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Induction or aggravation of sleep apnea is a known side effect of vagus nerve stimulation (VNS). We report the case of a 44 year old male with drug-resistant epilepsy and depression who did not experience any seizure reduction after 1 year of VNS but a worsening of depression and daytime sleepiness. After confirming VNS-associated sleep apnea we started the first bi-level VNS therapy with standard VNS settings during daytime and reduced settings during nighttime. Anti-seizure medication remained unchanged. Within 12 months his seizure frequency was reduced by 90 % and his depression improved, permitting a cessation of his antidepressant medication. The observations made in this case have contributed to the manufacturer of VNS developing new generator models that can automatically provide bi-level VNS.

Evidence supports the importance of ovarian hormones as potential tools against sleep apneas in women. On one hand, progesterone is largely acknowledged as being a respiratory stimulant that reduces the frequency of apneas, but the underlying mechanisms remain poorly understood. Recent studies in mice showed that the respiratory effects of progesterone are mediated by at least two classes of progesterone receptors, including the nuclear (nPR) and membrane receptors (mPR). Some of these receptors (nPR) have sex-specific effects on the frequency of apneas recorded during sleep in mice, while mPRβ acts in males as well as in females. Moreover, sleep apnea is a condition that induces an “oxidative stress” response in several tissues, and this contributes to the deleterious consequences of sleep apneas, including the development of hypertension. While estradiol is recognized as an antioxidant hormone, its potential protective role has remained mostly ignored in the field. We will review recent data supporting an antioxidant role of estradiol in female rats exposed to intermittent hypoxia, a reliable animal model of sleep apnea. Since estradiol has two main receptors (ERα and ERβ) we will discuss their relative implications, and present new data showing a key role for ERα to prevent the hypertension induced by intermittent hypoxia. Overall this review highlights the fact that ovarian hormones could potentially be used as efficient tools against the causes (i.e. instabilities of the respiratory control system) and consequences (oxidative stress) of sleep apnea. [ABSTRACT FROM AUTHOR]

Introduction: Among adults, sleep apnea is more common in highlanders than in lowlanders. We evaluated the sleep apnea prevalence in children living at high altitude compared to age-matched low-altitude controls., Methods: Healthy children, 7-14 y of age, living at 2500-3800m in the Tien Shan mountains, Kyrgyzstan, were prospectively studied in a health post at 3250m. Healthy controls of similar age living at 700-800m were studied in a University Hospital at 760m in Bishkek. Assessments included respiratory sleep studies scored according to pediatric standards, clinical examination, medical history, and the pediatric sleep questionnaire (PSQ, range 0 to 1 with increasing symptoms)., Results: In children living at high altitude (n = 37, 17 girls, median [quartiles] age 10.8y [9.6;13.0]), sleep studies revealed: mean nocturnal pulse oximetry 90% (89;91), oxygen desaturation index (ODI, >3% dips in pulse oximetry) 4.3/h (2.5;6.7), apnea/hypopnea index (AHI) total 1.7/h (1.0;3.6), central 1.6/h (1.0;3.3), PSQ 0.27 (0.18;0.45). In low-altitude controls (n=41, 17 girls, age 11.6y [9.5;13.0], between-groups comparison of age P=0.69) sleep studies revealed: pulse oximetry 97% (96;97), ODI 0.7/h (0.2;1.2), AHI total 0.4/h (0.1;1.0), central 0.3/h (0.1;0.7), PSQ 0.18 (0.14;0.31); P<0.05, all corresponding between-group comparisons., Conclusions: In school-age children living at high altitude, nocturnal oxygen saturation was lower, and the total and central AHI were higher compared to children living at low altitude. The greater score of sleep symptoms in children residing at high altitude suggests a potential clinical relevance of the nocturnal hypoxemia and subtle sleep-related breathing disturbances., Competing Interests: Conflicts of interest None., (Copyright © 2023 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To screen symptoms of sleep disorders among primary school children.Methods: Four schools from urban area and four rural schools were included in this study. Symptoms of sleep disorders were assessed using the validated Hindi version of Childhood Sleep Habit Questionnaire in 8-13 y old children. Comparison was made between urban and rural group and between boys and girls. Descriptive statistics was calculated.Results: Mean age of the subjects included in this study was 8.9 ± 1.5 y. Boys and girls were equally distributed, however, rural sample was smaller. More than one awakening each night was found in 12.2 % children. In the whole group, prevalence of bed-wetting was 8.7 %, sleep-talking 20.9 %, sleep-walking 3.2 %, teeth grinding 15.4 % and night terrors 8.4 %. Daytime sleepiness was reported by 25.5 % and napping by 56.4 %. 17.3 % used to fall asleep in unusual circumstances and the teacher or the friend in 6.9 % students noticed it. Snoring was reported by 11.4 % children, and 6.3 % reportedly struggled to breathe during sleep. Domicile and gender did not affect prevalence of parasomnia, however, symptoms of sleep apnea were more frequent among rural children. Daytime sleepiness was more common among rural children as compared to urban.Conclusions: Symptoms of sleep disorders are prevalent among primary school children. Common disorders are parasomnia, sleep apnea and daytime sleepiness. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of partial or complete upper-airway obstruction during sleep. Although cardiac autonomic impairment is involved in the development of cardiovascular disease in OSAS, the mechanism underlying this derangement is rather unknown. It can be assessed by a recently introduced analysis of the heart rate turbulence (HRT). The aim of the paper is to describe the effects of pathological respiratory pattern on HRT in OSAS. HRT has been assessed by turbulence onset (TO) and turbulence slope (TS) indexes in 20 polysomnographic recordings of severe OSAS patients, and separately calculated during both normal (NR) and obstructive apnea (OA) respiratory pattern. Results showed that, although there is an overall depressed HRT for both indexes, while the TO during OA phases is not significantly different from those of NR epochs, the TS during OA phases is very significantly higher than in NR phases. This novel finding shows a previously unknown paradoxical increase of TS during OA episodes, followed by a marked decrease during subsequent NR phases, where OSAS patient show higher sympathetic tone. Such deeper understanding of the integrated autonomic response in different OSAS pathophysiological conditions could be useful to address an overall cardiorespiratory assessment and treatment in sleep-related breathing disorders [ABSTRACT FROM AUTHOR]

The study was conducted to find out the association of various naso-oro-pharyngeal structures with sleep macro-architecture in suspected obstructive sleep apnea subjects. Study included 51 subjects with suspected obstructive sleep apnea. Subjects with possible central apnea and those consuming any substance that can affect sleep architecture were excluded. Level I polysomnography was performed after thorough physical examination. Overnight study was scored in 30 s epochs to find out the polysomnographic variables. Surgical treatment was offered wherever indicated. Subjects with moderate to severe obstructive sleep apnea were manually titrated on CPAP with the polysomnogram. SPSS v 17.0 was used for statistical analysis. We did not find any difference in the sleep architecture between genders. Sleep Efficiency was better in subjects with dental overjet, dental attrition, high tongue base, macroglossia, lesser oral cavity volume, edematous uvula, increased submental fat, hypertrophied facial muscles and Mallampatti grade III-IV. Shorter Sleep Latency was seen in subjects with tender TMJ and Mallampatti Gr III-IV. REM latency was shorter in subjects with high tongue base, macroglossia and hypertrophied muscles of mastication. Increased REM was observed in subjects with high tongue base, edematous uvula and tender TMJ. Enlarged tonsils had reversed effect with poor sleep efficiency, increased REM latency and decreased REM. CPAP therapy ( N = 20) lessened awake time, decreased N2 and increased REM. Oro-pharyngeal structures affect the sleep architecture in suspected OSA subjects. Nasal structures do not affect the sleep architecture in these subjects and enlarged tonsils have opposite effect. Sleep architecture changes on the titration night with CPAP. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated upper-airway obstruction during sleep. It is diagnosed by polysomnographic studies, scoring OSAS severity by an apneas/hypopneas index associated to worse prognosis, mainly for an increased cardiovascular morbidity. Cardiac autonomic impairments involved in the development of cardiovascular disease in OSAS can be assessed by heart rate turbulence (HRT) analysis and aim of the paper is to show the increased medical decision support by HRT evaluation in OSAS patients. HRT has been assessed in 274 polysomnographic recordings of mild-to-severe OSAS patients and an overall cardiorespiratory risk scoring (CRRIS) index has been proposed on the base of both OSAS severity and HRT assessment. Results showed that, while the only polysomnografic analysis would have equally ranked OSAS patients within their mild-to-severe classification, CRRIS index allows to identify a 19% of severe-OSAS patients at very high risk of sudden cardiac death, a 13% of moderate-OSAS patients with a risk level comparable to those of severe, and a 17% of mild-OSAS patients with evidence of an autonomic impairment. CRRIS index, detecting patients at greater probability of worsening could give to the physician a very useful medical decision support in the follow up of this particular chronic disease. [ABSTRACT FROM AUTHOR]

A 68 yr. old lady suffered from chronic cough. Bronchiectasis was diagnosed and treated with physiotherapy. Coughing persisted over years, although an asthma disease was controlled by inhalation, a carcinoid tumor was surgically removed, and a coronary artery disease was treated by revasculating surgery. Antibiotics and systemic corticosteroids did not relieve symptoms either. After all, diagnosis and treatment of obstructive sleep apnea led to symptom free life. We assume micro-aspiration during periods of apnea being the cause of the coughing. [ABSTRACT FROM AUTHOR]

Men from the general population and male professional lorry and bus drivers were surveyed with regard to sleep habits and motor vehicle and other types of accidents. A random sample of 4000 men in the general population of Dalarna County in mid-Sweden were mailed a questionnaire and served as referents. A total of 1389 male professional lorry and bus drivers from this county responded to the same questionnaire. A total of 161 of the drivers also underwent a sleep study in their homes.The proportion of total accidents was higher among the professional drivers as compared with the males in the population, P=0.03. Reports on traffic accidents were the same in both groups, but the professional drivers reported more accidents at leisure compared with referents, P<0.0001. Accidents of any kind, traffic accidents included, among those affected by both snoring and apneas, were not reported more in either of the groups. At the sleep study, 17% of those examined received the diagnosis of obstructive sleep-apnea syndrome (OSAS).The professional drivers reported proportionally more sleep debt than the referents, P<0.001. Among referents, traffic accidents at leisure, traffic accidents while commuting and accidents at work increased in proportion to sleep debt (P<0.001, 0.006 and 0.002, respectively). The finding that self-perceived sleep debt may have an adverse effect on males in the general population and male professional drivers concerning accident likelihood should have an impact on prevention. These results stress the need to educate the general population on the importance of complying with our biological need of sleep. [Copyright &y& Elsevier]