Showing papers on "Polysomnography published in 2004"
TL;DR: In adults, it appeared that sleep latency, percentages of stage 1 and stage 2 significantly increased with age while percentage of REM sleep decreased, and effect sizes for the different sleep parameters were greatly modified by the quality of subject screening, diminishing or even masking age associations with differentSleep parameters.
Abstract: Objectives: The purposes of this study were to identify age-related changes in objectively recorded sleep patterns across the human life span in healthy individuals and to clarify whether sleep latency and percentages of stage 1, stage 2, and rapid eye movement (REM) sleep significantly change with age. Design: Review of literature of articles published between 1960 and 2003 in peer-reviewed journals and meta-analysis. Participants: 65 studies representing 3,577 subjects aged 5 years to 102 years. Measurement: The research reports included in this meta-analysis met the following criteria: (1) included nonclinical participants aged 5 years or older; (2) included measures of sleep characteristics by “all night” polysomnography or actigraphy on sleep latency, sleep efficiency, total sleep time, stage 1 sleep, stage 2 sleep, slow-wave sleep, REM sleep, REM latency, or minutes awake after sleep onset; (3) included numeric presentation of the data; and (4) were published between 1960 and 2003 in peer-reviewed journals. Results: In children and adolescents, total sleep time decreased with age only in studies performed on school days. Percentage of slow-wave sleep was significantly negatively correlated with age. Percentages of stage 2 and REM sleep significantly changed with age. In adults, total sleep time, sleep efficiency, percentage of slow-wave sleep, percentage of REM sleep, and REM latency all significantly decreased with age, while sleep latency, percentage of stage 1 sleep, percentage of stage 2 sleep, and wake after sleep onset significantly increased with age. However, only sleep efficiency continued to significantly decrease after 60 years of age. The magnitudes of the effect sizes noted changed depending on whether or not studied participants were screened for mental disorders, organic diseases, use of drug or alcohol, obstructive sleep apnea syndrome, or other sleep disorders. Conclusions: In adults, it appeared that sleep latency, percentages of stage 1 and stage 2 significantly increased with age while percentage of REM sleep decreased. However, effect sizes for the different sleep parameters were greatly modified by the quality of subject screening, diminishing or even masking age associations with different sleep parameters. The number of studies that examined the evolution of sleep parameters with age are scant among school-aged children, adolescents, and middle-aged adults. There are also very few studies that examined the effect of race on polysomnographic sleep parameters.
2,601 citations
TL;DR: Differences in leptin and ghrelin are likely to increase appetite, possibly explaining the increased BMI observed with short sleep duration, and changes in appetite regulatory hormones with sleep curtailment may contribute to obesity.
Abstract: Background Sleep duration may be an important regulator of body weight and metabolism. An association between short habitual sleep time and increased body mass index (BMI) has been reported in large population samples. The potential role of metabolic hormones in this association is unknown. Methods and Findings Study participants were 1,024 volunteers from the Wisconsin Sleep Cohort Study, a population-based longitudinal study of sleep disorders. Participants underwent nocturnal polysomnography and reported on their sleep habits through questionnaires and sleep diaries. Following polysomnography, morning, fasted blood samples were evaluated for serum leptin and ghrelin (two key opposing hormones in appetite regulation), adiponectin, insulin, glucose, and lipid profile. Relationships among these measures, BMI, and sleep duration (habitual and immediately prior to blood sampling) were examined using multiple variable regressions with control for confounding factors. A U-shaped curvilinear association between sleep duration and BMI was observed. In persons sleeping less than 8 h (74.4% of the sample), increased BMI was proportional to decreased sleep. Short sleep was associated with low leptin (p for slope = 0.01), with a predicted 15.5% lower leptin for habitual sleep of 5 h versus 8 h, and high ghrelin (p for slope = 0.008), with a predicted 14.9% higher ghrelin for nocturnal (polysomnographic) sleep of 5 h versus 8 h, independent of BMI.
2,111 citations
TL;DR: The results of this study suggest that sleep-disordered breathing is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
Abstract: Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the respiratory disturbance index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a respiratory disturbance index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.
1,027 citations
TL;DR: Recent findings from populationbased epidemiology studies on risk factors for OSA in adults are reviewed to review recent findings from large population studies in different countries during the last decade.
Abstract: OBSTRUCTIVE SLEEP APNEA (OSA) is a sleep disorder characterized by intermittent complete and partial airway collapse, resulting in frequent episodes of apnea and hypopnea. The breathing pauses cause acute adverse effects, including oxyhemoglobin desaturation, fluctuations in blood pressure and heart rate, increased sympathetic activity, cortical arousal, and sleep fragmentation. The condition has received increasing attention during the past 3 decades. Until 1981, the only effective treatment for OSA was tracheostomy. The advent of continuous positive air pressure therapy, an effective noninvasive treatment, was a turning point, and clinical interest began to increase in tandem with the accumulation of research linking OSA to cognitive, behavioral, cardiovascular, and cerebrovascular morbidities (FIGURE). Findings from large population studies in different countries during the last decade have contributed to a better understanding of the epidemiology of OSA. In most population studies, OSA status has been indicated by the frequency of apnea and hypopnea events per hour of sleep (apnea-hypopnea index) as determined by polysomnography (a continuous overnight recording of sleep, breathing, and cardiac parameters). The apnea-hypopnea index cutpoints of 5, 15, and 30 (with or without daytime sleepiness) are commonly used to indicate mild, moderate, and severe OSA, respectively. These studies have demonstrated that OSA is highly prevalent in adults (TABLE). Approximately 1 in 5 adults has at least mild OSA and 1 in 15 adults has OSA of moderate or worse severity. In the United States, 75% to 80% of OSA cases that could benefit from treatment remain undiagnosed. Associations of OSA with serious morbidity have raised concern that untreated OSA is a substantial but underappreciated public health threat. Primary care physicians are currently being encouraged to be alert to OSA symptoms of disruptive snoring, breathing pauses, and excessive daytime sleepiness in their patients. It is important that physicians also recognize that not all OSA patients are “Pickwickian” (ie, male, obese, sleepy, snoring, and middle-aged), a stereotype that emerged from clinical observations of the highly selective patient populations observed in earlier years. The goal of this article is to review recent findings from populationbased epidemiology studies on risk factors for OSA in adults.
974 citations
TL;DR: There was strong evidence that interindividual differences in neurobehavioral deficits during sleep deprivation were systematic and trait-like, and not explained by subjects' baseline functioning or a variety of other potential predictors.
Abstract: OBJECTIVES: To investigate interindividual differences in neurobehavioral deficits during sleep deprivation, and to establish to what extent the neurobehavioral responses to sleep loss are a function of sleep history versus trait-like differential vulnerability. DESIGN: Individuals were exposed to sleep deprivation on 3 separate occasions in order to determine the stability of interindividual differences in neurobehavioral impairment. SETTING: The sleep-deprivation experiments were conducted under standardized laboratory conditions with continuous monitoring of wakefulness. Each subject underwent a laboratory-adaptation session before entering the sleep-deprivation phase of the study. PARTICIPANTS: A total of 21 healthy adults (aged 21-38 years) completed the experiment. INTERVENTIONS: Subjects came to the laboratory 3 times at intervals of at least 2 weeks. During each laboratory session, they underwent neurobehavioral testing every 2 hours during 36 hours of total sleep deprivation, which was preceded by baseline sleep and followed by recovery sleep. In the week prior to each sleep-deprivation session and on the baseline night in the laboratory, subjects were required to either restrict their sleep to 6 hours per day (prior sleep restriction condition) or to extend their time in bed to 12 hours per day (prior sleep extension condition), so as to experimentally manipulate sleep history (in randomized counterbalanced order). RESULTS: There was strong evidence that interindividual differences in neurobehavioral deficits during sleep deprivation were systematic and trait-like. The magnitude of interindividual variability was substantial relative to the magnitude of the effect of prior sleep restriction (which on average involved a reduction of 4.1 hours sleep per day, compared to prior sleep extension, for 7 days). Overall, interindividual differences were not explained by subjects' baseline functioning or a variety of other potential predictors. Interindividual variability clustered on 3 distinct neurobehavioral dimensions: self-evaluation of sleepiness, fatigue, and mood; cognitive processing capability; and behavioral alertness as measured by sustained attention performance. CONCLUSIONS: Neurobehavioral deficits from sleep loss varied significantly among individuals and were stable within individuals. Interindividual differences in neurobehavioral responses to sleep deprivation were not merely a consequence of variations in sleep history. Rather, they involved trait-like differential vulnerability to impairment from sleep loss, for which neurobiologic correlates have yet to be discovered. Language: en
777 citations
TL;DR: It is shown that, in humans, hippocampal areas that are activated during route learning in a virtual town are likewise activated during subsequent slow wave sleep, and that the amount of hippocampal activity expressed during slow waveSleep positively correlates with the improvement of performance in route retrieval on the next day.
727 citations
TL;DR: Men, but not women, show evidence of poorer sleep with aging, suggesting important sex differences in sleep physiology, and sleep architecture varies with sex, age, ethnicity, and SDB.
Abstract: Background Polysomnography is used to assess sleep quality and to gauge the functional effect of sleep disorders. Few population-based data are available to estimate the variation in sleep architecture across the population and the extent to which sleep-disordered breathing (SDB), a common health condition, contributes to poor sleep independent of other factors. The objective of this study was to describe the population variability in sleep quality and to quantify the independent associations with SDB. Methods Cross-sectional analyses were performed on data from 2685 participants, aged 37 to 92 years, in a community-based multicenter cohort study. Dependent measures included the percentage time in each sleep stage, the arousal index, and sleep efficiency. Independent measures were age, sex, ethnicity, comorbidity status, and the respiratory disturbance index. Results Lighter sleep was found in men relative to women and in American Indians and blacks relative to other ethnic groups. Increasing age was associated with impaired sleep in men, with less consistent associations in women. Notably, women had, on average, 106% more slow wave sleep. Sleep-disordered breathing was associated with poorer sleep; however, these associations were generally smaller than associations with sex, ethnicity, and age. Current smokers had lighter sleep than ex-smokers or never smokers. Obesity had little effect on sleep. Conclusions Sleep architecture varies with sex, age, ethnicity, and SDB. Individual assessment of the effect of SDB on sleep quality needs to account for other host characteristics. Men, but not women, show evidence of poorer sleep with aging, suggesting important sex differences in sleep physiology.
608 citations
TL;DR: Results indicate that increased sleep stage 2 spindle activity is related to an increase in recall performance and, thus, may reflect memory consolidation in stage 2 sleep.
Abstract: Study Objectives: Functional significance of stage 2 sleep spindle activity for declarative memory consolidation. Design: Randomized, within-subject, multicenter. Setting: Weekly sleep laboratory visits, actigraphy, and sleep diary (4 weeks). Participants: Twenty-four healthy subjects (12 men) aged between 20 and 30 years. Interventions: Declarative memory task or nonlearning control task before sleep. Measurement and Results: This study measured spindle activity during stage 2 sleep following a (declarative) word-pair association task as compared to a control task. Participants performed a cued recall in the evening after learning (160 word pairs) as well as in the subsequent morning after 8 hours of undisturbed sleep with full polysomnography. Overnight change in the number of recalled words, but not absolute memory performance, correlated significantly with increased spindle activity during the experimental night (r 24 =.63, P <.01). Time spent in each sleep stage could not account for this relationship. Conclusion: A growing body of evidence supports the active role of sleep for information reprocessing. Whereas past research focused mainly on the distinct rapid eye movement and slow-wave sleep, these results indicate that increased sleep stage 2 spindle activity is related to an increase in recall performance and, thus, may reflect memory consolidation.
532 citations
01 Aug 2004
TL;DR: Substantial evidence shows that patients with OSA have an increased incidence of hypertension compared with individuals without OSA and that OSA is a risk factor for the development of hypertension.
Abstract: Obstructive sleep apnea (OSA) is a common medical condition that occurs in approximately 5% to 15% of the population. The pathophysiology of OSA is characterized by repetitive occlusions of the posterior pharynx during sleep that obstruct the airway, followed by oxyhemoglobin desaturation, persistent inspiratory efforts against the occluded airway, and termination by arousal from sleep. Obstructive sleep apnea is associated with daytime sleepiness and fatigue, likely due to fragmented sleep from recurrent arousals. Substantial evidence shows that patients with OSA have an increased incidence of hypertension compared with individuals without OSA and that OSA is a risk factor for the development of hypertension. Recent studies show that OSA may be implicated in stroke and transient ischemic attacks. Obstructive sleep apnea appears to be associated with coronary heart disease, heart failure, and cardiac arrhythmias. Pulmonary hypertension may be associated with OSA, especially in patients with preexisting pulmonary disease. Although the exact cause that links OSA with cardiovascular disease is unknown, there is evidence that OSA is associated with a group of proinflammatory and prothrombotic factors that have been identified to be important in the development of atherosclerosis. Obstructive sleep apnea is associated with increased daytime and nocturnal sympathetic activity. Autonomic abnormalities seen in patients with OSA include increased resting heart rate, decreased R-R interval variability, and increased blood pressure variability. Both atherosclerosis and OSA are associated with endothelial dysfunction, increased C-reactive protein, interleukin 6, fibrinogen, and plasminogen activator inhibitor, and reduced fibrinolytic activity. Obstructive sleep apnea has been associated with enhanced platelet activity and aggregation. Leukocyte adhesion and accumulation on endothelial cells are common in both OSA and atherosclerosis. Clinicians should be aware that OSA may be a risk factor for the development of cardiovascular disease.
520 citations
TL;DR: It is suggested that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia.
Abstract: Background Chronic sleep-onset insomnia is a prevalent health complaint in adults. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy, singly and in combination, for chronic sleep-onset insomnia. Methods This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. The main outcome measures were sleep-onset latency as measured by sleep diaries; secondary measures included sleep diary measures of sleep efficiency and total sleep time, objective measures of sleep variables (Nightcap sleep monitor recorder), and measures of daytime functioning. Results In most measures, CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation. Conclusions These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia.
494 citations
TL;DR: The findings show that SDB is a common problem in the Korean adult population and understanding and treatment of SDB may be essential in terms of intervention to reduce the risk of related medical problems.
Abstract: With many epidemiologic studies made to establish the prevalence of sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) in Western countries, no such data have been reported in Korea. The purpose of this study was to examine the prevalence of SDB and OSAS, and their related factors in Korean adults aged 40-69 years. Among the total of 5,020 participants at the baseline examination of the Korean Health and Genome Study, a random sample of 457 men and women was studied with employment of overnight full polysomnography to determine the prevalence of SDB and OSAS. The prevalence of SDB (apnea-hypopnea index > or = 5) was 27% and 16% in men and women, respectively. When OSAS was defined by an apnea-hypopnea index > or = 5 plus excessive daytime sleepiness, its prevalence was 4.5% in men and 3.2% in women. Logistic regression analyses showed that sex, body mass index, and hypertension were closely associated with the risk of SDB. Our findings show that SDB is a common problem in the Korean adult population. Understanding and treatment of SDB may be essential in terms of intervention to reduce the risk of related medical problems.
TL;DR: Accident risk was related to increasing chronic sleepiness and antihistamine and narcotic analgesic use and sleep-disordered breathing, which are common in Australian commercial vehicle drivers.
Abstract: Sleep-disordered breathing and excessive sleepiness may be more common in commercial vehicle drivers than in the general population. The relative importance of factors causing excessive sleepiness and accidents in this population remains unclear. We measured the prevalence of excessive sleepiness and sleep-disordered breathing and assessed accident risk factors in 2,342 respondents to a questionnaire distributed to a random sample of 3,268 Australian commercial vehicle drivers and another 161 drivers among 244 invited to undergo polysomnography. More than half (59.6%) of drivers had sleep-disordered breathing and 15.8% had obstructive sleep apnea syndrome. Twenty-four percent of drivers had excessive sleepiness. Increasing sleepiness was related to an increased accident risk. The sleepiest 5% of drivers on the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire had an increased risk of an accident (odds ratio [OR] 1.91, p = 0.02 and OR 2.23, p < 0.01, respectively) and multiple accidents (OR 2.67, p < 0.01 and OR 2.39, p = 0.01), adjusted for established risk factors. There was an increased accident risk with narcotic analgesic use (OR 2.40, p < 0.01) and antihistamine use (OR 3.44, p = 0.04). Chronic excessive sleepiness and sleep-disordered breathing are common in Australian commercial vehicle drivers. Accident risk was related to increasing chronic sleepiness and antihistamine and narcotic analgesic use.
TL;DR: The recommended limits for normal values are as follows: OA index, 1; CA index, 0.9; oxygen desaturation, 89%; baseline saturation, 92%; and PETCO(2) > 45 mm Hg for < 10% of TST.
TL;DR: The results showing a relationship between FIRST scores and nocturnal polysomnography and Multiple Sleep Latency Test scores suggest individuals with high FIRST scores may be predisposed to developing chronic primary insomnia and the vulnerability identified may underlie vulnerability to transient sleep disturbance associated with other sleep-disruptive factors.
Abstract: Study objectives To determine the presence of a hypothesized trait vulnerability to sleep disturbance and hyperarousal. Design Polysomnographic assessment of sleep in response to stress during a first night in the laboratory and subsequent physiologic arousal. Participants One hundred and four individuals (46% men, mean age 40.4 +/- 12.9 years) drawn from a population-based sample. Interventions Individuals were exposed to a first night in the laboratory. Measurements and results Participants completed a Likert-scale questionnaire, consisting of 27 items, that assesses sleep disturbance in response to commonly experienced stressful situations. Factor analytic techniques identified a single 9-item factor that was representative of the construct of "stress-related" vulnerability to sleep disturbance. Reliability of the resulting 9-item scale was high (Cronbach's alpha = .83). Individuals with higher scores on this scale, the Ford Insomnia Response to Stress Test (FIRST; median split), had a lower sleep efficiency (P = .001), as well as an increased latency to stage 1 sleep (P = .001) and persistent sleep (P = .002) on the first night of nocturnal polysomnography. Moreover, these high-scoring individuals showed increased arousal as evidenced by an elevated sleep latency on the Multiple Sleep Latency Test compared to individuals with low FIRST scores. Importantly, after controlling for current and past insomnia, the differences between individuals scoring high and low on the FIRST in terms of nocturnal sleep and daytime arousal remained significant. Other stages of sleep (stage 2, slow-wave, and rapid eye movement sleep) were not different between the groups. Conclusions These results showing a relationship between FIRST scores and nocturnal polysomnography and Multiple Sleep Latency Test scores have 3 potential implications: (1) the data demonstrate a characteristic that relates to vulnerability to stress-related sleep disturbance as manifested by a first night in the laboratory; (2) the elevated latencies on the Multiple Sleep Latency Test in these individuals, despite significantly disturbed sleep, support the notion of physiologic hyperarousal in these individuals and suggests they may be predisposed to developing chronic primary insomnia; and (3) the vulnerability identified may underlie vulnerability to transient sleep disturbance associated with other sleep-disruptive factors.
TL;DR: Although the ESS score of children with S-SDB was within the normal range for adults, these children were sleepier and more hyperactive than control subjects, however, these data should be confirmed by a population-based study.
Abstract: Objectives. Excessive daytime sleepiness (EDS) is seen less frequently as a presenting complaint in children with sleep-disordered breathing than in adults. Instead, symptoms of hyperactivity are often described. We hypothesized that children with suspected sleep-disordered breathing (S-SDB) were both sleepier and more hyperactive than control subjects. Furthermore, we hypothesized that overnight polysomnographic parameters correlated with sleepiness and hyperactivity. Methods. A cross-sectional study was conducted at a university-affiliated hospital and a community-based pediatric clinic. A total of 108 patients with S-SDB (mean [standard deviation] age: 7 ± 4 years) and 72 control subjects (8 ± 4 years) were recruited. A modified Epworth Sleepiness Scale (ESS) and the Conners Abbreviated Symptom Questionnaire were administered. Polysomnography was performed in patients with S-SDB. Results. Patients with S-SDB had a higher ESS (8.1 ± 4.9 vs 5.3 ± 3.9) and a higher Conners score (12.8 ± 7.6 vs 9.0 ± 6.2) than control subjects. On the basis of adult criteria, 28% of patients had EDS. There was no difference in the ESS and Conners scores of patients with primary snoring and patients with obstructive sleep apnea. The ESS had weak correlations with polysomnographic parameters. Conclusions. Although the ESS score of children with S-SDB was within the normal range for adults, these children were sleepier and more hyperactive than control subjects. However, these data should be confirmed by a population-based study.
TL;DR: It is concluded that neutralizing TNFalpha activity is associated with a significant reduction of objective sleepiness in obese patients with OSA and suggests that proinflammatory cytokines contribute to the pathogenesis of OSA/sleepiness.
Abstract: The proinflammatory cytokines, TNFalpha and IL-6, are elevated in obstructive sleep apnea (OSA) and have been proposed as mediators of excessive daytime sleepiness in humans. We tested the effects of etanercept, a medication that neutralizes TNFalpha and is approved by the FDA for the treatment of rheumatoid arthritis, in eight obese male apneics. These patients participated in a pilot, placebo-controlled, double-blind study during which nighttime polysomnography, multiple sleep latency test, and fasting blood glucose and plasma levels of IL-6, C-reactive protein, insulin, and adiponectin were obtained. There was a significant and marked decrease in sleepiness by etanercept, which increased sleep latency during the multiple sleep latency test by 3.1 +/- 1.0 min (P < 0.05) compared with placebo. Also, the number of apneas/hypopneas per hour was reduced significantly by the drug compared with placebo (52.8 +/- 9.1 vs. 44.3 +/- 10.3; adjusted difference, -8.4 +/- 2.3; P < 0.05). Furthermore, IL-6 levels were significantly decreased after etanercept administration compared with placebo (3.8 +/- 0.9 vs. 1.9 +/- 0.4 pg/ml; adjusted difference, -1.9 +/- 0.5; P < 0.01). However, no differences were observed in etanercept vs. placebo in the levels of fasting blood glucose and plasma C-reactive protein, insulin, and adiponectin. We conclude that neutralizing TNFalpha activity is associated with a significant reduction of objective sleepiness in obese patients with OSA. This effect, which is about 3-fold higher than the reported effects of continuous positive airway pressure on objective sleepiness in patients with OSA (0.9 vs. 3.1 min), suggests that proinflammatory cytokines contribute to the pathogenesis of OSA/sleepiness.
TL;DR: Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care.
Abstract: Objective. Obstructive sleep apnea (OSA) in children is usually effectively treated by adenotonsillectomy (TA 22%) had no additional sleep studies before T&A. Timing of T&A was based on oximetry score, leading to a significant reduction in waiting time for surgery for those with higher oximetry scores. Postoperative respiratory complications were more common with increasing oximetry score. Conclusions. Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care.
TL;DR: Critically ill patients exhibit more frequent arousals and awakenings than is normal, and decreases in rapid eye movement and slow wave sleep, and measures to improve the quantity and quality of sleep in critically ill patients include careful attention to mode of mechanical ventilation, decreasing noise, and sedative agents (although the latter are double-edged swords).
Abstract: Abnormalities of sleep are extremely common in critically ill patients, but the mechanisms are poorly understood. About half of total sleep time occurs during the daytime, and circadian rhythm is markedly diminished or lost. Judgments based on inspection consistently overestimate sleep time and do not detect sleep disruption. Accordingly, reliable polygraphic recordings are needed to measure sleep quantity and quality in critically ill patients. Critically ill patients exhibit more frequent arousals and awakenings than is normal, and decreases in rapid eye movement and slow wave sleep. The degree of sleep fragmentation is at least equivalent to that seen in patients with obstructive sleep apnea. About 20% of arousals and awakenings are related to noise, 10% are related to patient care activities, and the cause for the remainder is not known; severity of underlying disease is likely an important factor. Mechanical ventilation can cause sleep disruption, but the precise mechanism has not been defined. Sleep disruption can induce sympathetic activation and elevation of blood pressure, which may contribute to patient morbidity. In healthy subjects, sleep deprivation can decrease immune function and promote negative nitrogen balance. Measures to improve the quantity and quality of sleep in critically ill patients include careful attention to mode of mechanical ventilation, decreasing noise, and sedative agents (although the latter are double-edged swords).
TL;DR: It is concluded that obstructive apnea in children is associated with 24-hour BP dysregulation and that, independent of obesity, the frequency of obstructive Apnea, oxygen desaturation, and arousal contributes to abnormal BP control.
Abstract: Obstructive sleep apnea causes intermittent elevation of systemic blood pressure (BP) during sleep. To determine whether obstructive apnea in children has a tonic effect on diurnal BP, 24-hour ambulatory blood pressure was obtained from 60 children with mean age of 10.8 ± 3.5 years. Thirty-nine children had obstructive apnea and 21 had primary snoring. Children with obstructive apnea had significantly greater mean BP variability during wakefulness and sleep, a higher night-to-day systolic BP, and a smaller nocturnal dipping of mean BP. Variability of mean arterial pressure during wakefulness was predicted by the desaturation, body mass, and arousal indices, whereas variability during sleep was predicted by apnea–hypopnea and body mass indices. Nocturnal BP dipping was predicted by the desaturation index. There were no significant differences in systolic, diastolic, or mean arterial BP during sleep between the groups. Diastolic BP during wakefulness was significantly different between the groups and correl...
TL;DR: Rapid maxillary expansion may be a useful approach in dealing with abnormal breathing during sleep in children with nasal breathing and obstructive sleep apnea syndrome.
Abstract: Objective: To evaluate the effect of rapid maxillary expansion on children with nasal breathing and obstructive sleep apnea syndrome. Method: Recruitment of children with maxillary contraction, without of adenoid hypertrophy, with a body mass index < 24 kg/m2, with obstructive sleep apnea syndrome demonstrated by polysomnography, and whose parents signed informed consent. Otolaryngologic and orthognathic-odontologic evaluation with clinical evaluation, anterior rhinometry and nasal fibroscopy, panoramic radiographs, anteroposterior and laterolateral telecephalometry were performed at entry and follow-up. Intervention: Rapid maxillary expansion (ie, active phase of treatment) was performed for 10 to 20 days; maintenance of device (for consolidation) and orthodontic treatment on teeth lasted 6 to 12 months. Results: 31 children (19 boys), mean age 8.7 years, participated in the study. The mean apnea-hypopnea index was 12.2 events per hour. At the 4-month follow-up, the anterior rhinometry was normal, and all children had an apnea-hypopnea index < 1 event per hour. The mean cross-sectional expansion of the maxilla was 4.32 +/- 0.7 mm. There was a mean increase of the pyriform opening of 1.3 +/- 0.3 mm. Conclusion: Rapid maxillary expansion may be a useful approach in dealing with abnormal breathing during sleep.
TL;DR: Compared to Chinese men, the prevalence of sleep-disordered breathing and obstructive sleep apnea syndrome in women was lower, but the gender difference decreased with age, and BMI and age were significant independent predictors of SDB.
TL;DR: Conclusions that actigraphy is not an accurate sleep-wake indicator and that it is inappropriate to infer sleep from actigraphY data are not supported by the findings.
Abstract: Objectives The Standards of Practice Committee of the American Sleep Disorders Association has supported the use of actigraphy in the assessment of sleep disorders Pollak et al disagree The objective of this paper is to identify and critically evaluate several theoretic and methodologic issues that are central to these divergent views regarding the valid use of actigraphy for sleep assessment Design Critical review, analysis, and comment Setting N/A Patients/participants N/A Interventions N/A Measurements and results N/A Conclusions (1) Coefficients of the validity of actigraphy exceed those associated with common medical tests and the best psychological tests (2) Reasons why actigraphy should be held to a substantially higher empirical standard than common medical tests and the best psychological tests have yet to be advanced (3) Differences between actigraphy and polysomnography are not random and can be reduced (3a) Sleep onset is a gradual rather than a discrete process Actigraphy keys on an earlier phase of the sleep-onset process than does polysomnography, resulting in systematic rather than random differences (3b) A sleep switch device can be used to substantially increase the accuracy of sleep-onset times (3c) The residual unreliability of polysomnographic data explains a portion of the differences between actigraphy and polysomnography Actigraphy cannot be expected to agree more completely with polysomnography than polysomnography does with itself (4) Complete agreement between actigraphy and polysomnography has been presumed, but achieving such a limit is theoretically impossible Some lower maximum agreement limit should be identified (5) Conclusions that actigraphy is not an accurate sleep-wake indicator and that it is inappropriate to infer sleep from actigraphy data are not supported by the findings Conclusions reached, including caveats, by the Standards of Practice Committee remain supported
TL;DR: Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure, similar to that reported with continuous positive airway pressure therapy.
Abstract: STUDY OBJECTIVE To investigate the short-term effect (4 weeks) of oral appliance therapy for obstructive sleep apnea on blood pressure. DESIGN Randomized, controlled, crossover trial. SETTING Multidisciplinary sleep disorders clinic in a university teaching hospital. PATIENTS Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography (apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms--daytime sleepiness, snoring, witnessed apneas, fragmented sleep; age > 20 years; and minimum mandibular protrusion of 3 mm). INTERVENTION A mandibular advancement splint (MAS) and control oral appliance for 4 weeks each. MEASUREMENTS AND RESULTS Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period. Patients showed a 50% reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index. There was a significant reduction with the MAS in mean (+/- SEM) 24-hour diastolic blood pressure (1.8 +/- 0.5 mmHg) compared with the control (P = .001) but not in 24-hour systolic blood pressure. Awake blood-pressure variables were reduced with the MAS by an estimated mean (+/- SEM) of 3.3 +/- 1.1 mmHg for systolic blood pressure (P = .003) and 3.4 +/- 0.9 mmHg for diastolic blood pressure (P < .0001). There was no significant difference in blood pressure measured asleep. CONCLUSION Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure, similar to that reported with continuous positive airway pressure therapy.
TL;DR: There is sufficient evidence to warrant future testing of the hypothesis that mild sleep restriction would decrease mortality in long sleepers, and sleep restriction may be most beneficial for older adults, who tend to spend excessive time in bed and have more sleep fragmentation compared with young adults.
TL;DR: The results suggest that sleep disturbances and, possibly, elevated resting heart rate, in middle-aged men, are associated with an increased risk of diabetes.
Abstract: OBJECTIVE —Sleep deprivation in healthy men has been experimentally found to result in disturbances in glucose metabolism and in sympathovagal imbalance. The aim of the present study was to investigate whether sleep disturbances and elevated resting heart rate are associated with increased risk of developing diabetes. RESEARCH DESIGN AND METHODS —A group of 6,599 initially healthy, nondiabetic men aged 44.5 ± 4.0 years took part in a prospective, population-based study in Malmo, Sweden. The incidence of diabetes during a mean follow-up of 14.8 ± 2.4 years was examined in relation to self-reported difficulties in falling asleep and resting heart rate at baseline. Diabetes was assessed at follow-up in all subjects by questionnaire and in a subgroup of 1,551 men by blood glucose measurement. RESULTS —A total of 615 (9.3%) subjects reported either difficulties in falling asleep or regular use of hypnotics (seen as markers of sleep disturbances), and 158 (2.4%) subjects reported both of these. Altogether, 281 (4.3%) of the men developed diabetes during the follow-up period. Logistic regression models showed difficulties in falling asleep or regular use of hypnotics (odds ratio [OR] 1.52 [95% CI 1.05–2.20]) and resting heart rate (OR per 10 bpm 1.13 [0.99–1.30]) to be associated with development of diabetes when full adjustments were made for baseline age, biological risk factors, lifestyle, family history of diabetes, and social class. CONCLUSIONS —The results suggest that sleep disturbances and, possibly, elevated resting heart rate, in middle-aged men, are associated with an increased risk of diabetes.
TL;DR: It is concluded that loop gain has a substantial impact on apnea severity in certain patients with sleep apnea, particularly those with a pharyngeal closing pressure near atmospheric.
Abstract: Ventilatory instability may play an important role in the pathogenesis of obstructive sleep apnea. We hypothesized that the influence of ventilatory instability in this disorder would vary depending on the underlying collapsibility of the upper airway. To test this hypothesis, we correlated loop gain with apnea-hypopnea index during supine, nonrapid eye movement sleep in three groups of patients with obstructive sleep apnea based on pharyngeal closing pressure: negative pressure group (pharyngeal closing pressure less than -1 cm H(2)O), atmospheric pressure group (between -1 and +1 cm H(2)O), and positive pressure group (greater than +1 cm H(2)O). Loop gain was measured by sequentially increasing proportional assist ventilation until periodic breathing developed, which occurred in 24 of 25 subjects. Mean loop gain for all three groups was 0.37 +/- 0.11. A significant correlation was found between loop gain and apnea-hypopnea index in the atmospheric group only (r = 0.88, p = 0.0016). We conclude that loop gain has a substantial impact on apnea severity in certain patients with sleep apnea, particularly those with a pharyngeal closing pressure near atmospheric.
TL;DR: Sleep apnea measures were associated with baseline diameter and the percentage of flow-mediated dilation, although these associations were weakened after adjustment for other cardiovascular risk factors, particularly body mass index.
Abstract: Clinical studies have suggested that sleep apnea is associated with impaired brachial artery flow-mediated dilation, a surrogate of endothelial dysfunction. We examined this question among older participants in the baseline examination of the Sleep Heart Health/Cardiovascular Health Study cohort (n = 1,037, age 68 years or older, 56% female). Indices of sleep apnea, derived from 12-channel home polysomnography, were the apnea–hypopnea index (average number of apneas/hypopneas per hour) and the hypoxemia index (percentage of time below 90% O2 saturation). Baseline arterial diameter and percentage of flow-mediated dilation were measured by ultrasound. Sleep apnea measures were associated with baseline diameter and the percentage of flow-mediated dilation, although these associations were weakened after adjustment for other cardiovascular risk factors, particularly body mass index. However, a statistically significant linear association between the hypoxemia index and baseline diameter was observed even afte...
TL;DR: It is concluded that children with ADHD demonstrate objective daytime somnolence, which may explain the beneficial effects of treatment with stimulant medications.
Abstract: Study Objectives: Children with attention-deficit/hyperactive disorder (ADHD), in spite of being hyperactive, still benefit from treatment with stimulant medications. We hypothesized that children with ADHD are in fact sleepy during the day, and we sought to test it objectively. Design: Single blind comparative study Setting: University medical center Participants: Thirty-four children with a previous diagnosis of ADHD (mean age ± SD, 12.4 ± 4.6 years) and 32 matched controls (mean age, 12.0 ± 3.6 years ). Interventions: N/A. Measurements: All participants underwent a full-night polysomnographic study followed by a multiple sleep latency test (MSLT). Results: Sleep latency, total sleep time, and sleep efficiency were comparable between the groups, yet children with ADHD were significantly sleepier during the day than those in the control group (mean MSLT score of 21.9 ± 5.5 minutes versus 27.9 ± 2.0 minutes, P <.005). Of the children with ADHD, 17 (50%) had signs of sleep-disordered breathing, compared with 7 of the control group (22%, P <.05). Five of the ADHD group had periodic limb movements during sleep (15%) versus none in the control group. Children without sleep-disordered breathing or periodic limb movements during sleep had the lowest nocturnal sleep efficiency and total sleep time. Conclusions: We conclude that children with ADHD demonstrate objective daytime somnolence, which may explain the beneficial effects of treatment with stimulant medications. Primary sleep disorders, especially sleep-disordered breathing and periodic limb movement disorder, should be looked for in children with ADHD. Citation: Golan, N; Shahar E; Ravid S; Pillar G. Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder.
TL;DR: Evidence suggests that sedative-hypnotics, such as benzodiazepine site-specific agonists, may have a role in some cases, whereas atypical antipsychotics may be necessary in other cases, and the utility of melatonin as a hypnotic in this population appears equivocal.
TL;DR: It is likely that women with OSA may be underdiagnosed due to circumstances related to the family lifestyle and sociocultural factors in addition to different OSA clinical expression.