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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Indirect effect of sleep on abdominal pain through daytime dysfunction in adults with irritable bowel syndrome.

J Clin Sleep

Sleep deficiency, psychological distress, daytime dysfunction and abdominal pain are common in adults with irritable bowel syndrome (IBS). Prior research on individuals with chronic pain has identified the indirect effect of sleep on pain through psychological distress or daytime dysfunction; however, it is less clear in IBS. The purpose of this study was to examine potential indirect effects of sleep on abdominal pain symptoms simultaneously through psychological distress and daytime dysfunction in adults with IBS.

Daily symptoms of nighttime sleep complaints (sleep quality and refreshment), psychological distress, daytime dysfunction (fatigue, sleepiness, and hard to concentrate) and abdominal pain were collected in baseline assessments from two randomized controlled trials of 332 adults (mean age 42 years and 85 % female) with IBS. Structural equation modeling (SEM) was used to examine the global relationships among nighttime sleep complaints, psychological distress, daytime dysfunction and abdominal pain.

SEM analyses found a strong indirect effect of poor sleep on abdominal pain via daytime dysfunction, but not psychological distress. More than 95% of the total effect of nighttime sleep complaints on abdominal pain is indirect.

These findings suggest that the primary impact of nighttime sleep complaints on abdominal pain is indirect. The indirect effect appears primarily through daytime dysfunction. Such understanding provides a potential avenue to optimize personalized and hybrid behavioral interventions for adults with IBS through addressing daytime dysfunction and sleep behaviors. Additional study integrating symptoms with biological markers is warranted to explore the underlying mechanisms accounting for these symptoms.

Sleep in hospitalized patients with chronic obstructive pulmonary disease: an observational study.

J Clin Sleep

The aim of this study was to compare risk of undiagnosed sleep disorders among medical inpatients with COPD compared to those without COPD.

In a prospective cohort study, hospitalized medical ward patients without a known sleep disorder were screened for sleep disorders such as obstructive sleep apnea and insomnia while hospitalized using validated questionnaires. Daily sleep duration and efficiency in the hospital were measured via wrist actigraphy. Participants were classified into 2 groups: those with a primary or secondary diagnosis of COPD or those without history of COPD diagnosis. Sleep outcomes were compared by COPD diagnosis.

From March 2010 to July 2015, 572 patients completed questionnaires and wrist actigraphy. On admission, patients with COPD had a greater adjusted risk of OSA (aOR 1.82, 95% CI 1.12-2.96, p = .015) and clinically significant insomnia (aOR 2.07, 95% CI 1.12-3.83, p = .021); no differences were observed for sleep quality or excess sleepiness on admission. After adjustment, compared to patients without COPD, patients with COPD averaged 34 fewer minutes of nightly sleep (95% CI 4.2-64.0 minutes, p = .026) as well as 22.5% lower odds of normal sleep efficiency while in the hospital (95% CI 3.3%-37.9%, p = .024). No statistically significant differences were observed for in-hospital sleep quality, soundness, or ease of falling asleep.

Among hospitalized patients on medical wards, those with COPD have higher risk of OSA and insomnia, and worse in-hospital sleep quality and quantity, compared to those without COPD.

Cardiovascular and somatic comorbidities and sleep measures using three hypopnea criteria in mild obstructive sleep-disordered breathing: sex, age and body mass index differences in a retrospective sleep clinic cohort.

J Clin Sleep

To describe sex, age and body mass index (BMI) differences in comorbidities and polysomnography (PSG) measures, categorized using three different apnea-hypopnea index (AHI) criterion, in sleep clinic patients with mild obstructive sleep-disordered breathing (SDB).

A retrospective cohort of 305 (64% female) adult sleep clinic patients who underwent full night in-laboratory polysomnography diagnosed with mild SDB and prescribed positive airway pressure (PAP). Effects of sex, age and BMI on comorbidities and PSG measures including rates of AHI defined by ≥3% desaturations (AHI3%), with arousals (AHI3%A), by ≥4% desaturations (AHI4%) and by respiratory disturbance index (RDI) were evaluated.

69 (23%), 116 (38%), 258 (85%) and 267 (88%) patients had AHI4%, AHI3%, AHI3%A and RDI ≥5, respectively. 90- day PAP adherence rates were 45.9% overall and higher in women > 50 (51.2%, p=0.013)) and men (54.5%, p= 0.024) with no difference whether AHI4% or AHI3%A was <5 or ≥5. Men and women had similar rates of daytime sleepiness (43.3%), anxiety (44.9%) and hypertension (44.9%). Women were more likely to have obesity, anemia, asthma, depression, diabetes, fibromyalgia, hypothyroidism, migraine and lower rates of coronary artery disease. More patients with AHI4% <5 had depression, migraines, and anemia and more patients with AHI4% ≥5 had CHF. Women were more likely to have higher sleep maintenance and efficiency, shorter average obstructive apnea and hypopnea durations and less supine-dominant pattern. Average obstructive apnea and hypopnea duration decreased with increasing BMI and average hypopnea duration increased with age. Obstructive apnea duration and obstructive hypopnea with arousal duration decreased with increasing BMI. More women had AHI4% <5 (81.5% vs 69.1%), AHI3% <5 (68.7% v 49.1%), and AHI3%A <5 (18.5% vs 10.0%). Older age and higher BMI were associated with higher AHI.

Current AHI criteria do not predict comorbidities or adherence in mild sleep-disordered breathing patients. In this hypothesis generating descriptive analysis, sex, BMI and age may all be factors that should be accounted for in future research of mild SDB patients. Different sleep study measures may weigh differently into risks of cardiovascular versus somatic comorbidities.

Central sleep apnea and Chiari 1 malformation in a pediatric patient with Klippel-Feil syndrome.

J Clin Sleep

Klippel-Feil sequence (KFS) is a rare congenital condition that presents with congenital cervical spine fusion, reduced cervical spine flexion, and...

Partial epiglottectomy improves residual apnea-hypopnea index in patients with epiglottis collapse.

J Clin Sleep

Continuous positive airway pressure (CPAP) treatment aggravates airway obstruction in patients with epiglottis collapse. In these patients, partial...

Impact of obstructive sleep apnea on left ventricular mass index in men with coronary artery disease.

J Clin Sleep

Left ventricular hypertrophy (LVH) is associated with augmented risk for mortality in patients with coronary artery disease (CAD). These patients often have obstructive sleep apnea (OSA). We aimed to evaluate the relationship between OSA and the left ventricular mass index (LVMI) in men with CAD.

Consecutive patients with CAD were recruited and underwent overnight portable monitoring for the assessment of OSA. LVMI was ascertained using high-resolution echocardiography. Univariate and multivariate regression analyses were conducted to explore the associations between the OSA parameters and the LVMI levels.

Of the 1,053 examined male patients with CAD, 425 (40.4%) had moderate-to-severe OSA (respiratory event index [REI] ≥15 events/h). The prevalence of LVH (LVMI >125 g/m²) was 36.0% (n = 379). The mean LVMI values increased with increasing OSA severity (P <0.001). Patients with REI ≥30 had 2.30 (95% confidence interval [CI] 1.50-3.54, P <0.001) times increased risk of LVH than those without OSA (REI <5) independent of confounders. The minimum oxygen saturation levels (minSaO₂) were the strongest factor correlated with LVMI (𝛽=-0.299, P = 0.004) of several OSA indices. Patients with minSaO₂ <70% had an adjusted odds ratio of 3.62 (95% CI 1.81-7.25, P <0.001) for LVH development compared with those with minSaO₂ ≥90%.

OSA severity was associated with a higher likelihood of LVH in men with CAD, which is partially related to severe nocturnal intermittent hypoxemia. Aggressive effort at managing OSA among patients with CAD may further reduce the cardiovascular risk.

When reason sleeps: attempted suicide during the circadian night.

J Clin Sleep

Disrupted sleep and nocturnal wakefulness are evidence-based risk factors for suicidal thoughts and behaviors. We present a suicide attempt followi...

Tridimensional upper airway assessment in male patients with OSA using oral advancement devices modifying their vertical dimension.

J Clin Sleep

Mandibular advancement devices (MAD) constitute an alternative treatment in selected patients with obstructive sleep apnea (OSA). A mandibular advanced position has been suggested to be beneficial whereas its combination with an increased bite-raise might increase its negative side effects. The objective of this study was to assess UA volume and inspiratory pressure gradient variations in a group of 17 patients with OSA. The study was performed under three mandibular positions: intercuspal position (IP) (P1), mandibular advancement device position in both closed mouth (C+MADP) (P2) and with an increased bite-raise (BR +MADP) (P3).

3D reconstruction of the pharynx using a Finite Element Method (FEM) via a computed tomography scan (CT) and subsequent calculation using Fluid-Dynamic Analysis.

100% of the sample showed an increase in the UA volume in both P2 and P3, being P2 the position in which 76.47% of the patients showed the largest UA volume. P2 /Velopharynx was the position/region in which the largest UA volume increase was achieved (4.73 mm³). A better gradient in P2 (mean 0.62) in 58.82% of the patients and 41.18% in P3 (mean 0.74) respect P1 was observed. In 82.35% of the patients a better volume-pressure gradient match was also found.

Best efficiency scores for both volume increase and better inspiratory pressure gradient were obtained in MAD closed mouth position. This study findings suggest that, in a MAD, the minimal bite opening position necessary for mandibular protrusion, is more effective in increasing airway volume and inspiratory gradient compared to a larger bite-raising (15mm).

Upper airway collapsibility in patients with OSA treated with continuous positive airway pressure: a retrospective preliminary study.

J Clin Sleep

To investigate the prevalence of mildly collapsible upper airways (defined by therapeutic continuous positive airway pressure (CPAP) values ≤8 cm H₂O) in moderate to severe obstructive sleep apnea (OSA) patients treated with CPAP and to determine their clinical, functional and nocturnal polysomnographic characteristics.

87 moderate to severe OSA patients consecutively treated with CPAP were retrospectively investigated. Two nocturnal home sleep portable monitoring (HSPM) studies were performed at baseline and during treatment. Participants were categorized according to therapeutic CPAP values: ≤8 cm H₂O (Group 1), 8-12 cm H₂O (Group 2), ≥12 cm H₂O (Group 3). Anthropometric, awake respiratory function, symptoms, comorbidities and nocturnal HSPM data were collected.

25.3% of patients had mild upper airway collapsibility (therapeutic CPAP values ≤8 cm H₂O). They showed more favorable apnea-hypopnea index, oxygen desaturation index (ODI), mean nocturnal saturation, sleep time with oxygen saturation <90%, desaturation nadir and supine position. ODI showed a weak association with anatomical collapsibility. Using the receiver operating characteristic curve, the area under the curve for ODI versus CPAP pressure requirements ≤8 cm H₂O was low and ODI ≤40.8/h showed a sensitivity of 63.3% and a specificity of 69.2% to detect patients with mild collapsibility.

A quarter of moderate to severe patients under CPAP therapy had mild collapsibility and were likely to also be good candidates for alternative and better tolerated non-CPAP therapies. Baseline anthropometric, clinical and respiratory function characteristics did not predict mild upper airway collapsibility determined by CPAP pressure requirements ≤8 cm H₂O.

Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps.

Respirology

Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges...

Serum Krebs von den Lungen-6 level in the disease progression and treatment of Mycobacterium avium complex lung disease.

Respirology

The lack of useful biomarkers reflecting the disease state limits the management of Mycobacterium avium complex lung disease (MAC-LD). We clarified the associations between serum KL-6 level, disease progression and treatment response.

Resected lung tissues from MAC-LD patients were immunostained for KL-6. We compared serum KL-6 levels between MAC-LD and healthy control or bronchiectasis patients without nontuberculous mycobacterial lung disease (NTM-LD). Serum KL-6 level was assessed in a prospective observational study at Keio University Hospital between May 2012 and May 2016. We investigated associations between serum KL-6 level and disease progression and treatment response in patients untreated for MAC-LD on registration (n = 187).

The KL-6+ alveolar type 2 cell population in the lung and serum KL-6 level were significantly higher in MAC-LD patients than in controls. Serum KL-6 level in bronchiectasis patients without NTM-LD showed no significant increase. Of the 187 patients who did not receive treatment on registration, 53 experienced disease progression requiring treatment. Multivariable Cox analysis revealed that the serum KL-6 level (aHR: 1.18, P = 0.005), positive acid-fast bacilli smear (aHR: 2.64, P = 0.001) and cavitary lesions (aHR: 3.01, P < 0.001) were significantly associated with disease progression. The change in serum KL-6 (ΔKL-6) was significantly higher in the disease progression group; it decreased post-treatment, reflecting the negative sputum culture conversion.

Serum KL-6 level is associated with disease progression and treatment response. Longitudinal assessment combined with AFB smear status and presence of cavitary lesions may aid MAC-LD management.

Blocking protein phosphatase 2A with a peptide protects mice against bleomycin-induced pulmonary fibrosis.

Exp Lung Res

Emerging data indicate that endothelial-mesenchymal transition (EndMT) is involved in the pathogenesis of idiopathic pulmonary fibrosis (IPF). A pr...