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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Autonomic dysfunction in idiopathic hypersomnia: an overlooked association and potential management.

J Clin Sleep

There is a small yet robust body of literature regarding autonomic dysfunction in Idiopathic hypersomnia (IH) as well as sleep disturbances in Post...

An unusual cause of diaphragm pacer failure in congenital central hypoventilation syndrome.

J Clin Sleep

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder affecting ventilatory response to hypercapnia and/or hypoxemia. We de...

Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study.

J Clin Sleep

To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated OSA differs by rural versus urban residential address.

In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated OSA that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included: the proportion of patients who were adherent to CPAP; change in Epworth Sleepiness Scale (ESS) score; change in EuroQOL-5D score; and Visit-Specific Satisfaction Instrument score. All outcomes were measured three months after CPAP initiation.

We enrolled 242 patients (100 rural) with mean (SD) age 51 (13) years and respiratory event index 24 (18) events/hour. Mean (95% CI) CPAP use was 3.19 (2.8,3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at three months, mean CPAP use was 4.89 (4.51,5.28) hours/night and was not different between rural and urban patients. Improvement in ESS and patient satisfaction were similar between groups, but EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence in multivariable regression analysis.

Rural versus urban residence was not associated with differences in CPAP adherence when guided by specialist-interpreted diagnostic sleep testing.

Clinical utility of repeated positive airway pressure titrations in children with obstructive sleep apnea syndrome.

J Clin Sleep

Positive airway pressure (PAP) is the second line of treatment for OSAS in children. It is common practice following initiation of PAP to perform repeat titration polysomnography (PSG) to re-evaluate the patient's therapeutic pressure, however data supporting this practice is lacking. We hypothesized that repeat PAP titration would result in significant setting changes in children with OSAS.

We retrospectively analyzed demographic, polysomnographic and PAP data of children with OSAS aged 0-18 years who were initiated on PAP and underwent two titration studies over a two-year period. PAP mode and recommended pressure differences between the two titrations were compared.

64 children met inclusion criteria. The median (IQR) baseline obstructive apnea hypopnea index (OAHI) and SpO2 nadir were 14.8 (8.7-32.7) events/h and 88.5% (85-92%), respectively. The mean differences in OAHI, SpO2 nadir, and %TST with SpO2 < 90% between both titrations were negligible, including children with obesity, adenotonsillar hypertrophy, and Trisomy 21. Additionally, there was no significant difference in mean PAP pressure between two separate titration studies for those on continuous PAP or bilevel PAP.

Overall, repeat PAP titration in children with OSAS within the timeframe here described did not result in significant changes in PAP mode, continuous PAP pressure or OAHI. Based on these data, repeat PAP titration within two years of an initial titration does not appear to be necessary.

Use of the STBUR questionnaire to predict perioperative respiratory adverse events in children.

J Clin Sleep

The Snoring, Trouble Breathing, Un-Refreshed (STBUR) screening questionnaire has been validated in identifying pediatric surgical patients with symptoms of sleep-disordered breathing who may be at risk for perioperative respiratory adverse events. We sought to assess the performance of the STBUR questionnaire when adjusting for potential confounders such as patient comorbidities or surgical service.

This was a retrospective cohort study of children aged 2-18 years undergoing elective procedures under general anesthesia over a three-month period. Procedure specialties included general surgery, urology, orthopedic surgery, neurosurgery, plastic surgery, otolaryngology, dentistry, and gastroenterology. Preoperative STBUR questionnaire responses and perioperative respiratory adverse events were documented prospectively. Multivariate logistic regression was used to quantify associations between preoperative questionnaire responses, other potential risk factors (including age, sex, surgical specialty, comorbidities) and risk of perioperative respiratory adverse events.

Of 555 children, 17% had a positive STBUR screen. The prevalence of perioperative respiratory adverse events with a positive questionnaire screen was significantly greater than with a negative screen (29% vs 9% respectively, P < 0.001). A positive questionnaire screen was associated with significantly increased risk of a perioperative respiratory adverse event (adjusted OR 3.47 [95% CI 1.53, 7.84], P = 0.003).

A positive screen on the STBUR questionnaire was associated with a three-and-a-half-fold increased risk of perioperative respiratory adverse events in pediatric surgical patients. The STBUR questionnaire should be considered as a routine preoperative screening tool in children undergoing elective procedures.

EBUS versus EUS-B for diagnosing sarcoidosis: The International Sarcoidosis Assessment (ISA) randomized clinical trial.

Respirology

Endosonography with intrathoracic nodal sampling is proposed as the single test with the highest granuloma detection rate in suspected sarcoidosis stage I/II. However, most studies have been performed in limited geographical regions. Studies suggest that oesophageal endosonographic nodal sampling has higher diagnostic yield than endobronchial endosonographic nodal sampling, but a head-to-head comparison of both routes has never been performed.

Global (14 hospitals, nine countries, four continents) randomized clinical trial was conducted in consecutive patients with suspected sarcoidosis stage I/II presenting between May 2015 and August 2017. Using an endobronchial ultrasound (EBUS) scope, patients were randomized to EBUS or endoscopic ultrasound (EUS)-B-guided nodal sampling, and to 22- or 25-G ProCore needle aspiration (2 × 2 factorial design). Granuloma detection rate was the primary study endpoint. Final diagnosis was based on cytology/pathology outcomes and clinical/radiological follow-up at 6 months.

A total of 358 patients were randomized: 185 patients to EBUS-transbronchial needle aspiration (EBUS-TBNA) and 173 to EUS-B-fine-needle aspiration (FNA). Final diagnosis was sarcoidosis in 306 patients (86%). Granuloma detection rate was 70% (130/185; 95% CI, 63-76) for EBUS-TBNA and 68% (118/173; 95% CI, 61-75) for EUS-B-FNA (p = 0.67). Sensitivity for diagnosing sarcoidosis was 78% (129/165; 95% CI, 71-84) for EBUS-TBNA and 82% (115/141; 95% CI, 74-87) for EUS-B-FNA (p = 0.46). There was no significant difference between the two needle types in granuloma detection rate or sensitivity.

Granuloma detection rate of mediastinal/hilar nodes by endosonography in patients with suspected sarcoidosis stage I/II is high and similar for EBUS and EUS-B. These findings imply that both diagnostic tests can be safely and universally used in suspected sarcoidosis patients.

Circulating C-reactive protein levels in patients with suspected obstructive sleep apnea.

J Clin Sleep

To assess determinants of CRP in a cohort of patients referred for investigation of OSA and to determine whether overlap of OSA and COPD (overlap syndrome, OVS) is associated with higher levels of CRP.

This was a cross-sectional study that included 2352 patients seen at the West Australian Sleep Disorders Research Institute between 2006 and 2010. All patients had circulating CRP levels, and spirometry performed. OSA was defined apnea-hypopnea index (AHI) ≥ 5 events per hour and COPD defined as FEV1/FVC ratio <0.70 and age > 40 years. Univariate and multivariate regression analysis were used to identify CRP determinants.

Mean age was 51 years (60% male), median (AHI) was 27 events/h, median 3% oxygen desaturation index (ODI3%) was 24 events/h, mean FEV1 was 88% predicted, and median CRP was 3.0 mg/L. In multivariate analyses: age, body mass index, female sex, neck circumference, AHI, and desaturation markers (nadir and mean oxygen saturation) were independently associated with higher CRP. Spirometric variables were not predictors. There was no significant difference in CRP among OSA patients with or without co-existing COPD.

Markers of OSA severity (AHI and oxygenation), age, BMI, neck circumference and female sex were independent predictors of circulating CRP levels. OSA overlapping with COPD was not associated with increased CRP compared to either condition alone, suggesting other mechanisms for the increased CVD risk in OVS. Identification of factors that predict CRP will help identify patients at higher risk of CVD and aid risk stratification.

Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population.

J Clin Sleep

Dementia is associated with sleep disorders. However, the relationship between dementia and sleep arousal remains unclear. This study explored the associations among sleep parameters, arousal responses, and risk of mild cognitive impairment (MCI).

Participants with the chief complaints of memory problems and sleep disorders were screened from the sleep center database of Taipei Medical University Shuang-Ho Hospital, and the parameters related to the Cognitive Abilities Screening Instrument (CASI), Clinical Dementia Rating (CDR), and polysomnography (PSG) were determined. All the examinations were conducted within 6 months and without a particular order. The participants were divided into those without cognitive impairment (CDR = 0) and those with MCI (CDR = 0.5). Mean comparison, linear regression models, and logistic regression models were employed to investigate the associations among obtained variables.

This study included 31 participants without MCI and 37 with MCI (17 with amnestic MCI; 20 with multidomain MCI). Patients with MCI had significantly higher mean values of the spontaneous arousal index (SpArI) and SpArI in the nonrapid eye movement (NREM) stage (SpArINREM) than those without MCI. An increased risk of MCI was significantly associated with an increase SpArI and SpArINREM with various adjustments. Significant associations between the CASI scores and the oximetry parameters and sleep disorder indexes were observed.

Repetitive respiratory events with hypoxia were associated with cognitive dysfunction. Spontaneous arousal, especially in NREM sleep, was related to the risk of MCI. However, additional longitudinal studies are required to confirm their causality.

Barriers and facilitators to best care for idiopathic pulmonary fibrosis in Australia.

Respirology

In Australia, little is known about delivery of care for people with idiopathic pulmonary fibrosis (IPF). This study examined the organization of IPF care across Australia, how it aligns with guidance for best practice, and identified barriers and facilitators to best care.

Data on the organization of IPF care in Australia were collected from public hospitals using a study-specific questionnaire between February and July 2020. Semi-structured telephone interviews were conducted with respiratory physicians from around Australia between April and December 2020. Interviews were transcribed verbatim and thematic analysis was undertaken.

Almost all hospitals (n = 38, 97%) held multidisciplinary meetings (MDMs) for diagnosing IPF, with 90% of multidisciplinary teams including expert respiratory physicians and radiologists; however, rheumatologists, interstitial lung disease nurses and a histopathologist were often not available. More than 90% of institutions had access to oxygen therapy, pulmonary rehabilitation and advanced care planning, but access to psychological support and clinical trials was limited (53% and 58%, respectively). Fifteen respiratory physicians (27% regional) were interviewed. Approaches to diagnosis, treatment and access to referral services were generally consistent with best practice guidance; however, regional respondents reported barriers related to inadequate staffing, lack of a nurse coordinator, inadequate access to clinical trials and funding models. Telehealth technologies were perceived as facilitators to best care.

Clinical management of IPF in Australia generally aligns with best practice guidance, but there may be some inequity of access to specialist services, particularly in regional areas, that should be addressed to ensure optimal care for all.

Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: a systematic review and meta-analysis.

J Clin Sleep

Biological models suggest that obstructive sleep apnea (OSA) is potentially carcinogenic. We aim to clarify the inconsistent epidemiological literature by considering various traditional and novel OSA severity indices.

We systematically searched PubMed, Embase, Scopus and Cochrane Library for observational or randomized studies of associations of OSA, measured by diagnostic codes or any index, each with all-cancer incidence or mortality in adults, compared to participants with no/mild OSA. Two reviewers independently selected studies, extracted data, evaluated study bias using the Newcastle-Ottawa scale and quality of evidence using GRADE. We performed inverse variance-weighted, random-effects meta-analyses and sensitivity analyses.

We included 20 observational studies (5,340,965 participants), all with moderate/low bias, from 1,698 records. Based on T90 (sleep duration with oxygen saturation <90%), patients with OSA who had moderate (T90 >1.2%, HR=1.28, 95%CI=1.07-1.54) and severe nocturnal hypoxemia (T90 >12%, HR=1.43, 95%CI=1.16-1.76) experienced 30-40% higher pooled all-cancer risk than normoxemic patients, after multi-adjustment for covariates including obesity. Furthermore, severe nocturnal hypoxemia nearly tripled all-cancer mortality (HR=2.66, 95%CI=1.21-5.85). Patients with apnea-hypopnea index (AHI)-defined severe OSA, but not moderate OSA, had higher all-cancer risk (HR=1.18, 95%CI=1.03-1.35) but similar all-cancer mortality as patients without OSA. An OSA diagnosis was not associated with all-cancer risk. Evidence quality ranged from low to moderate. Insufficient evidence was available on the oxygen desaturation index, lowest/median saturation and arousal index.

In patients with OSA, nocturnal hypoxemia is independently associated with all-cancer risk and mortality. Future studies should explore if risk differs by cancer type, and whether cancer screening and OSA treatment are beneficial.

Registry: PROSPERO; Identifier: CRD42021220836; URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220836.

Risk factors associated with pulmonary hypertension in obesity hypoventilation syndrome.

J Clin Sleep

Pulmonary hypertension (PH) is prevalent in obesity hypoventilation syndrome (OHS). However, there is a paucity of data assessing pathogenic factors associated with PH. Our objective is to assess risk factors that may be involved in the pathogenesis of PH in untreated OHS.

In a post-hoc analysis of the Pickwick trial, we performed a bivariate analysis of baseline characteristics between patients with and without PH. Variables with a p value ≤0.10 were defined as potential risk factors and were grouped by theoretical pathogenic mechanisms in several adjusted models. Similar analysis was carried out for the two OHS phenotypes, with and without severe concomitant obstructive sleep apnea (OSA).

Of 246 patients with OHS, 122 (50%) had echocardiographic evidence of PH defined as systolic pulmonary artery pressure ≥40 mmHg. Lower levels of awake PaO2 and higher body mass index (BMI) were independent risk factors in the multivariate model, with a negative and positive adjusted linear association, respectively (adjusted odds ratio 0.96; 95% CI 0.93 to 0.98; p = 0.003 for PaO2, and 1.07; 95% CI 1.03 to 1.12; p = 0.001 for BMI). In separate analyses, BMI and PaO2 were independent risk factors in the severe OSA phenotype, whereas BMI and peak in-flow velocity in early (E)/late diastole (A) ratio were independent risk factors in the non-severe OSA phenotype.

This study identifies obesity per se as a major independent risk factor for PH, regardless of OHS phenotype. Therapeutic interventions targeting weight loss may play a critical role in improving PH in this patient population.

Registry: Clinicaltrial.gov; Identifier: NCT01405976.

The negative health effects of having a combination of snoring and insomnia.

J Clin Sleep

Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness.

The study population comprised 25,901 participants (16-75 years, 54.4% women) from four Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and non-respiratory disorders.

Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adj. OR 1.4, 95% CI: 1.2-1.6), chronic obstructive pulmonary disease (COPD) (adj. OR 1.8, 95% CI: 1.3-2.4), asthma (adj. OR 1.9; 95% CI: 1.6-2.3), daytime sleepiness (adj. OR 7.9, 95% CI 7.1-8.8) and the use of hypnotics (adj. OR 7.5, 95% CI: 6.1-9.1) was highest for the group with both insomnia symptoms and snoring.

Participants with both snoring and insomnia run an increased risk of hypertension, COPD, asthma, daytime sleepiness and the use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia.