respectively. Adding features of gender, AHI, and PLM index to short movements increased accuracy to 0.886. Conclusion One-night video data from conventional video-polysomnography can detect iRDB using machine learning techniques. Automated video analysis of REM sleep could augment our current ability to screen and diagnose RBD in the sleep laboratory setting. Support (if any)
Study Objectives: Symptomatic therapies for rapid-eye-movement (REM) sleep behavior disorder (RBD) are limited. Sodium oxybate (SXB), a gamma-aminobutyric acid (GABA)-B agonist, could be effective ...but has not been evaluated against placebo. Methods: This double-blind, parallel-group, randomized, placebo-controlled trial in 24 participants was conducted at the Stanford Sleep Center. Patients were adults with definite iRBD or Parkinson's disease and probable RBD (PD-RBD), and persistence of greater than or equal to 2 weekly episodes despite standard therapy. Patients were randomized 1:1 to receive SXB during a 4-week titration followed by a 4-week stable dosing period. Primary outcome was number of monthly RBD episodes according to a diary filled by patients and partners. Secondary outcomes were severity, number of severe RBD episodes, and objective RBD activity on video polysomnography. Results: Twelve iRBD and 12 PD-RBD participated (mean 65.8 years), and 22 (n = 10 SXB, 12 placebo) completed the study. Although no significant between-group difference was found, SXB showed reduction of monthly RBD episodes by 23.1 (95% CI -36.0, -10.2; p = 0.001) versus 10.5 with placebo (95% CI, -22.6, 1.6; p = 0.087). Improvement from baseline was similarly observed for RBD overall severity burden (each episode weighted for severity), number of severe episodes, and objective RBD activity per video-polysomnography. Two participants receiving SXB withdrew due to anxiety and dizziness. The majority of adverse events are otherwise resolved with dose adjustment. Conclusion: SXB could reduce RBD symptoms; however, response was inconsistent and a large placebo effect was observed across patient-reported outcomes. Larger studies using objective endpoints are needed. Clinical Trial: Treatment of REM Sleep Behavior Disorder (RBD) With Sodium Oxybate Key words: REM sleep behavior disorder; Parkinson's disease; sodium oxybate; parasomnia Statement of Significance REM sleep behavior disorder (RBD) is the leading cause of sleep-related injuries but there is currently no symptomatic therapy approved by the Federal Drug Administration. This study is among the rare randomized clinical trials in RBD and the first controlled study using sodium oxybate. This double-blind placebo-controlled study suggests that sodium oxybate may plausibly be effective, not only per patients' report, but per objective video-polysomnography measures. Our findings provide the basis for future larger studies evaluating the efficacy of sodium oxybate in RBD. Importantly, our protocol is the first to implement guidelines from the International RBD Study Group on clinical trials and outcome measures in RBD and use objective endpoints.
Abstract
Study Objectives
Symptomatic therapies for rapid-eye-movement (REM) sleep behavior disorder (RBD) are limited. Sodium oxybate (SXB), a gamma-aminobutyric acid (GABA)-B agonist, could be ...effective but has not been evaluated against placebo.
Methods
This double-blind, parallel-group, randomized, placebo-controlled trial in 24 participants was conducted at the Stanford Sleep Center. Patients were adults with definite iRBD or Parkinson’s disease and probable RBD (PD-RBD), and persistence of ≥ 2 weekly episodes despite standard therapy. Patients were randomized 1:1 to receive SXB during a 4-week titration followed by a 4-week stable dosing period. Primary outcome was number of monthly RBD episodes according to a diary filled by patients and partners. Secondary outcomes were severity, number of severe RBD episodes, and objective RBD activity on video polysomnography.
Results
Twelve iRBD and 12 PD-RBD participated (mean 65.8 years), and 22 (n = 10 SXB, 12 placebo) completed the study. Although no significant between-group difference was found, SXB showed reduction of monthly RBD episodes by 23.1 (95% CI −36.0, −10.2; p = 0.001) versus 10.5 with placebo (95% CI, −22.6, 1.6; p = 0.087). Improvement from baseline was similarly observed for RBD overall severity burden (each episode weighted for severity), number of severe episodes, and objective RBD activity per video-polysomnography. Two participants receiving SXB withdrew due to anxiety and dizziness. The majority of adverse events are otherwise resolved with dose adjustment.
Conclusion
SXB could reduce RBD symptoms; however, response was inconsistent and a large placebo effect was observed across patient-reported outcomes. Larger studies using objective endpoints are needed.
Clinical Trial
Treatment of REM Sleep Behavior Disorder (RBD) With Sodium Oxybate
https://clinicaltrials.gov/ct2/show/NCT04006925 ClinicalTrials.gov identifier: NCT04006925
Graphical abstract
Graphical Abstract
Atherosclerosis, a chronic inflammatory disease of the arteries that appears to have been as prevalent in ancient as in modern civilizations, is predisposing to life-threatening and life-ending ...cardiac and vascular complications, such as myocardial and cerebral infarctions. The pathogenesis of atherosclerosis involves intima plaque buildup caused by vascular endothelial dysfunction, cholesterol deposition, smooth muscle proliferation, inflammatory cell infiltration and connective tissue accumulation. Hypertension is an independent and controllable risk factor for atherosclerotic cardiovascular disease (CVD). Conversely, atherosclerosis hardens the arterial wall and raises arterial blood pressure. Many CVD patients experience both atherosclerosis and hypertension and are prescribed medications to concurrently mitigate the two disease conditions. A substantial number of publications document that many pathophysiological changes caused by atherosclerosis and hypertension occur in a manner dependent upon circadian clocks or clock gene products. This article reviews progress in the research of circadian regulation of vascular cell function, inflammation, hemostasis and atherothrombosis. In particular, it delineates the relationship of circadian organization with signal transduction and activation of the renin-angiotensin-aldosterone system as well as disturbance of the sleep/wake circadian rhythm, as exemplified by shift work, metabolic syndromes and obstructive sleep apnea (OSA), as promoters and mechanisms of atherogenesis and risk for non-fatal and fatal CVD outcomes. This article additionally updates advances in the clinical management of key biological processes of atherosclerosis to optimally achieve suppression of atherogenesis through chronotherapeutic control of atherogenic/hypertensive pathological sequelae.
