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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Request AccessMinimal effect of long-term clonazepam on cognitive function in patients with isolated RBD.
J Clin SleepDespite its widespread use in patients with isolated rapid eye movement sleep behavior disorder (iRBD), the cognitive effect of clonazepam is uncertain. This study aimed to investigate effect of cumulative clonazepam on cognitive function in patients with iRBD.
Demographic characteristics, baseline cognitive test, and most recent cognitive test information were collected retrospectively. Based on cumulative clonazepam doses, patients were classified into four subgroups: group 1 < 365 mg (1 mg * 1 year); 365 mg ≤ group 2 < 1,095 mg (1 mg * 3 years); 1,095 mg ≤ group 3 < 2,190 mg (1 mg * 6 years); and group 4 ≥ 2,190 mg. Cognitive test scores were calculated as z-scores adjusted for age, education, and sex.
This study included 101 patients with iRBD (63 males). Groups 1, 2, 3, and 4 had 14, 20, 32, and 35 patients, respectively. In within-group comparisons, follow-up Digit Span Backward test and the Trail Making Test A (TMT-A) scores decreased in group 3, and follow-up TMT-A and the Trail Making Test B scores decreased significantly in group 4. In the multiple regression analysis to determine influential factors on cognitive decline, cumulative clonazepam dose did not show a significant correlation with any cognitive domain. Follow-up cognitive function showed significant correlation only with baseline cognitive function.
Memory and executive functions tended to decline in patients with iRBD. However, there was no significant effect of cumulative clonazepam. There was no evidence that long-term use of clonazepam was related to cognitive decline in patients with iRBD.
Effect of norepinephrine reuptake inhibitors combined antimuscarinic agents versus monotherapy for OSA: a systematic review and meta-analysis.
J Clin SleepRandomized controlled trials have shown that combining norepinephrine reuptake inhibitors and antimuscarinics can ameliorate the severity of obstructive sleep apnea (OSA). This article explores whether the effectiveness and safety of combining norepinephrine reuptake inhibitors with antimuscarinic agents surpass monotherapy for treating OSA.
We searched the randomized controlled trials (RCTs) with adult patients of OSA who received combination and monotherapy in eight databases from inception until April 5, 2023, next evaluated the included studies' quality, and conducted a meta-analysis and systematic review. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcome measures included loop gain, hypoxic load, oxygen desaturation index, and Vpassive, among other indicators. We assessed the quality of the studies using Cochrane Methods criteria.
Identifying four RCTs for systematic review and two for meta-analysis. The results of the meta-analysis showed that norepinephrine reuptake inhibitors combined with antimuscarinic agents in patients with OSA prolonged total sleep time by a mean of 28.20 min [95% CI (5.78, 50.61), P = 0.01], increased sleep efficiency by 4.73% [95%CI (0.50, 8.97), P = 0.03] compared with norepinephrine reuptake inhibitors alone. Other indices and adverse events were no statistical significance. The systematic reviews revealed that norepinephrine reuptake inhibitors combined with antimuscarinics may be superior to monotherapy in improving AHI and endotypic traits.
This article demonstrated the potential advantages of combining norepinephrine reuptake inhibitors plus antimuscarinics for treating OSA, contrasting with the norepinephrine reuptake inhibitors alone, and revealed no statistically significant safety.
Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU).
J Clin SleepObservational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children. Multi-center trials exploring PICU-SCD have been impractical as measuring sleep in this setting is challenging. This study validates a questionnaire for caregivers to describe children's sleep in the PICU.
This prospective, multi-center, case-control study enrolled caregivers of children in four PICUs or in a hospital-based sleep lab (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires. Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability.
In 152 PICU and 61 sleep lab caregivers, sleep survey items had acceptable internal reliability (α=0.75) and reproducibility on re-test surveys (ICC>0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified three sub-scales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ=0.823) and sleep onset latency (κ=0.707). There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r=0.844, p<0.001). Scores had a linear association with caregiver-reported child sleep quality. There were no site-specific differences in sleep quality. Nearly all respondents found the survey easy to understand and of appropriate length.
The SSqPICU provides a reliable, accurate description of inpatient sleep disruption in non-sedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations.
Sleep-related painful erections treated with sodium oxybate.
J Clin SleepA 39-year-old male with a medical history significant for migraine, psoriatic arthritis, postural orthostatic tachycardia syndrome (POTS), vitamin ...
Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep.
J Clin SleepSupportive co-parenting between couples has been shown to have positive effects on the dyadic relationship, child development, and parental and child sleep. This study aimed to investigate the association between paternal involvement in nighttime childcare and child and maternal sleep, while exploring relationship satisfaction, and maternal competence about child sleep as mediators.
The sample consisted of 290 mothers (Mage±SD=34.8±4.1) with children (50.7% male) aged 6 - 36 (M±SD=22.7±8.6) months. Participants reported their paternal involvement in nighttime childcare and completed the following questionnaires: Brief Infant Sleep Questionnaire-Revised, Dyadic Adjustment Scale-4 items, and Insomnia Severity Index. Path analysis was conducted to examine the impact of paternal involvement on child and maternal sleep through relationship satisfaction and maternal competence.
Among the sample, 74.8% responded that paternal participation in nighttime childcare was less than 25%. Path analysis showed that paternal involvement had a significant direct effect on maternal insomnia (β=-.15, p<.05), but not on child sleep. Direct pathways from paternal involvement to relationship satisfaction (β=.17), from relationship satisfaction to maternal competence (β=.19), from maternal competence to child's sleep (β=-.57), and from child sleep to maternal insomnia (β=.48) were significant (ps<.01). Relationship satisfaction mediated the associations between paternal involvement and child (β=-.08, p<.05) and maternal sleep (β=-.04, p<.05).
Paternal nighttime childcare involvement was low in South Korea. The results highlight the importance of considering paternal supportive participation and relationship satisfaction in future research on child and maternal sleep.
Severe obstructive sleep apnea in children with syndromic craniosynostosis: analysis of pulse transit time.
J Clin SleepWe examined the association between pulse transit time (PTT) and obstructive sleep apnea (OSA) in children with syndromic craniosynostosis (SCS), where OSA is a common problem and may cause cardiorespiratory disturbance.
Retrospective study of children (age <18 years) with SCS and moderate-to-severe OSA (i.e., obstructive apnea-hypopnea index [oAHI] ≥ 5), or no OSA (oAHI < 1) who underwent overnight polysomnography (PSG). Children without SCS and normal PSG were included as controls. Reference intervals (RIs) for PTT were computed by non-parametric bootstrap analysis. Based on RIs of controls, the sensitivity and specificity of PTT to detect OSA were determined. In a linear mixed-model the explanatory variables assessed were sex, age, sleep stage, and time after obstructive events.
In all 68 included children (19 SCS with OSA, 30 SCS without OSA, 19 controls), obstructive events occurred throughout all sleep stages, most prominently during rapid eye movement sleep (REM) and non-REM sleep stages N1 and N2, with evident PTT changes. Greatest reductions were observed 4 - 8 s after an event (p < 0.05). In SCS with OSA, PTT RIs were lower during all sleep stages compared to SCS without OSA. The highest sensitivity was observed during N1 (55.5%), and the highest specificity during REM (76.5%). Lowest PTT values were identified during N1.
Obstructive events occur throughout all sleep stages with transient reductions in PTT. However, PTT as a variable for OSA detection is limited by its sensitivity and specificity.
Effects of different types of exercise on sleep quality based on PSQI in middle-aged and older adults: a network meta-analysis.
J Clin SleepA 2021 survey by the World Health Organization showed that 27% of the global population suffers from sleep problems and that middle-aged and older adults are more likely to have sleep disorders. Sleep deprivation increases cardiovascular disease risk. This study aimed to assess the effects of aerobic exercise (AE), resistance exercise (RE), combined training (CBT) and yoga on the quality of sleep in middle-aged and older adults through their effects on the Pittsburgh sleep quality index (PSQI) and its components. Direct and indirect comparisons were used to determine which exercise modality most effectively improves sleep quality in middle-aged and older adults.
This study conducted a systematic review and frequency network meta-analysis of all randomized controlled trials comparing the effects of AE, RE, CBT, YG and control group (CG) on sleep quality in middle-aged and older adults.
We included 28 studies involving 3460 subjects. According to the surface under the cumulative ranking (SUCRA) curve results, AE was the most effective in improving total PSQI score (SUCRA = 93.2%), sleep latency (SUCRA = 96.8%), and sleep medication use (SUCRA = 77.1%). In addition, yoga was the most effective in improving sleep disorders (SUCRA = 90.4%), sleep efficiency (SUCRA = 95.9%), sleep duration (SUCRA = 93.8%), and daytime dysfunction (SUCRA = 98.3%).
AE is the most effective exercise modality for improving PSQI total score in middle-aged and older adults.
Case report of hypoglossal nerve stimulation therapy failure due to significant underlying central sleep apnea.
J Clin SleepHypoglossal nerve stimulation (HNS) is indicated for obstructive sleep apnea (OSA) but is ineffective in treating central sleep apnea (CSA). We des...
Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data.
J Clin SleepTo characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database.
Merative MarketScan insurance claims (n=12,394,902) were used to identify youth (6-17 years) newly diagnosed with narcolepsy (ICD-10 codes). Narcolepsy diagnosis and care 1-year post-diagnosis included polysomnography (PSG) with Multiple Sleep Latency Test (MSLT), pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only).
The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black versus White youth with Medicaid. Two-thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had a PSG with MSLT (± 1-year post-diagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have a PSG with MSLT.
Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black versus White children with Medicaid. Only half had evidence of a diagnostically required PSG with MSLT, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible insurance-related disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management.
Assessment of Fitbit Charge 4 for sleep stage and heart rate monitoring against polysomnography and during home monitoring in Huntington's disease.
J Clin SleepWearable devices, monitoring sleep stages and heart rate (HR), bring the potential for longitudinal sleep monitoring in patients with neurodegenerative diseases. Sleep quality reduces with disease progression in Huntington's disease (HD). However, the involuntary movements characteristic of HD may affect the accuracy of wrist-worn devices. This study compares sleep stage and heart rate data from the Fitbit Charge 4 (FB) against polysomnography (PSG) in participants with HD.
Ten participants with manifest HD wore a FB during overnight hospital-based PSG, and for nine of these participants continued to wear the FB for seven nights at home. Sleep stages (30s epochs) and minute-by-minute HR were extracted and compared against PSG data.
FB-estimated total sleep and wake times, and sleep stage times were in good agreement with PSG, with intra-class correlations 0.79-0.96. However, poor agreement was observed for Wake After Sleep Onset, and the number of awakenings. FB detected wake with 68.6±15.5% sensitivity and 93.7±2.5% specificity, rapid eye movement (REM) sleep with high sensitivity and specificity (78.7±31.9%, 95.6±2.3%), and deep sleep with lower sensitivity but high specificity (56.4±28.8%, 95.0±4.8%). FB HR was strongly correlated with PSG, and the mean absolute error between FB and PSG HR data was 1.16 ± 0.42 bpm. At home, longer sleep and shorter wake times were observed compared to hospital data, while percentage sleep stage times were consistent with hospital data.
Results suggest the potential for long-term monitoring of sleep patterns using wrist-worn wearable devices as part of symptom management in HD.
Low dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings.
J Clin SleepThe purpose of the present study was to preliminarily evaluate whether knowing the dim light melatonin onset (DLMO) time is advantageous when treating delayed sleep-wake phase disorder (DSWPD) with low dose melatonin treatment plus behavioral interventions (i.e., evening dim light and time in bed (TIB) scheduling).
In this randomized, controlled, double-blind trial, 40 adults with DSWPD were randomly assigned to 4 weeks of 0.5 mg timed to be administered either 3 hours before the DLMO (measured DLMO group, n = 20) or 5 hours before sleep onset time per actigraphy (estimated DLMO group, n = 20), in conjunction with behavioral interventions. The primary outcome was change in the DLMO (measured in-home). Secondary outcomes included sleep parameters per diary and actigraphy (sleep onset and offset times and total sleep time), Morningness-Eveningness Questionnaire (MEQ), Multidimensional Fatigue Inventory (MFI), PROMIS-Sleep Disturbance (SD), PROMIS-Sleep Related Impairment (SRI), and Pittsburgh Sleep Quality Index (PSQI). Mixed effects models tested for group differences in these outcome.
After applying the Bonferroni correction for multiple comparisons (significant p-value set at ˂ .004), there were significant main effects for visit on all outcomes except PSQI and total sleep time per wrist actigraphy and diary. There were no group by visit interactions for any of the outcomes (p > .004).
Scheduled low dose melatonin plus behavioral interventions may improve many circadian and sleep parameters regardless of whether melatonin administration is scheduled based on estimated or measured DLMO. A larger-scale trial is needed to confirm these preliminary findings.
Clinicaltrials.gov Identifier: NCT03715465; Name: The Clinical Utility of Measuring the Circadian Clock in Treatment of Delayed Sleep-Wake Phase Disorder; URL: https://clinicaltrials.gov/study/NCT03715465.
Global practice of sleep medicine: Iran.
J Clin SleepThis study aimed to conduct a comprehensive review of sleep medicine in Iran, focusing on the country's advancements, challenges, and the global context.
We conducted a comprehensive review of sleep medicine in Iran, using various sources to ensure a thorough analysis. The national educational curriculum for sleep medicine and guidelines on sleep clinics issued by Iran's Ministry of Health served as a foundational resource. Additionally, we gathered information from the Iranian Sleep Medicine Society (ISM) website and relevant committee data sources. To enhance our understanding of the current research landscape, we performed a targeted search on PubMed using keywords related to sleep and Iran.
The study presents a dynamic overview of sleep medicine in Iran, highlighting key advancements and challenges. Significant progress was observed in establishing standardized sleep medicine training and accredited sleep clinics. The ISM plays a pivotal role in spearheading these developments, contributing to implementing regional guidelines for sleep tests. However, challenges such as a limited number of trained specialists, a scarcity of certified sleep clinics, and obstacles to accessing sleep disorder treatments were identified.
We advocate for the implementation of increased research initiatives, nationwide education and screening programs, and proactive measures to strengthen the landscape of sleep and circadian medicine in the country.