The latest medical research on Sleep Apnoea

Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, while the criteria recommended by the American Academy of Sleep Medicine requires either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these two definitions for men and women in a clinical setting.

We reviewed polysomnography (PSG) reports for all patients who completed a diagnostic PSG study at one sleep disorders center in 2019. Every PSG was scored using both sets of criteria to determine AHI-4 and AHI-3A.

Data from 279 women (64.7%), and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9±27.3, and the mean AHI-3A was 34.7±32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (p=0.001) for women and 21.7% (p=0.006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, while men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition.

The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by autonomic dysfunction associated with a combination of cerebellar, parkinsonian, or pyramidal signs. Sleep-disordered breathing (SDB) such as stridor, obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in MSA and can impact survival. Several studies have evaluated treatment modalities. However, the optimal strategy often remains unclear in these patients. This review aims to provide an overview of the current evidence on treatment of SDB in MSA.

Systematic review of the current literature through combined keyword search in PubMed, Embase, the Cochrane Library and cited references: multiple system atrophy, stridor, sleep apnea syndrome, sleep-disordered breathing, Shy Drager syndrome.

Twenty-nine papers were included, with a total of 681 MSA patients with SDB. Treatment modalities are: continuous positive airway pressure (CPAP); tracheostomy; tracheostomy invasive ventilation (TIV); non-invasive positive pressure ventilation (NPPV); adaptive servoventilation (ASV); vocal cord surgery; botulinum toxin injections; oral appliance therapy; cervical spinal cord stimulation; selective serotonin reuptake inhibitors (SSRIs).

Conflicting results on survival are found for CPAP therapy. Tracheostomy has a proven survival benefit. Most beneficial outcomes are seen with TIV. CPAP, other types of PAP and tracheostomy can adequately control symptoms of OSA. However, CPAP may exacerbate central sleep apnea. There was a lack of sufficient data regarding ASV or NPPV. Some patients exhibit a floppy epiglottis and require a different approach. In conclusion, due to the complex characteristics of SDB in MSA, an individualized and multidisciplinary approach is mandatory.

To study the association between sleep-quality, total sleep duration and wound-healing among adult patients having good sleep-quality at the time of admission in hospital, undergoing laparotomy for various reasons.

In this observational study , consecutive adult subjects undergoing emergency laparotomy were followed up until the eighth postoperative day. The primary outcome (wound healing) was assessed using the Southampton Wound Grading System. Sleep quality (assessed by the single item sleep quality scale) was the primary predictor. Pain was assessed using visual analogue pain scale. We studied the effect of postoperative sleep quality on wound healing on postoperative day 8. Secondary analyses assessed the effect of total sleep time, severity of pain and markers of systemic inflammation on wound healing.

In this study 110 participants were included. The average age of participants was 41.7±16.2 years. On postoperative day 8, 34.5% rated their sleep quality as "poor to fair" and rest as "good". Postoperative poor sleep quality was associated with impaired wound healing, starting from third postoperative day (P<0.001 for each subsequent day). Multiple logistic regression was overall significant (χ2= 118.40; df=9; P<0.001), classified 92.7% cases correctly and explained 88% variance to the outcome. This model showed that shorter total-sleep-time (P=0.009), higher total leukocyte count (P=0.005), presence of comorbidities (P=0.01) and poor sleep quality during the postoperative week (OR=78.14; P=0.005) increased odds for impaired healing of wound.

Poor sleep quality during the healing phase is associated with wound complications, a surrogate marker of impaired wound healing.

Obstructive sleep apnea (OSA) is a prevalent condition effectively treated by continuous positive airway pressure (CPAP) therapy. CPAP adherence data, routinely gathered in clinical practice, include detailed information regarding both duration and timing of use. The purpose of the present study was to develop a systematic way to measure the diurnal pattern of CPAP adherence data and to see if distinct patterns exist in a clinical cohort.

Machine learning techniques were employed to analyze CPAP adherence data. A cohort of 200 unselected patients was assessed and a cluster analysis was subsequently performed. Application of this methodology to 17 patients with different visually noted patterns was carried out to further assess performance.

Each 30-day period of CPAP use for each patient was characterized by four variables describing the time of day of initiation and discontinuation of CPAP use, as well as the consistency of use during those times. Further analysis identified six distinct clusters, reflecting different timing and adherence patterns. Specifically, clusters with relatively normal timing versus delayed timing were identified. Finally, application of this methodology showed generally good performance with limitations in the ability to characterize shift worker and non-24 rhythms.

This study demonstrates a methodology for analysis of diurnal patterns from CPAP adherence data. Furthermore, distinct timing and adherence patterns are demonstrated. The potential impact of these patterns on the beneficial effects of CPAP requires elucidation.