Summary
Recent studies indicate that ambient temperature may modulate obstructive sleep apnoea (OSA) severity. However, study results are contradictory warranting more investigation in this field. We ...analysed 19,293 patients of the European Sleep Apnoea Database (ESADA) cohort with restriction to the three predominant climate zones according to the Köppen–Geiger climate classification: Cfb (warm temperature, fully humid, warm summer), Csa (warm temperature, summer dry, hot summer), and Dfb (snow, fully humid, warm summer). Average outside temperature values were obtained and several hierarchical regression analyses were performed to investigate the impact of temperature on the apnea–hypopnea index (AHI), oxygen desaturation index (ODI), time of oxygen saturation <90% (T90) and minimum oxygen saturation (MinSpO2) after controlling for confounders including age, body mass index, gender, and air conditioning (A/C) use. AHI and ODI increased with higher temperatures with a standardised coefficient beta (β) of 0.28 for AHI and 0.25 for ODI, while MinSpO2 decreased with a β of −0.13 (all results p < .001). When adjusting for climate zones, the temperature effect was only significant in Cfb (AHI: β = 0.11) and Dfb (AHI: β = 0.08) (Model 1: p < .001). The presence of A/C (3.9% and 69.3% in Cfab and Csa, respectively) demonstrated only a minor increase in the prediction of the variation (Cfb: AHI, R2 +0.003; and Csa: AHI, R2 +0.007; both p < .001). Our present study indicates a limited but consistent influence of environmental temperature on OSA severity and this effect is modulated by climate zones.
The present study aimed to assess the influence of gender and age on snoring and sleep bruxism in non‐apneic snoring patients. Adult participants with clinical suspicion of snoring and with no other ...significant medical history were recruited. Single‐night video polysomnography was performed to detect snoring and sleep bruxism. Finally, 137 snoring non‐apneic participants were included. Statistical analysis of gender groups showed that the total snore index and snore train were significantly higher in men than in women. Men also presented severe bruxism, with significantly more frequent episodes and higher bruxism episodes index scores. The correlation analysis showed the presence of significant linear relationships in the supine sleep position between age and snore index, snore index in non‐rapid eye movement 2 (N2) sleep stage, and snore train. The analysis of groups separated according to the criterion of third age quartile showed that the average, maximum and minimum audio volume in the non‐supine sleep position was significantly higher in the older group. The analysis of groups separated according to the criterion of median age showed that the bruxism episode index and bruxism phasic episodes were significantly higher in the younger group. Thus, it can be concluded that both age and gender influence snoring and sleep bruxism. Snoring and sleep bruxism seem to be more intensive in men. Older patients seem to snore more in N2 sleep and the supine sleep position and present lower bruxism episodes, especially the phasic type. The results of the present study indicate the need for further research on this topic to establish the possible relationship between snoring and sleep bruxism.
Abstract
Context
Prader-Willi syndrome (PWS) is a rare, genetic, multisymptom, neurodevelopmental disease due to lack of the expression of the paternal genes in the q11 to q13 region of chromosome ...15. The main characteristics of PWS are muscular hypotonia, hyperphagia, obesity, behavioral problems, cognitive disabilities, and endocrine deficiencies, including growth hormone (GH) deficiency. Sleep apnea and abnormal sleep patterns are common in PWS. GH treatment might theoretically have a negative impact on respiration.
Objective
Here we present the effect of GH treatment on polysomnographic measurements.
Methods
Thirty-seven adults, 15 men and 22 women, with confirmed PWS were randomly assigned to 1 year of GH treatment (n = 19) or placebo (n = 18) followed by 2 years of GH treatment to all. Polysomnographic measurements were performed every 6 months. A mixed-effect regression model was used for comparison over time in the subgroup that received GH for 3 years.
Results
At baseline median age was 29.5 years, body mass index 27.1, insulin-like growth factor 115 µg/L, apnea-hypopnea index (AHI) 1.4 (range, 0.0-13.9), and sleep efficiency (SE) 89.0% (range, 41.0%-99.0%). No differences in sleep or respiratory parameters were seen between GH- and placebo-treated patients. SE continuously improved throughout the study, also after adjustment for BMI, and the length of the longest apnea increased. AHI inconsistently increased within normal range.
Conclusion
SE improved during GH treatment and no clinical, significantly negative impact on respiration was seen. The etiology of breathing disorders is multifactorial and awareness of them should always be present in adults with PWS with or without GH treatment.
Summary
Excessive daytime sleepiness (EDS) is a hallmark symptom in obstructive sleep apnea (OSA). It is commonly eliminated by obstructive sleep apnea therapy and constitutes a major treatment ...indication. This study aimed to identify determinants of excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS) scores in the large, representative national obstructive sleep apnea patient cohort of the Swedish Sleep Apnea Registry (SESAR, www.sesar.se). Data from 34,684 patients with obstructive sleep apnea recruited at 23 sites (33% females, mean age 55.7 ± 13.7 years, BMI 30.2 ± 6.3 kg/m2, AHI 29.1 ± 22.3, and ODI 24.9 ± 21.4 events/h) had a mean ESS score in the mild to moderate excessive daytime sleepiness range (9.7 ± 4.9). The proportion of patients with excessive daytime sleepiness was 41.4% in men and 44.6% in women. Independent predictors of excessive daytime sleepiness included gender, age, and hypoxic markers (high ODI and low mean saturation). Univariate and multivariate analyses were used to identify significant predictors for the ESS score and for excessive daytime sleepiness (ESS ≥10) amongst anthropometric factors, sleep apnea frequency (apnea‐hypopnea index (AHI)), markers of intermittent hypoxia (oxygen desaturation index (ODI), mean saturation (mSaO2)), as well as prevalent comorbidities. Depression was associated with higher ESS scores and hypertension/atrial fibrillation with lower scores. The oxygen desaturation index provided a stronger predictor of excessive daytime sleepiness than the apnea‐hypopnea index. The severity of obstructive sleep apnea, captured as the apnea‐hypopnea index, was only weakly associated with daytime sleepiness in this representative obstructive sleep apnea patient cohort. Age had different effects in men and women.The impact of obstructive sleep apnea in a wider patient related perspective needs to be determined after the inclusion of factors other than the apnea‐hypopnea index.
A ranula is a mucous cyst that forms on one side of the floor of the mouth as a result of damage to the excretory salivary duct. It is a common condition in young people, however congenital cases are ...rare. We report a case of congenital ranula that grew rapidly to a large size after a mass was noted on the left side of the floor of the mouth during the neonatal examination. A pea-sized mass was identified on the left side of the floor of the mouth during the neonatal examination. An MRI was performed at the age of 1 year and 2 months due to sleep apnea, snoring and a suckling disorder, and an egg-sized mass was found on the floor of the mouth. An experimental puncture aspiration was performed and the ranula was surgically removed under general anesthesia the next day. Histopathological findings showed a mucous extravasated lesion associated with extensive fibrosis with acute and chronic inflammatory cells, leading to a diagnosis of sublingual ranula. The possibility of functional impairment such as breathing and suckling disorders should be fully considered in cases of congenital ranula, and follow-up and the timing of surgery should be carefully considered.
Sleep breathing disorder (SBD) may be an important factor in age-related cognitive decline. In a cohort of healthy elderly subjects, we performed an 8-y longitudinal study to assess whether changes ...in cognitive function occur in untreated elderly patients with SBD and without dementia and the factors implicated in these changes.
A population-based longitudinal study.
Clinical research settings.
A total of 559 participants of the PROOF study aged 67 y at the study entry and free from neurological disorders were examined.
N/A.
Abnormal breathing events were defined by an apnea-hypopnea index (AHI) > 15. The raw cognitive data and averaged Z-scores for the attentional, executive, and memory functions were collected at the baseline and follow-up. At baseline, AHI > 15 was found in 54% of subjects with 18% having an AHI > 30. At follow-up, the presence of abnormal breathing events was associated with a slight but significant decline in the attentional domain (P = 0.01), which was more evident in the subjects with an AHI > 30 (P = 0.004). No significant changes over time were observed in the executive and memory functions. Several indices of chronic hypoxemia, defined either as a cumulative peripheral oxygen saturation (SpO2) < 90% or a minimal SpO2, accounted for portions of the variance in the decline in attention. All observed effects were small, accounting for 4-7% of variance in multivariate models.
In healthy elderly subjects, various components of sleep breathing disorder at baseline were associated with small changes in selected cognitive functions specific to the attention domain after controlling for multiple comorbidities, such as sleepiness, hypertension, diabetes, anxiety, and depression.
ClinicalTrials.gov identifiers NCT 00759304 and NCT 00766584.
Background: Polysomnography is continually advancing technically, with its applica-bility expanding across various fields. This narrative review aims to highlight its recent develop-ments, current ...applications, and future perspectives from a clinical point of view. Methods: Relevant articles written in English published from 2015 to 2024 were searched in PubMed and Google Scholar. Results: Polysomnography remains the gold standard test in sleep disorders but in certain categories of patients it is not very accesible. Some of the home sleep tests (HSAT) perform closely to PSG testing. Identifying REM movement disorders early is important because it is a predictor factor for developing neurodegenerative diseases. Artificial intelligence (AI) cаn be used for diаgnosis by integrаting АI in weаrаble devices for remote monitoring, using it for fаster аnd а more аccurаte scoring, аs well аs using it to offer рersonаlized treаtment for eаch individuаl. Polysomnography can play a pivotal role in diagnosing sleep related breathing disorders in reha-bilitation patients to offer treatment, help in the improvement of sleep quality and consequently, offer better rehabilitation outcomes. Conclusions: Polysomnography opens up numerous possi-bilities for investigating sleep disorders, providing a comprehensive understanding of an indi-vidual's sleep health, and improving the management of sleep-related disorders
A review of sleep disorders and melatonin Xie, Zizhen; Chen, Fei; Li, William A. ...
Neurological research (New York),
06/2017, Volume:
39, Issue:
6
Journal Article
Peer reviewed
Open access
Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis and cause significant impairments in social and occupational functions. Although currently approved ...medications are efficacious, they are far from satisfactory. Benzodiazepines, antidepressants, antihistamines and anxiolytics have the potential for dependence and addiction. Moreover, some of these medications can gradually impair cognition. Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous hormone produced by the pineal gland and released exclusively at night. Exogenous melatonin supplementation is well tolerated and has no obvious short- or long-term adverse effects. Melatonin has been shown to synchronize the circadian rhythms, and improve the onset, duration and quality of sleep. It is centrally involved in anti-oxidation, circadian rhythmicity maintenance, sleep regulation and neuronal survival. This narrative review aims to provide a comprehensive overview of various therapeutic functions of melatonin in insomnia, sleep-related breathing disorders, hypersomnolence, circadian rhythm sleep-wake disorders and parasomnias. Melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects.
Background
The first edition of the European position paper (EPP) on drug‐induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in‐depth ...insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD.
Methods
The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in‐depth insight into the main aspects of this technique.
Results
After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
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