The latest medical research on Sleep Medicine

To examine the feasibility, acceptability, and impact of a Sleep Promotion Program (SPP).

This pilot trial randomized adolescents (13-15y) with insufficient sleep duration and irregular sleep timing to SPP-continuation (n=24; SPP in month 1, continuation treatment in month 2) or monitoring-SPP (n=20; monitoring in month 1, SPP in month 2). SPP included one clinician session and at-home delivery of web-based reports of each youth's sleep diary data with accompanying intervention questions that prompt youth to engage in sleep behavior change. Attrition rate primarily measured feasibility. Program satisfaction measured acceptability. Total sleep time (TST), sleep timing, and sleep timing regularity were measured via sleep diary at baseline, follow-up 1, and follow-up 2 (each ∼1 month apart). Linear mixed effects models compared treatment arms on changes in sleep from baseline to follow-up 1 (month 1). We also compared changes in sleep during month 1 to changes in sleep during month 2 among SPP-continuation participants.

Attrition rate was 8.5%. 96.5% participants rated the quality of care received as good or excellent. In month 1, SPP-continuation youth showed a significantly greater increase in mean TST than monitoring-SPP youth (0.57 vs. -0.38 hours; contrast=0.95; CI=0.14, 1.76, p=0.024). SPP-continuation participants showed an increase in TST during month 1 (0.51h) but a decrease during month 2 (-0.74 h; contrast=-1.24, CI=-2.06, -0.42, p=0.005). No other significant effects were observed.

SPP is highly feasible, acceptable, and associated with a significant increase in TST early in treatment.

Registry: ClinicalTrials.gov; Name: Targeted Intervention for Insufficient Sleep among Typically-Developing Adolescents; Identifier: NCT04163003; URL: https://clinicaltrials.gov/ct2/show/NCT04163003.

To examine the feasibility, adherence to therapy, and efficacy of hypoglossal nerve stimulation (HGNS) in adults with Down syndrome (DS) with obstructive sleep apnea.

Adults patients with DS who met criteria for hypoglossal nerve stimulation were prospectively enrolled. Objective adherence was extracted from a cloud-based compliance database. Pre-operative sleep studies were compared to follow-up testing performed no sooner than 3 months after device activation.

Eleven adults with DS underwent implantation of HGNS between May 2021 and July 2024. Median age was 27 years old (interquartile range 26, 33), BMI 28.5kg/m2 (26.5, 32.4), 27% were female, and had severe OSA (apnea-hypopnea index (AHI) 40/hr, (28.4, 42.9)). All patients were successfully implanted on an outpatient basis with no post-operative complications or readmissions and activated on schedule at 1 month after surgery. Adherence data show nightly usage longer than 4 hours was 100% and 96% of nights and a median of 9.2 and 8.5 hours/night in the first 30 and 90 days, respectively. Seven patients have undergone follow up testing and the median entire night AHI was reduced by 76%. All patients experienced a >50% decrease in AHI and to less than 15/hr. Median time spent below 88% improved from 2.0% (0.3,5.0) to 0.2% (0,0.6), and oxygenation nadir improved from 79.0% (75.5,85) to 88.0% (86.5,91).

In this small initial cohort, HGNS appears to be a safe, well-tolerated and efficacious treatment option for adults with DS with moderate-severe obstructive sleep apnea and positive airway pressure therapy intolerance.

Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry.

This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI.

Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001).

Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

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.

The use of sleep tracking devices is increasing as people become more aware of the importance of sleep and interested in monitoring their patterns. With many devices on the market, we conducted a meta-analysis comparing sleep-scoring data from consumer wrist-worn sleep tracking devices with polysomnography to validate the accuracy of devices.

We retrieved studies from the databases of SCOPUS, EMBASE, Cochrane Library, PubMed, Web of Science, and KoreaMed, and OVID Medline up to March 2024. We compared personal data about participants and information on objective sleep parameters.

From 24 studies, data of 798 patient using Fitbit, Jawbone, myCadian watch, WHOOP strap, Garmin, Basis B1, Zulu Watch, Huami Arc, E4 wristband, Fatigue Science Readiband, Apple Watch, or Xiaomi Mi Band 5 were analyzed. There were significant differences in total sleep time {mean difference (MD) -16.854, 95% confidence interval (CI) [-26.332; -7.375]}, sleep efficiency (MD -4.691, 95% CI [-7.079; -2.302]), sleep latency (MD 2.574, 95% CI [0.606; 4.542]), and wake after sleep onset (MD 13.255, 95% CI [4.522; 21.988]) between all consumer sleep tracking devices and polysomnography. In subgroup analysis, there was no significant difference of wake after sleep onset between Fitbit and polysomnography. There was also no significant difference sleep latency between other devices and polysomnography. Fitbit measured sleep latency longer than other devices, and other devices measured wake after sleep onset longer. Based on Begg and Egger's test, there was no publication bias in total sleep time and sleep efficiency.

Wrist-worn sleep tracking devices, while popular, are not as reliable as polysomnography in measuring key sleep parameters like total sleep time, sleep efficiency, and sleep latency. Physicians and consumers should be aware of their limitations and interpret results carefully, though they can still be useful for tracking general sleep patterns. Further improvements and clinical studies are needed to enhance their accuracy.