Showing papers on "Polysomnography published in 2018"
Academic Center for Dentistry Amsterdam1, University of Helsinki2, New York University3, University of Missouri–Kansas City4, Osaka University5, Tel Aviv University6, Katholieke Universiteit Leuven7, University of Kentucky8, Kyushu University9, Université de Montréal10, Karolinska Institutet11, Aarhus University12, University of Siena13
TL;DR: There is a need for an updated consensus on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible to be confirmed.
Abstract: In 2013, consensus was obtained on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible and specified as either sleep bruxism or awake bruxism. In addition, a grading system was proposed to determine the likelihood that a certain assessment of bruxism actually yields a valid outcome. This study discusses the need for an updated consensus and has the following aims: (i) to further clarify the 2013 definition and to develop separate definitions for sleep and awake bruxism; (ii) to determine whether bruxism is a disorder rather than a behaviour that can be a risk factor for certain clinical conditions; (iii) to re-examine the 2013 grading system; and (iv) to develop a research agenda. It was concluded that: (i) sleep and awake bruxism are masticatory muscle activities that occur during sleep (characterised as rhythmic or non-rhythmic) and wakefulness (characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively; (ii) in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences; (iii) both non-instrumental approaches (notably self-report) and instrumental approaches (notably electromyography) can be employed to assess bruxism; and (iv) standard cut-off points for establishing the presence or absence of bruxism should not be used in otherwise healthy individuals; rather, bruxism-related masticatory muscle activities should be assessed in the behaviour's continuum.
566 citations
TL;DR: The National Sleep Research Resource (NSRR) provides a single point of access to analysis-ready physiological signals from polysomnography obtained from multiple sources, and a wide variety of clinical data to facilitate sleep research.
332 citations
TL;DR: Fitbit Charge 2™ shows promise in detecting sleep-wake states and sleep stage composition relative to gold standard PSG, particularly in the estimation of REM sleep, but with limitations in N3 detection.
Abstract: We evaluated the performance of a consumer multi-sensory wristband (Fitbit Charge 2™), against polysomnography (PSG) in measuring sleep/wake state and sleep stage composition in healthy adults.In-l...
260 citations
TL;DR: The heuristic algorithm uses the variance in estimated z-axis angle and makes basic assumptions about sleep interruptions to detect the SPT-window and shows the value of this algorithm lies in studies such as UK Biobank where a sleep diary was not used.
Abstract: Wrist worn raw-data accelerometers are used increasingly in large-scale population research. We examined whether sleep parameters can be estimated from these data in the absence of sleep diaries. Our heuristic algorithm uses the variance in estimated z-axis angle and makes basic assumptions about sleep interruptions. Detected sleep period time window (SPT-window) was compared against sleep diary in 3752 participants (range = 60–82 years) and polysomnography in sleep clinic patients (N = 28) and in healthy good sleepers (N = 22). The SPT-window derived from the algorithm was 10.9 and 2.9 minutes longer compared with sleep diary in men and women, respectively. Mean C-statistic to detect the SPT-window compared to polysomnography was 0.86 and 0.83 in clinic-based and healthy sleepers, respectively. We demonstrated the accuracy of our algorithm to detect the SPT-window. The value of this algorithm lies in studies such as UK Biobank where a sleep diary was not used.
225 citations
TL;DR: Insomnia or poor sleep with PSG-short sleep was associated with higher risk of incident CVD, and future studies should evaluate the impact of interventions to improve insomnia with PSg- short sleep on CVD.
Abstract: Study Objectives To quantify the association between insomnia or poor sleep with objective short sleep duration and incident cardiovascular disease (CVD) and mortality in the general population. Methods We conducted a time-to-event analysis of Sleep Heart Health Study data. Questionnaires and at-home polysomnography (PSG) were performed between 1994 and 1998. Participants were followed for a median of 11.4 years (Q1-Q3, 8.8-12.4 years) until death or last contact. The primary exposure was insomnia or poor sleep with short sleep defined as follows: difficulty falling asleep, difficulty returning to sleep, early morning awakenings, or sleeping pill use, 16-30 nights per month; and total sleep of <6 hr on PSG. We used proportional hazard models to estimate the association between insomnia or poor sleep with short sleep and CVD, as well as all-cause mortality. Results Among 4994 participants (mean age: 64.0 ± 11.1 years), 14.1 per cent reported insomnia or poor sleep, of which 50.3 per cent slept <6 hr. Among 4437 CVD-free participants at baseline, we observed 818 incident CVD events. After propensity adjustment, there was a 29 per cent higher risk of incident CVD in the insomnia or poor sleep with short sleep group compared with the reference group (HR: 1.29, 95% CI: 1.00, 1.66), but neither the insomnia or poor sleep only nor short sleep only groups were associated with higher incident CVD. Insomnia or poor sleep with objective short sleep was not associated with all-cause mortality (HR: 1.07, 95% CI: 0.86, 1.33). Conclusions Insomnia or poor sleep with PSG-short sleep was associated with higher risk of incident CVD. Future studies should evaluate the impact of interventions to improve insomnia with PSG-short sleep on CVD.
221 citations
TL;DR: Patients with idiopathic REM sleep behaviour disorder had fully developed pathology in the peripheral autonomic nervous system and the locus coeruleus, equal to that in diagnosed Parkinson's disease.
Abstract: Summary Background Accumulating evidence suggests that α-synuclein aggregates—a defining pathology of Parkinson's disease—display cell-to-cell transmission. α-synuclein aggregation is hypothesised to start in autonomic nerve terminals years before the appearance of motor symptoms, and subsequently spread via autonomic nerves to the spinal cord and brainstem. To assess this hypothesis, we investigated sympathetic, parasympathetic, noradrenergic, and dopaminergic innervation in patients with idiopathic rapid eye movement (REM) sleep behaviour disorder, a prodromal phenotype of Parkinson's disease. Methods In this prospective, case-control study, we recruited patients with idiopathic REM sleep behaviour disorder, confirmed by polysomnography, without clinical signs of parkinsonism or dementia, via advertisement and through sleep clinics in Denmark. We used 11 C-donepezil PET and CT to assess cholinergic (parasympathetic) gut innervation, 123 I-metaiodobenzylguanidine (MIBG) scintigraphy to measure cardiac sympathetic innervation, neuromelanin-sensitive MRI to measure integrity of pigmented neurons of the locus coeruleus, 11 C-methylreboxetine (MeNER) PET to assess noradrenergic nerve terminals originating in the locus coeruleus, and 18 F-dihydroxyphenylalanine (DOPA) PET to assess nigrostriatal dopamine storage capacity. For each imaging modality, we compared patients with idiopathic REM sleep behaviour disorder with previously published reference data of controls without neurological disorders or cognitive impairment and with symptomatic patients with Parkinson's disease. We assessed imaging data using one-way ANOVA corrected for multiple comparisons. Findings Between June 3, 2016, and Dec 19, 2017, we recruited 22 consecutive patients with idiopathic REM sleep behaviour disorder to the study. Compared with controls, patients with idiopathic REM sleep behaviour disorder had decreased colonic 11 C-donepezil uptake (−0·322, 95% CI −0·112 to −0·531; p=0·0020), 123 I-MIBG heart:mediastinum ratio (−0·508, −0·353 to −0·664; p 18 F-DOPA uptake (Ki; −0·0023, −0·0009 to −0·0037; p=0·0013). No between-group differences were detected between idiopathic REM sleep behaviour disorder and Parkinson's disease groups with respect to 11 C-donepezil (p=0·39), 123 I-MIBG (p>0·99), neuromelanin-sensitive MRI (p=0·96), and 11 C-MeNER (p=0·56). By contrast, 15 (71%) of 21 patients with idiopathic REM sleep behaviour disorder had 18 F-DOPA Ki values within normal limits, whereas all patients with Parkinson's disease had significantly decreased 18 F-DOPA Ki values when compared with patients with idiopathic REM sleep behaviour disorder (p Interpretation Patients with idiopathic REM sleep behaviour disorder had fully developed pathology in the peripheral autonomic nervous system and the locus coeruleus, equal to that in diagnosed Parkinson's disease. These patients also showed noradrenergic thalamic denervation, but most had normal putaminal dopaminergic storage capacity. This caudorostral gradient of dysfunction supports the hypothesis that α-synuclein pathology in Parkinson's disease initially targets peripheral autonomic nerves and then spreads rostrally to the brainstem. Funding Lundbeck Foundation, Jascha Foundation, and the Swiss National Foundation.
205 citations
TL;DR: By creating accurate deep learning models for sleep scoring, this work opens the path toward broader and more timely access to sleep diagnostics, potentially extending the reach of sleep expertise beyond specialty clinics.
199 citations
TL;DR: The review of the market indicates the most valued sleep apps, but it also identifies problems and gaps, e.g., many hardware devices have not been validated and (especially software apps) should be studied before their clinical use.
Abstract: Purpose A literature review is presented that aims to summarize and compare current methods to evaluate sleep. Methods Current sleep assessment methods have been classified according to different criteria; e.g., objective (polysomnography, actigraphy…) vs. subjective (sleep questionnaires, diaries…), contact vs. contactless devices, and need for medical assistance vs. self-assessment. A comparison of validation studies is carried out for each method, identifying their sensitivity and specificity reported in the literature. Finally, the state of the market has also been reviewed with respect to customers' opinions about current sleep apps. Results A taxonomy that classifies the sleep detection methods. A description of each method that includes the tendencies of their underlying technologies analyzed in accordance with the literature. A comparison in terms of precision of existing validation studies and reports. Discussion In order of accuracy, sleep detection methods may be arranged as follows: Questionnaire < Sleep diary < Contactless devices < Contact devices < PolysomnographyA literature review suggests that current subjective methods present a sensitivity between 73% and 97.7%, while their specificity ranges in the interval 50%-96%. Objective methods such as actigraphy present a sensibility higher than 90%. However, their specificity is low compared to their sensitivity, being one of the limitations of such technology. Moreover, there are other factors, such as the patient's perception of her or his sleep, that can be provided only by subjective methods. Therefore, sleep detection methods should be combined to produce a synergy between objective and subjective methods. The review of the market indicates the most valued sleep apps, but it also identifies problems and gaps, e.g., many hardware devices have not been validated and (especially software apps) should be studied before their clinical use.
196 citations
Stanford University1, Technical University of Denmark2, Peking University3, University of Montpellier4, Innsbruck Medical University5, Catholic University of Korea6, University of Bologna7, Queensland University of Technology8, University of Pennsylvania9, Mount Sinai St. Luke's and Mount Sinai Roosevelt10, University of Wisconsin-Madison11
TL;DR: In this article, the authors used neural networks in approximately 3,000 normal and abnormal sleep recordings to automate sleep stage scoring, producing a hypnodensity graph, a probability distribution conveying more information than classical hypnograms.
Abstract: Analysis of sleep for the diagnosis of sleep disorders such as Type-1 Narcolepsy (T1N) currently requires visual inspection of polysomnography records by trained scoring technicians. Here, we used neural networks in approximately 3,000 normal and abnormal sleep recordings to automate sleep stage scoring, producing a hypnodensity graph—a probability distribution conveying more information than classical hypnograms. Accuracy of sleep stage scoring was validated in 70 subjects assessed by six scorers. The best model performed better than any individual scorer (87% versus consensus). It also reliably scores sleep down to 5 s instead of 30 s scoring epochs. A T1N marker based on unusual sleep stage overlaps achieved a specificity of 96% and a sensitivity of 91%, validated in independent datasets. Addition of HLA-DQB1*06:02 typing increased specificity to 99%. Our method can reduce time spent in sleep clinics and automates T1N diagnosis. It also opens the possibility of diagnosing T1N using home sleep studies.
169 citations
TL;DR: The two actigraphs provided comparable and accurate data compared to in-home polysomnography (PSG), although both poorly identified wake episodes (i.e., had low specificity).
Abstract: Objectives Actigraphy is widely used to estimate sleep-wake time, despite limited information regarding the comparability of different devices and algorithms. We compared estimates of sleep-wake times determined by two wrist actigraphs (GT3X+ versus Actiwatch Spectrum [AWS]) to in-home polysomnography (PSG), using two algorithms (Sadeh and Cole-Kripke) for the GT3X+ recordings. Subjects and methods Participants included a sample of 35 healthy volunteers (13 school children and 22 adults, 46% male) from Boston, MA, USA. Twenty-two adults wore the GT3X+ and AWS simultaneously for at least five consecutive days and nights. In addition, actigraphy and PSG were concurrently measured in 12 of these adults and another 13 children over a single night. We used intraclass correlation coefficients (ICCs), epoch-by-epoch comparisons, paired t-tests, and Bland-Altman plots to determine the level of agreement between actigraphy and PSG, and differences between devices and algorithms. Results Each actigraph showed comparable accuracy (0.81-0.86) for sleep-wake estimation compared to PSG. When analyzing data from the GT3X+, the Cole-Kripke algorithm was more sensitive (0.88-0.96) to detect sleep, but less specific (0.35-0.64) to detect wake than the Sadeh algorithm (sensitivity: 0.82-0.91, specificity: 0.47-0.68). Total sleep time measured using the GT3X+ with both algorithms was similar to that obtained by PSG (ICC=0.64-0.88). In contrast, agreement between the GT3X+ and PSG wake after sleep onset was poor (ICC=0.00-0.10). In adults, the GT3X+ using the Cole-Kripke algorithm provided data comparable to the AWS (mean bias=3.7±19.7 minutes for total sleep time and 8.0±14.2 minutes for wake after sleep onset). Conclusion The two actigraphs provided comparable and accurate data compared to PSG, although both poorly identified wake episodes (i.e., had low specificity). Use of actigraphy scoring algorithm influenced the mean bias and level of agreement in sleep-wake times estimates. The GT3X+, when analyzed by the Cole-Kripke, but not the Sadeh algorithm, provided comparable data to the AWS.
163 citations
TL;DR: In this middle-to-older age population-based sample, the prevalence of RBD was 1.06% (95% CI=0.61-1.50), with no difference between men and women, andRBD was associated with antidepressant and antipsychotic use and with minor differences in sleep structure.
Abstract: Study objectives Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with neurodegenerative synucleinopathies. Its prevalence is largely unknown. This study determined the prevalence and characteristics of RBD in the general population using gold-standard polysomnography. Methods Full polysomnographic data from 1,997 participants (age = 59 ± 11.1 years, 53.6% women) participating in a population-based study (HypnoLaus, Lausanne, Switzerland) were collected. Sleep-related complaints and habits were investigated using various sleep measures including the Munich Parasomnia Screening (MUPS) questionnaire, which includes two questions evaluating complex motor behaviors suggestive of RBD. Full polysomnography was performed at home. For participants screening positive for RBD, muscle activity during REM sleep was quantified to diagnose RBD. Results Three hundred sixty-eight participants endorsed dream-enactment behavior on either of the two MUPS questions, and 21 fulfilled polysomnographic criteria for RBD, resulting in an estimated prevalence of 1.06% (95% CI = 0.61-1.50), with no difference between men and women. Compared with RBD- participants, RBD+ took more frequently antidepressants and antipsychotics (23.8% vs. 5.4%, p = .005; 14.3% vs. 1.5%, p = .004, respectively) and were more frequently smokers or ex-smokers (85% vs. 56.6%, p = .011). On polysomnography, RBD+ had more stage N2 sleep (52 ± 11.5% vs. 46.3 ± 10.2%, p = .024) and less REM sleep (18 ± 6.4% vs. 21.9 ± 6.2%, p = .007), lower apnea-hypopnea index in REM sleep (3.8 ± 5.2 vs. 8.9 ± 13/hour, p = .035), and lower autonomic arousal index (31 ± 14.9 vs. 42.6 ± 19.5/hour, p = .002). Conclusions In our middle-to-older age population-based sample, the prevalence of RBD was 1.06%, with no difference between men and women. RBD was associated with antidepressant and antipsychotic use and with minor differences in sleep structure.
TL;DR: Hostility, depressive symptoms, and perceptions of poor health were associated with the magnitude of differences among some estimates, and these findings may be useful in understanding the health consequences of short or long self‐reported sleep duration and for guiding investigator decisions about choices of measures in specific populations.
TL;DR: Objective polysomnographic measures indicate that individuals with CP experience significant sleep disturbances, particularly with respect to sleep initiation and maintenance.
University of Cologne1, University of Bern2, University of Palermo3, University of Barcelona4, Vita-Salute San Raffaele University5, Sahlgrenska University Hospital6, University of Zurich7, Foundation University, Islamabad8, University of Grenoble9, Ghent University10, University of Bologna11, University College Dublin12, University of Antwerp13, Guangzhou Medical University14
TL;DR: An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.
Abstract: Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities. An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA. The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities ( e.g. nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
TL;DR: The arousal threshold in patients with OSA can be estimated using polysomnographic signals and may enable more personalized therapeutic interventions for patients with a low arousal threshold.
Abstract: Precision medicine for obstructive sleep apnea (OSA) requires non-invasive estimates of each patient's pathophysiological "traits". Here we provide the first, automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA. Ventilatory drive preceding clinically-scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill P et al. ERJ 2015) to the pattern of ventilation during spontaneous respiratory events. Conceptually, the magnitude of the airflow signal immediately after arousal onset reveals information on the underlying ventilatory drive that triggered the arousal. Polysomnographic arousal threshold measures were compared to gold standard values taken from esophageal pressure and intraoesophageal diaphragm electromyography recorded simultaneously; N=29). Comparisons were also made to arousal threshold measures using CPAP dial-downs (N=28). The validity of using (linearized) nasal pressure rather than pneumotachograph ventilation was also assessed (N=11). Polysomnographic arousal threshold values were correlated with those measured using esophageal pressure and diaphragm EMG (R=0.79, P The arousal threshold in patients with OSA can be estimated using polysomnographic signals, and may enable more personalized therapeutic interventions for patients with a low arousal threshold.
TL;DR: There is a wealth of evidence to say that sleep impacts maternal health during pregnancy, however, little has been published on fetal health and maternal sleep, and existing evidence suggests that this is an important area for future research.
University of South Carolina1, University of Michigan2, Kaiser Permanente3, University of Virginia4, University of Washington5, University of Pennsylvania6, University of Rochester7, Mayo Clinic8, Johns Hopkins University School of Medicine9, University of Pittsburgh10, Washington University in St. Louis11, University of California, Los Angeles12, Veterans Health Administration13, University Hospitals of Cleveland14, Wayne State University15
TL;DR: Given the lack of validation and United States Food and Drug Administration clearance, CSTs cannot be utilized for the diagnosis and/or treatment of sleep disorders at this time, but may be utilized to enhance the patient-clinician interaction when presented in the context of an appropriate clinical evaluation.
Abstract: Consumer sleep technologies (CSTs) are widespread applications and devices that purport to measure and even improve sleep. Sleep clinicians may frequently encounter CST in practice and, despite lac...
TL;DR: Phenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and ventilatory drive during sleep, enabling noninvasive phenotyping in the clinic and may facilitate precision therapeutic interventions for OSA.
Abstract: Rationale: Therapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient’s own phenotypic causes (“traits”) if a clinically applicable approach were available.Objectiv...
TL;DR: The data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities, therefore, female- specific questionnaires should be developed and used for preventing underdiagnosis of OSA.
Abstract: Obstructive sleep apnea (OSA) is underdiagnosed in females due to different clinical presentation. We aimed to determine the effect of gender on clinical and polysomnographic features and identify predictors of OSA in women. Differences in demographic, clinical, and polysomnographic parameters between 2052 male and 775 female OSA patients were compared. In female OSA patients, age (56.1 ± 9.7 vs. 50.4 ± 11.6 years, p < 0.0001) and body mass index (36.3 ± 8.6 vs. 31.8 ± 5.9 kg/m2, p < 0.0001) were increased, whereas men had higher waist-to-hip ratio and neck circumference (p < 0.0001). Hypertension, diabetes mellitus, thyroid disease, and asthma were more common in females (p < 0.0001). Men reported more witnessed apnea (p < 0.0001), but nocturnal choking, morning headache, fatigue, insomnia symptoms, impaired memory, mood disturbance, reflux, nocturia, and enuresis were more frequent in women (p < 0.0001). The indicators of OSA severity including apnea-hypopnea index (AHI) (p < 0.0001) and oxygen desaturation index (p = 0.007) were lower in women. REM AHI (p < 0.0001) was higher, and supine AHI (p < 0.0001) was lower in females. Besides, women had decreased total sleep time (p = 0.028) and sleep efficiency (p = 0.003) and increased sleep latency (p < 0.0001). In multivariate logistic regression analysis, increased REM AHI, N3 sleep, obesity, age, morning headache, and lower supine AHI were independently associated with female gender. These data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities. Therefore, female-specific questionnaires should be developed and used for preventing underdiagnosis of OSA.
TL;DR: A novel framework for performing real-time automatic sleep stage classification is developed and used to facilitate the automatic delivery of acoustic stimuli at targeted phase of slow-sleep oscillations to enhance slow-wave sleep.
Abstract: Sleep staging is a fundamental but time consuming process in any sleep laboratory. To greatly speed up sleep staging without compromising accuracy, we developed a novel framework for performing real-time automatic sleep stage classification. The client-server architecture adopted here provides an end-to-end solution for anonymizing and efficiently transporting polysomnography data from the client to the server and for receiving sleep stages in an interoperable fashion. The framework intelligently partitions the sleep staging task between the client and server in a way that multiple low-end clients can work with one server, and can be deployed both locally as well as over the cloud. The framework was tested on four datasets comprising ≈1700 polysomnography records (≈12000 hr of recordings) collected from adolescents, young, and old adults, involving healthy persons as well as those with medical conditions. We used two independent validation datasets: one comprising patients from a sleep disorders clinic and the other incorporating patients with Parkinson's disease. Using this system, an entire night's sleep was staged with an accuracy on par with expert human scorers but much faster (≈5 s compared with 30-60 min). To illustrate the utility of such real-time sleep staging, we used it to facilitate the automatic delivery of acoustic stimuli at targeted phase of slow-sleep oscillations to enhance slow-wave sleep.
TL;DR: The use of consumer-targeted wearable and mobile sleep monitoring technology has largely focused on validation of devices and applications compared with polysomnography but opportunities exist for observational research and for delivery of behavioral interventions.
TL;DR: Activating vlPAG GABAergic neurons in mice suppresses the initiation and maintenance of REM sleep while consolidating NREM sleep, partly through their projection to the dorsolateral pons and may contribute to the ultradian rhythm of REM/NREM alternation.
Abstract: Mammalian sleep consists of distinct rapid eye movement (REM) and non-REM (NREM) states. The midbrain region ventrolateral periaqueductal gray (vlPAG) is known to be important for gating REM sleep, but the underlying neuronal mechanism is not well understood. Here, we show that activating vlPAG GABAergic neurons in mice suppresses the initiation and maintenance of REM sleep while consolidating NREM sleep, partly through their projection to the dorsolateral pons. Cell-type-specific recording and calcium imaging reveal that most vlPAG GABAergic neurons are strongly suppressed at REM sleep onset and activated at its termination. In addition to the rapid changes at brain state transitions, their activity decreases gradually between REM sleep and is reset by each REM episode in a duration-dependent manner, mirroring the accumulation and dissipation of REM sleep pressure. Thus, vlPAG GABAergic neurons powerfully gate REM sleep, and their firing rate modulation may contribute to the ultradian rhythm of REM/NREM alternation.
15 May 2018-Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
TL;DR: OSA is highly prevalent in children with Down syndrome, and the prevalence of moderate to severe OSA is higher in younger age.
Abstract: Study Objectives:To estimate the prevalence of obstructive sleep apnea (OSA) in children with Down syndrome.Methods:Two authors independently searched databases, namely PubMed, MEDLINE, EMBASE, and...
TL;DR: This study tested the hypotheses that late‐midlife obstructive sleep apnea (OSA) and short and long sleep duration are associated with dementia over 15 years of follow‐up.
Abstract: Introduction This study tested the hypotheses that late-midlife obstructive sleep apnea (OSA) and short and long sleep duration are associated with dementia for more than 15 years of follow-up. Methods A total of 1667 Atherosclerosis Risk in Communities Study participants underwent in-home polysomnography (1996–1998) and were followed for dementia. Dementia was defined by (1) hospitalization diagnosis codes (1996–2012) and (2) a comprehensive neurocognitive examination (2011–2013) with adjudication. Results OSA and sleep duration were not associated with risk of incident dementia. When using adjudicated outcomes, severe OSA (≥30 vs. Discussion When adjudicated outcome definitions were used, late-midlife OSA and short sleep duration were associated with all-cause and Alzheimer's disease dementia in later life.
TL;DR: It is the position of the AasM that the RECOMMENDED AASM Scoring Manual scoring criteria for hypopneas, which includes diminished airflow accompanied by either an arousal or ≥ 3% oxygen desaturation, should be used to calculate the AHI.
Abstract: The diagnostic criteria for obstructive sleep apnea (OSA) in adults, as defined in the International Classification of Sleep Disorders, Third Edition, requires an increased frequency of obstructive
TL;DR: The PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks provide subjective assessments of child's difficulty falling and staying asleep as well as daytime sleepiness and its impact on functioning and may prove useful in the future for clinical research and practice.
Abstract: Study objectives To develop and evaluate the measurement properties of child-report and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Sleep Disturbance and Sleep-Related Impairment item banks. Methods A national sample of 1104 children (8-17 years old) and 1477 parents of children 5-17 years old was recruited from an internet panel to evaluate the psychometric properties of 43 sleep health items. A convenience sample of children and parents recruited from a pediatric sleep clinic was obtained to provide evidence of the measures' validity; polysomnography data were collected from a subgroup of these children. Results Factor analyses suggested two dimensions: sleep disturbance and daytime sleep-related impairment. The final item banks included 15 items for Sleep Disturbance and 13 for Sleep-Related Impairment. Items were calibrated using the graded response model from item-response theory. Of the 28 items, 16 are included in the parallel PROMIS adult sleep health measures. Reliability of the measures exceeded 0.90. Validity was supported by correlations with existing measures of pediatric sleep health and higher sleep disturbance and sleep-related impairment scores for children with sleep problems and those with chronic and neurodevelopmental disorders. The sleep health measures were not correlated with results from polysomnography. Conclusions The PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks provide subjective assessments of child's difficulty falling and staying asleep as well as daytime sleepiness and its impact on functioning. They may prove useful in the future for clinical research and practice. Future research should evaluate their responsiveness to clinical change in diverse patient populations.
TL;DR: An updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography (PSG) using the main databases to filter studies published between January 2010 and April 2017 found SQ and SBQ are reliable tools for screening OSA among sleep clinic patients.
Abstract: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is associated with significant morbidity. We sought to present an updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test. Using the main databases (including Medline, Cochrane Database of Systematic Reviews and Scopus) we used a combination of relevant keywords to filter studies published between January 2010 and April 2017. Population-based studies evaluating the accuracy of screening questionnaires for OSA against PSG were included in the review. Thirty-nine studies comprising 18 068 subjects were included. Four screening questionnaires for OSA had been validated in selected studies including the Berlin questionnaire (BQ), STOP-Bang Questionnaire (SBQ), STOP Questionnaire (SQ), and Epworth Sleepiness Scale (ESS). The sensitivity of SBQ in detecting mild (apnea-hypopnea index (AHI) ≥ 5 events/hour) and severe (AHI ≥ 30 events/hour) OSA was higher compared to other screening questionnaires (range from 81.08% to 97.55% and 69.2% to 98.7%, respectively). However, SQ had the highest sensitivity in predicting moderate OSA (AHI ≥ 15 events/hour; range = 41.3% to 100%). SQ and SBQ are reliable tools for screening OSA among sleep clinic patients. Although further validation studies on the screening abilities of these questionnaires on general populations are required.
TL;DR: Sleep deficiency due to either sleep apnea or insufficient sleep duration is strongly associated with motor vehicle crashes in the general population, independent of self-reported excessive sleepiness.
Abstract: Insufficient sleep duration and obstructive sleep apnea, two common causes of sleep deficiency in adults, can result in excessive sleepiness, a well-recognized cause of motor vehicle crashes, although their contribution to crash risk in the general population remains uncertain. The objective of this study was to evaluate the relation of sleep apnea, sleep duration, and excessive sleepiness to crash risk in a community-dwelling population. This was a prospective observational cohort study nested within the Sleep Heart Health Study, a community-based study of the health consequences of sleep apnea. The participants were 1745 men and 1456 women aged 40–89 years. Sleep apnea was measured by home polysomnography and questionnaires were used to assess usual sleep duration and daytime sleepiness. A follow-up questionnaire 2 years after baseline ascertained driving habits and motor vehicle crash history. Logistic regression analysis was used to examine the relation of sleep apnea and sleep duration at baseline to the occurrence of motor vehicle crashes during the year preceding the follow-up visit, adjusting for relevant covariates. The population-attributable fraction of motor vehicle crashes was estimated from the sample proportion of motor vehicle crashes and the adjusted odds ratios for motor vehicle crash within each exposure category. Among 3201 evaluable participants, 222 (6.9%) reported at least one motor vehicle crash during the prior year. A higher apnea-hypopnea index (p < 0.01), fewer hours of sleep (p = 0.04), and self-reported excessive sleepiness (p < 0.01) were each significantly associated with crash risk. Severe sleep apnea was associated with a 123% increased crash risk, compared to no sleep apnea. Sleeping 6 hours per night was associated with a 33% increased crash risk, compared to sleeping 7 or 8 hours per night. These associations were present even in those who did not report excessive sleepiness. The population-attributable fraction of motor vehicle crashes was 10% due to sleep apnea and 9% due to sleep duration less than 7 hours. Sleep deficiency due to either sleep apnea or insufficient sleep duration is strongly associated with motor vehicle crashes in the general population, independent of self-reported excessive sleepiness.
TL;DR: The heuristic algorithm uses the variance in estimated z-axis angle and makes basic assumptions about sleep interruptions to detect the SPT-window and shows the value of this algorithm lies in studies such as UK Biobank where a sleep diary was not used.
Abstract: Wrist worn raw-data accelerometers are used increasingly in large scale population research. We examined whether sleep parameters can be estimated from these data in the absence of sleep diaries, which are common in sleep actigraphy. Our heuristic algorithm uses the variance in estimated z-axis angle and makes basic assumptions about sleep interruptions. Detected sleep period time window (SPT-window), was compared against sleep diary in 3741 participants (range=60-83years) and polysomnography in sleep clinic patients (N=28) and in healthy good sleepers (N=22). The SPT-window derived from the algorithm was 10.9 and 2.9 minutes longer compared with sleep diary in men and women, respectively. Average c-statistic to detect the SPT-window compared to polysomnography was 0.86 and 0.83 in clinic and healthy sleepers, respectively. We demonstrated the accuracy of our algorithm to detect the SPT-window. The value of this algorithm lies in studies such as UK Biobank where a sleep diary was not used.
TL;DR: Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present, however, because of contraindications, other options should be considered.