The latest medical research on Sleep Apnoea

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about sleep apnoea gathered by our medical AI research bot.

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Equal effect of a non-custom versus a custom mandibular advancement device in treatment of obstructive sleep apnea.

J Clin Sleep

Numerous types of mandibular advancement devices (MADs) are available to treat patients with obstructive sleep apnea (OSA), varying from non-custom to custom devices. Only a limited number of studies have been performed to determine whether a non-custom MAD could be used to predict treatment success of a custom MAD. In this study, we investigated the potential of a new generation non-custom MAD, by comparing its effectiveness with a custom MAD. We hypothesize that the effectiveness of the devices is similar with regard to both objective (polysomnography; PSG) and self-reported (questionnaires, adherence, and patient satisfaction) outcomes.

Single-center prospective randomized cross-over study including a consecutive series of patients with OSA. Patients were randomized to start either with the non-custom or custom MAD. Both MADs were applied for 12 weeks, followed by a PSG with MAD in situ and questionnaires. After the first 12 weeks of follow-up, a wash out period of one week was applied. Equal effectiveness was defined as no significant differences in both objective and self-reported outcomes between both devices.

Fifty-eight patients were included; forty completed the full follow-up. The median apnea-hypopnea index significantly reduced from 16.3 [7.7; 24.8] events/h to 10.7 [5.6; 16.6] events/h with the custom MAD (p=0.010) and to 7.8 [2.9; 16.1] events/h with the non-custom MAD (p<0.001). Self-reported outcomes significantly improved in both groups. No significant differences were found between both devices.

The effectiveness of a non-custom and custom MAD is comparable, which suggest that a non-custom MAD can be used as a selection tool for MAD treatment eligibility to improve MAD treatment outcome.

Registry: Netherlands Trial Register; Title: The use of a boil and bite Mandibular Advancement Device versus a custom Mandibular Advancement Device in Obstructive Sleep Apnea management; Identifier: NL64738.100.18; URL: https://www.trialregister.nl/trial/7249.

Association of accelerometry-derived social jetlag and sleep with temperament in children less than 6 years of age.

J Clin Sleep

Social jetlag (SJL) measures the discrepancy between circadian and social clocks. Using accelerometry-derived data, our objective was to assess the prevalence of SJL in young healthy children and determine the association of SJL and sleep with temperament.

Of 117 children participating in TARGet Kids!, a Canadian cohort of healthy preschool-aged children, 78 children (39 girls (50%)); mean age [SD]: 35.1[20.5] months) were included. Sleep was measured objectively using accelerometry. Temperament dimensions (surgency, negative affectivity, and effortful control) were assessed with the very short forms of Rothbart's child and infant behavior questionnaires. We examined associations of SJL and sleep with temperament using multivariable linear regression models adjusted for sex, age, ethnicity, and preschool/daycare attendance.

20 out of 78 (25.6%) experienced SJL of greater than 30 minutes. SJL was greater in children who attended preschool/daycare compared with children who did not (26.3[18.8]min vs. 17.6[14.8]min; p<0.05). There was no evidence of an association between SJL and any temperament dimension. We found evidence of an association between increased sleep duration and increased negative affectivity scores (longer 24h sleep (ß:0.347, 95% CI:0.182,0.512, p<0.0001); longer nighttime sleep duration (ß:0.413, 95% CI:0.163,0.663, p=0.002)).

In our cohort, 1 in 4 preschool-aged children experienced SJL. Increased sleep duration was associated with increased negative affect, which could have implications for children developing internalizing behavior such as depression or low-self-esteem. We found that sleep duration, but not SJL, was associated with temperament and may impact daytime behavior of young children.

Optical coherence tomography angiography and Humphrey visual field in patients with obstructive sleep apnea.

J Clin Sleep

To determine if obstructive sleep apnea (OSAS) predisposes patients to glaucoma and macular disease due to vascular compromise by evaluating retinal and optic nerve vasculature and function using optical coherence tomography angiography (OCT-A) and Humphrey visual field testing, respectively.

In this prospective, observational, cross-sectional study forty-five patients undergoing polysomnography ordered per standard of care were selected and stratified based on apnea-hypopnea index (AHI). Medical history, visual acuity testing, 24-2 Humphrey visual field (HVF), intra-ocular pressure measurement, optical coherence tomography angiography (OCT-A) studies of the macular and peripapillary retina were obtained. Correlations between polysomnography parameters and imaging data were analyzed.

The radial peripapillary capillary (RPC) vascular density (VD) demonstrated no relationship to AHI (95% CI (-0.026,0.038)) or severity of OSAS (95% CI: (-0.772, 3.648) for moderate OSAS compared to mild/normal and (-1.295, 3.1421) for severe comparing to mild/normal. OCT-A superficial parafoveal VD (95% CI: (-0.068,0.011), deep parafoveal VD (95% CI: (-0.080,0.009)), and FAZ (95% CI: (-0.001, 0.001)) showed no statistically significant relationship to AHI or OSAS severity after controlling for confounders. OCT retinal nerve fiber layer (RNFL) thickness increased with AHI (p=0.014), but there was no statistically significant correlation with OSAS severity with RNFL thickness (95% CI: (-12.543, 6.792) for moderate comparing to normal and (-2.883, 16.551) for severe comparing to normal). Visual field parameters were unaffected by OSAS (95% CI: Mean deviation (-0.21,0.29), Pattern standard deviation: (-0.351,0.121), Visual field index: (-0.166, 0.329)). OCT choroidal thickness showed a statistically significant decrease when OSAS was grouped by severity (p=0.0092), but did not correlate with AHI (p=0.129, 95% CI: (-1.210, 0.095)).

The severity of OSAS did not show a statistically significant effect on parameters associated with glaucoma or macular vascular disease. Larger cohorts may be required to determine the physiologic consequences of OSAS on the macular and optic nerve vasculature, structure, and function.

Static postural stability and neuropsychological performance after awakening from REM and NREM sleep in patients with chronic insomnia: a randomized, crossover, overnight polysomnography study.

J Clin Sleep

Chronic insomnia disorder (CID) is a common sleep disorder, with a prevalence ranging from 6% to 10% worldwide. Individuals with CID experience more fragmented sleep than healthy controls do. They awaken frequently during the night and have a higher risk of injury from falling. Awakening from different sleep stages may have different effects on postural stability and waking performance. However, limited research has been conducted on this topic.

This prospective randomized crossover study was conducted between January 2015 and January 2017. We included 20 adults aged 20-65 years who fulfilled diagnosis criteria for CID. Participants underwent two overnight polysomnography studies with an interval of at least 7 days. They were awakened during either rapid eye movement (REM) sleep or N1/N2 sleep alternatively. We compared measurements of static postural stability, vigilance scores, and neuropsychological tests between REM and N1/N2 sleep awakening.

Polysomnography parameters between the two nights were comparable. Participants who were awakened from REM sleep had worse static postural stability than those with N1/N2 awakening. Compared with N1/N2 awakening, larger mean sway areas of center of pressure (COP; p = 0.0413) and longer COP mean distances (p = 0.0139) were found in REM sleep awakening. There were no statistically significant differences in vigilance scores or neuropsychological tests between the two nights.

REM sleep awakening was associated with worse static postural stability than was N1/N2 awakening. No statistically significant differences were found in waking performance in alertness or in neuropsychological tests between N1/N2 and REM sleep awakening.

In-person versus video hookup instructions: a comparison of home sleep apnea testing quality.

J Clin Sleep

The high prevalence of obstructive sleep apnea (OSA) in the general population makes diagnosing OSA a high priority. Typically, patients receive in-person instructions to hook up the home sleep apnea test (HSAT) devices. Using recorded video instructions would save healthcare personnel time and improve access to OSA diagnostics for patients in remote areas. The aim of this study was to compare the quality of HSAT recordings when using in-person and video hookup instructions in a randomized study.

A total of 100 patients aged 18 to 70 years with suspected OSA were randomized to receive either in-person or video hookup instructions for the Nox T3 device (Nox Medical, Reykjavik, Iceland). The overall quality of the resulting sleep studies was analyzed by determining the number of technically invalid studies. The recording quality of four sensors (pulse oximeter, nasal cannula, thorax and abdominal respiratory inductance plethysmography belts) was assessed by checking for signal artifacts.

No significant difference was found between the two groups in any quality index. Only 1 (2%) and 2 (3.9%) sleep studies were technically invalid in the in-person and video instructions group, respectively. The average ± standard deviation recording quality of the four sensors combined was 94.8% ± 13.6% for the in-person and 96.0% ± 11.0% for the video instructions group.

This study found no difference in HSAT recording quality between the two groups. Video hookup instructions are therefore viable, and an important step towards a telemedicine-based way of diagnosing OSA.

The vision of dreams: from ontogeny to dream engineering in blindness.

J Clin Sleep

The mechanisms involved in dreams' origin remain one of the great unknowns in science. In the twenty-first century, studies in the field have focus...

Adherence Index: sleep depth and nocturnal hypoventilation predict long-term adherence with positive airway pressure therapy in severe obstructive sleep apnea.

J Clin Sleep

Treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) devices is limited by poor long-term adherence. Early identification of individual patient's probability of long-term PAP adherence would help in their management. We determined if conventional polysomnogram (PSG) scoring and measures of sleep depth based on the Odds Ratio Product (ORP) would predict adherence with PAP therapy twelve months after it was started.

Patients with OSA referred to an academic sleep center had split-night PSG, arterial blood gases (ABG) and a sleep questionnaire. Multiple linear regression analysis of conventional PSG scoring and the ORP both during diagnostic PSG and PAP titration provided an "Adherence Index" which was correlated with PAP use twelve months later.

Patients with OSA (n=236, AHI 72.2 ± 34.1) were prescribed PAP therapy (82% received CPAP, 18% received BPAP). Each patient's adherence with PAP therapy twelve months later was categorized as "Never used", "Quit using", "Poor adherence" and Good adherence". Polysomnography measures that were most strongly correlated with PAP adherence were AHI and ORP during non-rapid eye movement sleep; the additional contribution of nocturnal hypoxemia to this correlation was confined to those with chronic hypoventilation treated with BPAP. The Adherence Index derived from these measures, both during diagnostic PSG and PAP titration, was strongly correlated with PAP adherence twelve months later.

Long-term adherence with PAP therapy can be predicted from diagnostic PSG in patients with severe OSA which may facilitate a precision-based approach to PAP management.

"It made all the difference": a qualitative study of parental experiences with pediatric obstructive sleep apnea detection.

J Clin Sleep

To assess parental experience of their child's OSA detection process and inform the development of interventions and health communication strategies to improve OSA detection.

Semi-structured interviews were conducted with 30 parents of children (ages 3-14) who snored and were referred for an overnight polysomnogram (PSG). Parents (60.0% Black race; 93.3% mothers) described how their child was referred for PSG and their perceptions and feelings throughout the detection process. Parents also completed an OSA knowledge measure. Interview data were analyzed using a descriptive approach and thematic analysis was conducted using the NVivo 12 software system.

Twenty-one themes were identified across five categories (first steps; PSG facilitators and barriers; health information; health care experiences; parent experiences). Respondents experienced multiple pathways to OSA detection, with more than half of referrals initiated by parental concerns (vs. screening efforts). Parents reported a willingness to take any necessary steps to help their child. Both barriers and facilitators to completing a PSG were described. Parents observed both nighttime and daytime symptoms related to OSA in their child but often did not connect the symptoms to each other until later in the process. Participants had varying degrees of OSA knowledge, with a mean knowledge score of 56% correct (range 10%-90% correct).

Parental experiences highlight aspects of the health care system that are both effective and ineffective in detecting children with OSA. Implications include a need for strategies to promote timely detection and to provide parents with accurate information about pediatric OSA.

DOISNORE50: A perioperative sleep questionnaire predictive of obstructive sleep apnea and postoperative medical emergency team activation. a learning health system approach to sleep questionnaire development and screening.

J Clin Sleep

Patients with obstructive sleep apnea (OSA) have a disproportionate increase in post-operative complications and medical emergency team activation (META). We previously introduced DOISNORE50 (D-diseases, O-observed apnea, I-insomnia, S-snoring, N-neck circumference > 18 inches, O-obesity with BMI > 32, R-are you male, E-excessive daytime sleepiness, 50-age ≥ 50) from sleep questionnaire ISNORED (IS) using features associated with increased odds of META in perioperative patients. Performance of DOISNORE50 (DOISNORE) had yet to be tested.

The performance of DOISNORE was tested along with IS and STOP-Bang (SB) questionnaires among 300 out of 392 participants without known OSA referred to the sleep lab. In study 2, the performance of DOISNORE was tested among 64,949 lives screened in perioperative assessment clinic from 2016 to 2020.

Receiver operating characteristic (ROC) curve demonstrated that best performance was achieved with DOISNORE ≥ 6, with area under curve (AUC) of 0.801. DOISNORE's predictability of OSA risk remained stable from 2016-2020 with AUC of 0.78 and a Cronbach alpha of 0.65. Patients at High Risk for OSA (DOISNORE ≥ 6) were associated with an increase of META (OR 1.30, 95% CI 1.12 - 1.45). Higher relative risk was noted among patients with congestive heart failure and hypercapnia.

DOISNORE is predictive of OSA and postoperative META. Perioperative strategies against META should consider DOISNORE questionnaire and focused screening among patients with heart failure and hypercapnia.

Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure.

J Clin Sleep

Continuous positive airway pressure (CPAP) improves sleepiness in patients with obstructive sleep apnea (OSA), but some patients remain sleepy. The objective of this study was to identify determinants that are associated with improvements in self-reported sleepiness in patients with OSA on CPAP therapy.

A retrospective cohort study was performed in a clinic-based population to determine which variables contributed to the improvement in the Epworth Sleepiness Scale (ESS) in patients on CPAP therapy for OSA, stratified by baseline ESS score (<11 or ≥11). Variables associated with ESS scores normalizing with CPAP were also assessed.

Patients with a baseline high ESS score showed greater improvements in the ESS with CPAP. When looking at interactions between baseline ESS classification and changes in ESS, a higher apnea-hypopnea index (AHI) was only associated with improvement in the ESS among patients with a high baseline ESS. Other assessed factors or covariates were not significantly different. When looking at ESS normalization, female sex and lower BMI were associated with lower likelihood of ESS normalization. The difference in the rate of ESS normalization between females and males was higher with more days on CPAP.

Of all the assessed factors and covariates, only AHI was associated with the change in the ESS differently in patients with a high or normal baseline ESS score. ESS normalization rates were lower in females than in males and this disparity was amplified by more days on CPAP.

The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea.

J Clin Sleep

The impact of direct mail order sales of positive airway pressure (PAP) devices, accentuated by the COVID pandemic, on PAP adherence in patients with obstructive sleep apnea (OSA) remains unclear. In this study we compared the impact of different modes of CPAP delivery on adherence and daytime symptoms. We hypothesized that adherence would not be affected by remote PAP setup, aided by telehealth technology.

Three groups were studied: 1) standard group PAP set up (3-4 people), 2) direct home shipment of PAP, followed by telehealth interactions, 3) direct home shipment of PAP, during the COVID-19 pandemic where delivery choice was removed. Demographics, sleepiness, PAP data and insurance information were also compared.

A total of 666 patients were studied in 3 groups. 1) Standard group PAP set up had 225 pts and adherence with PAP (% of nights used more than 4 hours) was 65.3 ± 2.1%. 2) direct home shipment of PAP group had 231 pts and adherence was 54.2 ± 2.4%. 3) direct mailed PAP units during the COVD pandemic group had 210 pts and adherence was 55.9 ± 2.5%. Adherence was lower in both groups receiving home shipments compared to those in groups in-center (ANOVA, Tukey, p = 0.002). Discontinuation of PAP was less in the in-center group set up patients. (Chi Square X2 = 10.938 p = <0.001).

Patients receiving direct home PAP shipments had lower adherence and were more likely to discontinue PAP compared to standard in-person set up.

A surface electrode adjacent to vagal nerve stimulator lead can aid in characterizing vagal nerve stimulator mediated pediatric sleep-disordered breathing: a case series of 7 patients.

J Clin Sleep

The vagal nerve stimulator (VNS) is a nonpharmacological treatment for refractory epilepsy. A side effect of the VNS is sleep-disordered breathing (SDB). The purpose of this study was to demonstrate how a surface electrode placed over the VNS lead can help distinguish whether SDB is due to VNS discharge.

Seven pediatric patients (7.7 ± 2.2 years) with VNS underwent a polysomnogram with an additional surface electrode on the left anterolateral neck to detect VNS discharge. VNS-associated apnea-hypopnea index (vAHI) was calculated by determining the number of hypopneas and apneas occurring during VNS discharge. We evaluated the veracity of VNS electrode by comparing signal duration and total number to those expected by programmed settings. We compared these findings to chin EMG signal change.

3 patients had an obstructive pattern with VNS discharge and 3 had an increase in respiratory rate without gas exchange abnormalities, including 1 with both patterns; 1 patient experienced no respiratory abnormalities. Mean obstructive AHI (oAHI) was 8.2 ± 8.3 events/hour. The mean vAHI was 4.8 ± 6.2 events/hour and accounted for 46.9 ± 30.2% of the total oAHI. The additional electrode captured a statistically high percentage of expected discharges (94.7 ± 6.5%) compared to chin EMG (36.1 ± 35.8%) p<0.05.

We demonstrated that a surface electrode on the VNS lead can temporally co-register VNS discharges and enabled us to attribute SDB to VNS stimulation in 4 patients. We propose that this sensor be standard procedure in VNS patients undergoing polysomnogram.