The latest medical research on Sleep Medicine

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 medicine gathered by our medical AI research bot.

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Effect of depression, anxiety, and stress symptoms on response to cognitive behavioral therapy for insomnia in patients with comorbid insomnia and sleep apnea: a randomized controlled triall.

J Clin Sleep

Patients with comorbid insomnia and sleep apnea (COMISA) report increased severity of depression, anxiety, and stress symptoms compared to patients with either insomnia or sleep apnea alone. Although cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for COMISA, previous research suggests a reduced response to CBTi by insomnia patients with depression, anxiety, and stress symptoms. Therefore, we used RCT data to investigate the impact of depression, anxiety, and stress symptoms before treatment on changes in insomnia after CBTi versus control in patients with COMISA.

145 patients with COMISA (ICSD-3 insomnia, apnea-hypopnea index ≥ 15 events/h), were randomized to CBTi (n = 72), or no-treatment control (n = 73). One-week sleep diaries and standardized questionnaire measures of insomnia, sleepiness, fatigue, depression, anxiety, and stress were completed pre-treatment and post-treatment. Mixed models were used to examine interactions between depression, anxiety, and stress symptoms before treatment, intervention-group (CBTi, control), and time (pre-, post-treatment) on insomnia symptoms.

Approximately half of this COMISA sample reported at least mild symptoms of depression (57%), anxiety (53%), and stress (48%) before treatment. Patients reporting greater depression, anxiety, and stress symptoms before treatment also reported increased severity of insomnia, daytime fatigue, and sleepiness. Improvements in questionnaire and diary-measured insomnia symptoms improved during CBTi, and were not moderated by severity of depression, anxiety, or stress symptoms before treatment (all interaction p ≥ 0.11).

We found no evidence that symptoms of depression, anxiety, or stress impair the effectiveness of CBTi in improving insomnia symptoms in patients with COMISA. Patients with COMISA and comorbid symptoms of depression, anxiety and stress should be referred for CBTi to treat insomnia and improve subsequent management of their OSA.

Registry: Australian New Zealand Clinical Trials Registry, title: Treating comorbid insomnia with obstructive sleep apnoea (COMSIA) study: A new treatment strategy for patients with combined insomnia and sleep apnoea, identifier: ACTRN12613001178730, URL:

Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study.

J Clin Sleep

The effects of serotonergic agents on respiration neuromodulation may vary according to differences in the serotonin system, such as those linked to depression. This study investigated how sleep-related respiratory disturbances relate to depression and the use of medications commonly prescribed for depression.

Retrospective polysomnography was collated for 363 of 2,528 consecutive individuals referred to a specialized sleep clinic (Ottawa, Canada) between 2006 and 2016 who met the selection criteria. The apnea-hypopnea index (AHI), oxygen saturation nadir (minSpO₂), and oxygen desaturation index (ODI) during REM and NREM sleep were analyzed using mixed ANCOVAs comparing three main groups: (i) medicated individuals with depressive disorders (Antidepressant group; subdivided into Selective Serotonin Reuptake Inhibitor (SSRI) and Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) subgroups), (ii) non-medicated individuals with depressive disorders (Non-Medicated group), and (iii) mentally healthy controls (Control group).

Individuals with depressive disorders (on or off antidepressants) had significantly higher AHIs compared to controls (both p≤.007). The Antidepressant group had a lower NREM minSpO₂, and a higher NREM ODI than the Control and Non-Medicated groups (all p≤.009). Within individuals with depressive disorders, independent of depression severity, the SSRI group had a lower minSpO₂, and higher ODI during NREM sleep than the NDRI (both p≤.045) and Non-Medicated groups (both p<.001), and a higher NREM AHI than the Non-Medicated group (p=.014).

If confirmed by future prospective studies, these findings suggest that the use of SSRIs may be associated with impaired breathing and worse nocturnal oxygen saturation in individuals with depressive disorders and sleep complaints.

Smart polymer implants as an emerging technology for treating airway collapse in obstructive sleep apnea: a pilot (proof of concept) study.

J Clin Sleep

To assess the use of a novel magnetic polymer implant in reversing airway collapse and identifying potential anatomical targets for airway implant surgery in an in-vivo porcine model.

Target sites of airway collapse were genioglossus muscle, hyoid bone and middle constrictor. Magnetic polymer implants were sutured to these sites and external magnetic forces, through magnets with pull forces rated at 102 kg and 294 kg, were applied at the skin. The resultant airway movement was assessed via nasendoscopy. Pharyngeal plexus branches to the middle constrictor muscle were stimulated at 0.5 mA, 1.0 mA and 2.0 mA and airway movement assessed via nasendoscopy.

At the genioglossus muscles large magnetic forces were required to produce airway movement. At the hyoid bone, anterior movement of the airway was noted when using a 294 kg rated magnet. At the middle constrictor muscle, an anterolateral (or rotatory) pattern of airway movement was noted when using the same magnet. Stimulation of pharyngeal plexus branches to the middle constrictor revealed contraction and increasing rigidity of the lateral walls of the airway as stimulation amplitude increased. The resultant effect was prevention of collapse as opposed to typical airway dilation, a previously unidentified pattern of airway movement.

Surgically implanted smart polymers are an emerging technology showing promise in the treatment of airway collapse in obstructive sleep apnea. Future research should investigate their biomechanical role as an adjunct to treatment of airway collapse through nerve stimulation.

Clinical utility of ventilatory and gas exchange evaluation during low-intensity exercise for risk stratification and prognostication in pulmonary arterial hypertension.


Peak oxygen consumption (pVO2 ), determined from CPET, provides a valuable indication of PAH severity and patient prognosis. However, CPET is often contraindicated in severe PAH and frequently terminated prior to achievement of a sufficient exercise effort. We sought to determine whether in PAH low-intensity [i.e. freewheeling exercise (FW)] exercise reveals abnormal VE /VCO2 and PET CO2 responses that are associated with pVO2 and serve as indices of PAH risk stratification and mortality.

Retrospective analysis of CPET from 97 PAH patients and 20 age-matched controls was undertaken. FW VE /VCO2 and PET CO2 were correlated with pVO2 % age-predicted. Prognostication analysis was conducted using pVO2  > 65% age-predicted, as known to represent a low mortality risk. Primary outcome was mortality from any cause.

FW PET CO2 was correlated with pVO2 (P < 0.0001; r = 0.52), while FW VE /VCO2 was not (P = 0.13; r = -0.16). ROC curve analyses showed that FW PET CO2 (AUC = 0.659), but not FW VE /VCO2 (AUC = 0.587), provided predictive information identifying pVO2  > 65% age-predicted (best cut-off value of 28 mm Hg). By Cox analysis, FW PET CO2  < 28 mm Hg remained a predictor of mortality after adjusting for age and PAH aetiology (HR: 2.360, 95% CI: 1.144-4.866, P = 0.020).

Low PET CO2 during FW is associated with reduced pVO2 in PAH and provides predictive information for PAH risk stratification and prognostication.

Diagnostic performance of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea in different ethnic groups.

J Clin Sleep

The STOP-Bang questionnaire is a concise and easy screening tool for obstructive sleep apnea (OSA). Using modified body mass index (BMI), we assessed the diagnostic performance of the STOP-Bang questionnaire in predicting OSA in different ethnic groups undergoing surgery.

This was a multicentre prospective cohort study involving patients with cardiovascular risk factors undergoing major non-cardiac surgery. Patients underwent home sleep apnea testing. All patients completed the STOP-Bang questionnaire. The predictive parameters of STOP-Bang scores were calculated against apnea-hypopnea index (AHI).

1,205 patients from four ethnic groups (666 Chinese, 161 Indian, 195 Malay, and 183 Caucasian) were included in the study. The mean BMI ranged from 25 ± 4 to 30 ± 6 kg/m² and mean age ranged from 64 ±8 to 71 ±10 years. For the Chinese and Indian, diagnostic parameters were presented using BMI threshold of 27.5 kg/m² with the area under curve (AUC) to predict moderate-to-severe OSA were 0.709 (0.665-0.753) and 0.722 (0.635-0.808) respectively. For the Malay and Caucasian, diagnostic parameters were presented using BMI threshold of 35 kg/m² with the AUC for predicting moderate-to-severe OSA were 0.645 (0.572-0.720) and 0.657 (0.578-0.736) respectively. Balancing the sensitivity and specificity, the optimal STOP-Bang threshold for the Chinese, Indian, Malay and Caucasian were determined to be 4 or greater.

For predicting moderate-to-severe OSA, we recommend BMI threshold of 27.5 kg/m² for Chinese and Indian, and 35 kg/m² for Malay and Caucasian. The optimal STOP-Bang threshold for the Chinese, Indian, Malay and Caucasian is 4 or greater.

Registry:, title: Postoperative Vascular Events in Unrecognised Obstructive Sleep Apnea, identifier: NCT01494181, URL:

Association of heart rate variability with REM sleep without atonia in idiopathic REM sleep behavior disorder.

J Clin Sleep

Idiopathic rapid-eye-movement (REM) sleep behavior disorder (iRBD), characterized by REM sleep without atonia (RSWA) and dream-enactment behavior, has been suggested to be a predictor of α-synucleinopathies. Autonomic instability, represented by heart rate variability (HRV), is a common characteristic of both iRBD and α-synucleinopathies. Previous studies reported that RSWA was associated with autonomic dysfunction and was a possible predictor of phenoconversion. Therefore, we sought to compare HRV between iRBD and control groups and explore the relationship between HRV and RSWA in iRBD patients.

Nocturnal polysomnographic data on 47 patients (28 men, 19 women) diagnosed with iRBD based on video-polysomnography (v-PSG) and 26 age- and sex-matched controls were reviewed. The first 5-min epoch with a stable electrocardiogram (ECG) lead II on v-PSG was selected from stage N2, Wake, and REM. For quantification of RSWA, tonic activity was analyzed from the submentalis electromyogram, and phasic activity from the submentalis and bilateral anterior tibialis electromyogram channels.

Compared to the control group, the iRBD group showed significant reductions in the standard deviation of the RR intervals (SDNN), the root mean square of successive RR-interval differences (RMSSD), and high-frequency (HF) values. Quantified tonic activity was inversely correlated with normalized low-frequency (LF) values and LF/HF ratios, and positively correlated with normalized HF values.

This study implied decreased cardiac autonomic function in iRBD patients, which showed parasympathetic predominance. HRV of the iRBD patients in this study was associated with quantified tonic RSWA, which was previously reported to be a possible predictor of phenoconversion.

Urgent wake up call for the NBA.

J Clin Sleep

Frequent air travel and the condensed game schedule typical of a National Basketball Association (NBA) teams during the season, often results in ac...

Matrix metalloproteinase-9 as a messenger in the crosstalk between obstructive sleep apnea and comorbid systemic hypertension, cardiac remodeling, and ischemic stroke: a literature review.

J Clin Sleep

Obstructive sleep apnea is a common sleep disorder. There is a strong link between sleep related breathing disorders and cardiovascular and cerebrovascular diseases. Matrix metalloproteinase-9 (MMP-9) is a biological marker for extracellular matrix degradation which plays a significant role systemic hypertension, myocardial infarction and post-MI heart failure, and ischemic stroke. This manuscript reviews MMP-9 as an inflammatory mediator and a potential messenger between OSA and OSA-induced comorbidities.

We reviewed MEDLINE database (PubMed) for publications on MMP-9, OSA and cardiovascular disease. 1,592 studies were identified and of these, 50 articles were included and reviewed.

There is strong evidence that MMP-9 and tissue inhibitor of metalloproteinases-1 (TIMP-1) levels are elevated in patients with obstructive sleep apnea (mainly MMP-9), systemic hypertension, myocardial infarction, post-MI heart failure. Study showed variable results and that could be related to the sample size or laboratory methodology.

MMP-9 and its endogenous inhibitor TIMP-1 are a common denominator in obstructive sleep apnea, systemic hypertension, myocardial infarction, and heart failure. This makes MMP-9 a target for developing novel selective inhibitors that can serve as adjuvant therapy in patients with OSA. This may potentially ameliorate the cardiovascular and cerebrovascular mortality associated with OSA.

Obstructive sleep apnea during rapid eye movement sleep in patients with diabetic kidney disease.

J Clin Sleep

Although recent studies suggest that OSA during rapid eye movement (REM) is associated with different cardiometabolic and neurocognitive risks compared with non-REM (NREM) sleep, there is no information on whether OSA during REM and/or NREM sleep is independently associated with diabetic kidney disease (DKD).

In this cross-sectional study, 303 patients with type 2 diabetes who were followed up at our diabetes outpatient clinic underwent all-night polysomnography. Logistic regression analysis was performed to determine the separate effects of OSA during REM and/or NREM sleep (REM and/or NREM-AHI), apnea-hypopnea index (AHI) and several other polysomnography parameters on DKD, after adjustment for several known risk factors for DKD.

The median (interquartile range) AHI, REM-AHI and NREM-AHI of the patients (age 57.8 +/- 11.8 years, male sex 86.8%, hypertension 64.3% and DKD 35.2%) were 29.8 (18.0-45.4), 35.4 (21.1-53.3) and 29.1 (16.3-45.4) events/h respectively. REM-AHI quartiles, but not NREM-AHI quartiles, correlated independently and significantly with DKD (p=0.03 for linear trend, odds ratio (OR) and 95% confidence interval (CI) for Q2: 3.14 (1.10-8.98), Q3: 3.83 (1.26-11.60), Q4: 4.97 (1.60-15.46), compared with Q1). In addition, categorical AHI (p=0.01, OR and 95%CI for ≥15 to <30: 1.54 (0.64-3.71), ≥30: 3.08 (1.36-6.94) compared with <15), quartiles of AHI (p=0.01), quartiles of lowest arterial oxyhemoglobin saturation (SaO₂) (p<0.01), quartiles of percentage of time spent with SaO₂ <90 (T90SPT) (p<0.01) and quartiles of mean SaO₂ were independently associated with DKD.

OSA, especially during REM sleep, is a potential risk factor for DKD.

Patients with idiopathic pulmonary fibrosis with and without obstructive sleep apnea: differences in clinical characteristics, clinical outcomes, and the effect of PAP treatment.

J Clin Sleep

Obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is associated with worse mortality and clinical outcome. We aimed to assess differences between patients with IPF with and without OSA and the effect of positive airway pressure (PAP) treatment on sleep and overall life quality, morbidity and mortality in these patients.

Forty-five patients with newly diagnosed IPF underwent polysomnography. Using an apnea-hypopnea index (AHI) ≥ 15 events/h for OSA diagnosis resulted in 16 patients with IPF and 29 with IPF-OSA. The patients completed the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes in Sleep Questionnaire (FOSQ), Fatigue Severity Scale (FSS), Short Form-36 life questionnaire (SF-36) and Beck Depression scale (BDS) before and at the end of the follow up period.

Patients with IPF-OSA showed the most severe functional impairments in questionnaires, especially for General Health (GH) component of the SF-36 (37 vs 58 p = 0.03). At 7-year follow-up, 16 (36%) patients had died, 6 (38%) in the IPF and 10 (35%) in IPF-OSA Group. Patients with ≥6 hours PAP use had better survival compared to patients with <6 h use (p=0.04). Significant improvement was also observed in ESS (3 vs 6, p=0.03), PSQI (5 vs 8, p=0.01) and FSS (37 vs 48, p=0.008) score in patients with ≥4 hours PAP use.

OSA plays a significant role on clinical features and quality of life in IPF patients. Effective PAP treatment results in a significant improvement in sleepiness, fatigue, sleep quality and mortality. Identifier: NCT01637831.

Registry:, title: CPAP Therapy in Patients With Idiopathic Pulmonary Fibrosis and Sleep Apnea, identifier: NCT01637831, URL:

Ponatinib is a potential therapeutic approach for malignant pleural mesothelioma.

Exp Lung Res

Malignant pleural mesothelioma (MPM) is a rare and deadly malignancy. Current MPM therapies remain inadequate, and outcomes are often disappointing. New meaningful therapeutic approaches are urgently needed. Accumulating evidence indicates that the cAbl pathway promotes various tumor-stimulating processes in MPM. In this study, we sought to determine ponatinib's potential utility, a clinically approved and potent cAbl inhibitor, in MPM treatment.

Four MPM lines (MSTO211H, H28, H2452, H2052) were treated with ponatinib in vitro, and their growth was assessed. Scratch wound assay was used to investigate the ponatinib effect on cell migration. The expression levels of pAbl and its downstream effectors pCrkL, pAKT, and pSTAT5 were characterized. The in vivo ponatinib effect was evaluated in human MPM cells derived tumor model.

In all four MPM lines, significant expression levels of phosphorylated cAbl/Arg and pCrkl were observed. Differentially but strongly, ponatinib inhibited the in vitro cell growth and migration of all four MPM line. Western blot analysis showed that the activation of Abl signaling was blocked in the ponatinib-treated MMP lines. In keeping, the cellular levels of pAbl and its downstream effector pCrkL, pAKT, and pSTAT5 were markedly decrease following ponatinib treatment. Moreover, ponatinib treatment amplified the levels of γH2AX in cells denoting increased double-strand DNA breaks levels. Notably, ponatinib treatment reduced in vivo tumor growth and reduced pCrkl and pSTAT5 levels in tumor samples.

Ponatinib may offer a new therapeutic strategy for MPM patients based on cAbl signaling pathway inhibition.

Impact of the COVID-19 pandemic on obstructive sleep apnea: recommendations for symptom management.

J Clin Sleep

In the context of the current COVID-19 pandemic situation, we address the following important questions: (1) How can patients be identified for possible obstructive sleep apnea (OSA) while sleep clinic testing is temporarily unavailable or limited? and (2) What measures can be suggested to improve sleep health until proper diagnosis and treatment become safe and available again?

As a proxy for home or in-lab testing, validation of a symptom-based measure of OSA risk is presented, based on an on-going larger prospective study of 156 family medicine patients with OSA (88 women, 68 men; mean age 57) and 60 Control participants (36 women, 24 men; mean age 54) recruited from the community. Participants completed the Sleep Symptom Checklist (SSC) as well as a range of other self-report measures; primary care patients also underwent a polysomnographic sleep study.

Results show (a) that individuals with OSA reported more symptoms on the SSC related to Insomnia, Daytime Symptoms, Sleep Disorders and Psychological Maladjustment than the Control group (all p<.001), and (b) that their sleep-related symptoms were significantly more severe than those of Controls. In addition, (c) several PSG indices in recently diagnosed, untreated individuals with OSA were significantly correlated with SSC measured Sleep Disorder symptoms, and (d) SSC scores significantly distinguished OSA participants from Controls.

Our findings suggest that family practitioners can effectively pre-screen patients for possible OSA by inquiring about 5 items that form the SSC Sleep Disorders subscale. If OSA is suspected, there are a range of behavioral techniques which we recommend to improve symptoms. The current pandemic causes us to reflect that provisional targeting of symptoms and guidance as to mitigation strategies while waiting for specialist care could serve patients well at any time.