Search

Background: Pregnancy‐related anatomic, physiologic, and hormonal factors can occur at different stages of pregnancy and affect sleep disturbances. Sleep problems and habits among Japanese women across gestational stages have not been described. This study aimed to elucidate sleep problems, including a high risk of sleep‐disordered breathing and sleep habits, among Japanese women across gestational progress, including postpartum. Methods: A questionnaire survey using the Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire was conducted for 683 pregnant women (223 in the second trimester, 453 in the third trimester) and 386 postpartum (within 1 week after delivery). Results: The total PSQI score was 5.3 [2.6] in the second trimester, 6.1 [2.8] in the third trimester, and 6.8 [3.1] in the first week postpartum. The percentage of those at high risk for sleep‐disordered breathing, as determined by the Berlin Questionnaire, was 11.8% in the second trimester, 21.3% in the third trimester, and 19.2% in the first week postpartum, with the highest percentage of those at high risk in the third trimester of pregnancy. Conclusion: The PSQI total score exceeded the cut‐off value in the third trimester and the first week postpartum, suggesting sleep deterioration. Therefore, it is necessary to understand and support sleep in pregnant women to ensure safe delivery, postpartum recovery, and health. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the regional trends of sleep apnea medical care utilizing the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan (NDB-ODJ), which records data on the number of health insurance claims in Japan. Data were obtained on the number of adaptive servo-ventilation (ASV), continuous positive airway pressure (CPAP), and hypnotic agents used from the NDB-ODJ-published claims data. Government statistical data and data published by academic societies were also used. NDB-ODJ data were calculated using the indirect age standardization rates (ASR [ind]), and other relevant data were calculated per population. The association between NDB-ODJ and related data was assessed using the Spearman's rank correlation coefficient (r). ASV use tended to increase with age for both males and females. On the other hand, CPAP showed a clear difference in the peak age range for CPAP usage between males and females. The peak CPAP users were males aged 55–59 years and females aged 60–65 years. The ASR (ind) value of ASV and CPAP was 0.45–2.73 and 0.64–1.85 in 2017, respectively. There was a correlation with 2017 ASV and benzodiazepines (r = 0.32, P = 0.03), hypnotics (r = 0.37, P = 0.01), and cardiovascular disease (r = 0.32, P = 0.03). In addition, the correlation with CPAP was related to the number of sleep specialists (r = 0.30, P = 0.04). It was found that ASV has a large regional difference compared to CPAP. Even in ASV, it is desirable that regional differences become smaller with proper use. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether the features of sleep-disordered breathing (SDB) are stronger independent factors for proliferative diabetic retinopathy (PDR) compared to the incidence of metabolic syndrome (MetS) and the number of its individual components.Methods: We studied a cross-sectional total of 132 patients with type 2 diabetes. Thirty-nine patients had non-proliferative diabetic retinopathy (NPDR) and 93 patients had PDR. Pulse oximetry was conducted, and the patients' mean oxygen saturation (mean SpO2%) and 4% oxygen desaturation index (4% ODI times/hour) were evaluated. We compared the SDB and MetS variables between the NPDR and PDR patients. A logistic regression analysis was used to determine the independent factors for the diagnosis of PDR.Results: The MetS diagnosis was made significantly more often in the PDR group (p = 0.04). The number of individual MetS components was significantly greater in the PDR group compared to the NPDR group (p = 0.01). The mean SpO2 of the NPDR group was not significantly different from that of the PDR group. The 4% ODI in the NPDR group was significantly lower than that in the PDR group (p = 0.01). The logistic regression analysis using the prevalence of MetS and the number of MetS components revealed that younger age and high 4%ODI value were independent factors contributing to the diagnosis of PDR.Conclusion: Our findings confirmed that compared to MetS and the number of its individual components, SDB may be a factor contributing to the progression to PDR. However, further careful longitudinal validation studies are needed. [ABSTRACT FROM AUTHOR]

Objectives The aims of this study were to investigate the prevalence of sleep bruxism in children in Japan, and its relationships with sleep-related factors and daytime problematic behavior. Subjects and Methods Guardians of 6023 children aged 2-12 years completed the Japanese Sleep Questionnaire. Multiple regression analysis and structural equation modeling were performed. Results Sleep bruxism was reported in 21.0% children ( n = 1263): the prevalence was highest in the age group of 5-7 years (27.4%). Multiple regression analysis showed that sleep bruxism had significant correlations with age 5-7 years ( OR: 1.72; P < 0.0001), 'Moves a lot during sleep' ( OR: 1.47; P < 0.0001), 'sleeps with mouth open' ( OR: 1.56; P < 0.0001), and 'snores loudly' ( OR: 1.80; P < 0.0001). In structural equation modeling, sleep bruxism had a significant but weak direct effect on daytime problematic behavior, while sleep bruxism significantly correlated with obstructive sleep apnea, which had a higher direct effect on daytime problematic behavior. Conclusions Sleep bruxism was reported in 21.0% of Japanese children and had independent relationships with age, movements during sleep, and snoring. A comorbidity of sleep-disordered breathing might be related to daytime problematic behavior in children with sleep bruxism. [ABSTRACT FROM AUTHOR]

Background Sleep-disordered breathing (SDB) is highly associated with arterial hypertension (HT). Sympathetic hypertonia increases the risk of sudden cardiac death in patients with sleep apnea. This study aims to noninvasively investigate the electrophysiological features in SDB patients with and without arterial HT. Methods Fifty-three patients with SDB were classified into two groups: SDB group and SDB + HT group. Twenty subjects with arterial HT were enrolled as controls (HT group). To assess arrhythmogenic vulnerability, high-resolution 24-hour ambulatory electrocardiograms were obtained for analyzing continuous late potential (LP), T-wave amplitude variability (TAV), and heart rate variability (HRV). Results A higher incidence of positive LP was observed in the SDB + HT (85%) group than that observed in the SDB (50%) and HT (20%) groups (P < 0.01). TAV was highest in the SDB + HT group (78 μV) compared with the SDB (61 μV) and HT groups (42 μV; P < 0.01). Positive LP and TAV values were observed at night in the SDB + HT and SDB groups. The low-frequency/high-frequency of the HRV analysis was highest in the SDB + HT (4.7) group compared with that in the SDB (2.9) and HT (2.9) groups (P = 0.01). Conclusion Nocturnal LP, TAV, and HRV examinations were useful to investigate arrhythmogenesis. SDB patients with arterial HT showed a high prevalence of depolarization and repolarization abnormalities and relative sympathetic hyperactivity. This suggests that an electrophysiological instability is more prevalent in SDB patients with arterial HT. [ABSTRACT FROM AUTHOR]

Background: The recent SLEEMSA study that evaluated excessive daytime sleepiness (EDS) in Caucasian patients with multiple system atrophy (MSA) demonstrated that EDS was more frequent in patients (28%) than in healthy subjects (2%). However, the prevalence and determinants of EDS in other ethnic populations have not been reported to date. Methods: We performed a single-hospital prospective study on patients with probable MSA. To ascertain the prevalence and determinants of EDS in Japanese MSA patients, we assessed the patients' degree of daytime sleepiness by using the Japanese version of the Epworth Sleepiness Scale (ESS). In addition, we investigated the effects of sleep-disordered breathing (SDB) and abnormal periodic leg movements in sleep (PLMS), which were measured by polysomnography, on the patients' ESS scores. Results: A total of 25 patients with probable MSA (21 patients with cerebellar MSA and 4 patients with parkinsonian MSA) were included in this study. All patients underwent standard polysomnography. The mean ESS score was 6.2 ± 0.9, and EDS was identified in 24% of the patients. SDB and abnormal PLMS were identified in24 (96%) and 11 (44%) patients, respectively. The prevalences of EDS in patients with SDB and abnormal PLMS were25% and 18%, respectively. No correlations were observed between ESS scores and the parameters of SDB or abnormal PLMS. Conclusions: The frequency of EDS in Japanese patients with MSA was similar to that in Caucasian MSA patients.SDB and abnormal PLMS were frequently observed in MSA patients, although the severities of these factors were not correlated with EDS. Further investigations using objective sleep tests need to be performed. [ABSTRACT FROM AUTHOR]

The article focuses on the occupational physicians' study administered to Japanese steel workers on the relationship between sleep-disordered breathing (SDB) and hypertension. According to an animal experiment, a significant increase of the daytime blood pressure was observed after the intermittent airway occlusion on the nocturnal sleep. This, however, was regarded by the Joint National Committee (JNC) as sleep apnea syndrome which is claimed to be an identifiable cause of hypertension.

Background: Alcohol consumption as well as overweight is known to aggravate the severity of sleep-disordered breathing (SDB), but little is known about alcohol consumption in truck drivers. The aim of this study was to examine the relationship between alcohol consumption and SDB among truck drivers. Methods: We conducted a cross-sectional study of 1,465 men aged 20–69 years who were registered with the Japanese Trucking Association. The 3% oxygen desaturation index (3%ODI) was selected as an indicator of SDB, representing the number of desaturation events per hour of recording time in which blood oxygen fell by ≥3% based on overnight pulse-oximetry. Participants completed a self-administered questionnaire including alcohol consumption on the same night for SDB assessment. Results: The prevalence of 3%ODI ≥5, ≥10, and ≥15/h was 25.4%, 11.1%, and 6.6% respectively. The multivariable odds ratios (OR) of 3%ODI ≥ 10/h were 1.5(0.9–2.5) for 0.5 to <1.0 g of alcohol intake/kg and 3.4(1.8–6.6) for ≥1.0 g of alcohol intake/kg compared with non-drinkers. Similar associations with alcohol consumption were observed for 3%ODI ≥5 and ≥15/h. The relation between alcohol consumption (≥1.0 g of alcohol intake/kg) and 3%ODI ≥ 10/h tended to be more evident among men with body mass index (BMI) <23.4 kg/m2 than those with BMI ≥ 23.4 kg/m2 [11.4 (3.2–41) vs. 1.2 (0.6–2.7), p = 0.18 for interaction]. A similar trend was observed for 3%ODI ≥ 5/h. Conclusions: The prevalence of undiagnosed SDB and the significant association of alcohol consumption with SDB severity emphasize the need for SDB screening and alcohol modification as well as weight control to prevent and control SDB among truck drivers. [ABSTRACT FROM AUTHOR]

Purpose: With a rapidly aging society, there is increasing interest in the health of female workers in the field of care services for older adults due to increasing demands to maintain 24-h care and to support older adults without errors or accidents. Therefore, the purpose of this cross-sectional study was to examine the association between sleep-disordered breathing (SDB) and sustained attention in women caring for older adults in Japan., Methods: The study was conducted in women aged 18-67 years old working in care service facilities for older adults in Japan. The sustained attention of participants was measured by the 10-min psychomotor vigilance task (PVT). SDB was assessed based on the respiratory disturbance index (RDI), which was measured using an ambulatory airflow monitor with a polyvinylidene fluoride (PVDF) film sensor to monitor the respiratory airflow of nasal and oral breathing. The participants wore the monitor to record the breathing status while asleep at home. The severity of SDB was categorized as follows: normal, RDI < 5 events/h; mild SDB, RDI 5-10 events/h; and moderate-to-severe SDB, RDI ≥ 10 events/h., Results: Of 688 women enrolled, medians of age, body mass index (BMI), sleep duration, and prevalence of hypertension tended to be higher with increasing RDI. No significant association was found between RDI and PVT parameters. However, when we limited the analysis to women with BMI ≥ 22 kg/m 2 , those with moderate-to-severe SDB had significantly higher odds of having the slowest 10% reaction times compared to those without SDB (OR = 2.03; 95% CI = 1.17-3.53). The association did not decrease after adjusting to account for sleep duration, alcohol drinking habits, and history of hypertension (OR = 1.97; 95% CI = 1.10-3.52). A significant increasing trend was also found between RDI and the slowest 10% of reaction times (p for trend = 0.03)., Conclusions: Our findings suggest that SDB is associated with reduced sustained attention in participants with BMI ≥ 22 kg/m 2 , although the number of assessments of SDB and PVT was only once per participant due to the nature of the cross-sectional study., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

There is limited evidence regarding the combined effects of sleep-disordered breathing (SDB) and alcohol consumption on hypertension. The aim of this study was to examine the combined effects of SDB and alcohol consumption on hypertension in Japanese male bus drivers. This cross-sectional study included 2525 Japanese male bus drivers aged 20-65 years. SDB was assessed using a single-channel airflow monitor, which measured the respiratory disturbance index (RDI) during overnight sleep at home. Alcohol consumption (g/day) was assessed by a self-administered questionnaire and calculated per unit of body weight. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg and/or use of antihypertensive medications. Multiple logistic regression analyses were performed to examine the association of the combined categories of RDI and alcohol consumption with hypertension. The multivariable-adjusted odds ratio (OR) and 95% confidence interval (95% CI) of hypertension for the alcohol consumption ≥1.0 g/day/kg and RDI ≥ 20 events/h group were 2.41 (1.45-4.00) compared with the alcohol consumption <1.0 g/day/kg and RDI < 10 events/h group. Our results suggest that Japanese male bus drivers with both SDB and excessive alcohol consumption are at higher risk of hypertension than those without SDB and excessive alcohol consumption, highlighting the importance of simultaneous management of SDB and excessive alcohol consumption to prevent the development of hypertension among bus drivers., (© 2021. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Sleep-disordered breathing (SDB) is linked with brachial blood pressure. Although central systolic blood pressure (cSBP) is a better predictor of cardiovascular diseases than is brachial blood pressure, the association between SDB and cSBP is not fully understood. This cross-sectional study included 1484 participants without cardiovascular diseases who were enrolled in the Toon Health Study between 2009 and 2012. The respiratory disturbance index (RDI) was estimated with a one-night sleep test using an airflow monitor. Participants were grouped into three categories according to RDI level: mild (<10 events/h), moderate (10 to <20 events/h), and severe (≥20 events/h). The cSBP was measured using a noninvasive automated tonometer. Multivariable-adjusted cSBP means for the mild, moderate, and severe RDI categories were, respectively, 116.0, 118.0, and 120.7 mm Hg (p for trend = 0.02) for men and 111.8, 113.7, and 111.7 mm Hg (p for trend = 0.59) for women. The association for men was no longer significant after adjusting for BMI. When stratified by BMI (<22 or ≥22 kg/m 2 ), the RDI was associated with cSBP among men with BMI ≥ 22 kg/m 2 , and this association was of borderline significance. Augmentation index, pulse pressure amplification, and brachial blood pressure were not significantly associated with the RDI. Higher RDI values were associated with increased multivariable-adjusted cSBP means among men. This association was more evident among those with BMI ≥ 22 kg/m 2 . In conclusion, we found that the RDI was associated with cSBP among men, and this association was independent of confounding variables among individuals above the ideal weight.

Aims: The identification and appropriate management of commercial motor vehicle (CMV) drivers with unrecognized obstructive sleep apnea (OSA) is a major public health concern and priority; OSA among drivers has not been fully investigated in Japan, and a better understanding of this undiagnosed disease is warranted. Therefore, we evaluated the prevalence of OSA and the factors related to apnea-hypopnea index (AHI) in Japanese CMV drivers., Methods: This retrospective study included 1309 Japanese CMV drivers aged 40-69 years. All the subjects received type Ⅳ portable sleep monitors (PMs) with Epworth Sleepiness Scale (ESS) and a periodic health check including anthropometrical and laboratory measurements, and a questionnaire of medical history, smoking status, and life style, following which variables related to AHI were analyzed., Results: Of all the subjects, 23.9% had moderate to severe OSA (AHI ≥15). Age, body mass index (BMI), Log e HbA1c and diastolic blood pressure (DBP) showed significance with AHI in 1309 subjects. The following factors were found to have significant odds ratio (OR) for AHI of ≥15 in 1309 subjects: age, ESS, DBP, and Log e HbA1c., Conclusion: Notably, drivers with undiagnosed OSA exist. In these subjects, AHI was related to obesity, hypertension, and diabetes. For the early diagnosis and intervention of OSA, BMI, blood pressure, and HbA1c measurements may be helpful, particularly for drivers. Furthermore, when performing an objective assessment of the suspected OSA, evaluating these parameters during routine medical check-ups may be useful and feasible in the detection of drivers with latent OSA.

Objective: The Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES) was developed to measure the sleep habits and disturbances of Japanese children. The current study aimed to present psychometric properties and describe the score distribution of the JSQ-ES. In addition, it examined correlations between the sleep and daytime behavior of school-aged children., Method: Guardians of 4369 elementary school children and 100 children diagnosed with sleep disorders in two clinics completed the JSQ-ES., Results: Exploratory factor analysis and confirmatory factor analysis suggested a nine-factor structure. The JSQ-ES internal consistency was 0.876 and 0.907 for the community and clinical groups, respectively. Score distribution differences were observed between the two groups. A cut-off point of 80 was identified for the total JSQ-ES score., Conclusions: Exploratory factor analysis and confirmatory factor analysis suggested a nine-factor structure: (1) restless legs syndrome; (2) sleep-disordered breathing; (3) morning symptoms; (4) nighttime awakenings; (5) insomnia; (6) excessive daytime sleepiness; (7) daytime behavior; (8) sleep habits; and (9) irregular/delayed sleep phase. The study verified that the JSQ-ES is a valid and reliable instrument with which to evaluate Japanese sleep habits using a large population-based sample. The JSQ-ES may be useful in both clinical and academic settings., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Adaptive servo-ventilation (ASV) therapy using an innovative ventilator-originally developed to treat sleep-disordered breathing (SDB)-is a novel modality of noninvasive positive pressure ventilation and is gaining acceptance among Japanese cardiologists in expectation of its applicability to treat patients with chronic heart failure (CHF) based on its acute beneficial hemodynamic effects. We conducted a multicenter, retrospective, real-world observational study in 115 Japanese patients with CHF, who had undergone home ASV therapy for the first time from January through December 2009, to examine their profile and the effects on their symptoms and hemodynamics. Medical records were used to investigate New York Heart Association (NYHA) class, echocardiographic parameters including left ventricular ejection fraction (LVEF), cardiothoracic ratio (CTR), brain natriuretic peptide (BNP), and other variables. Most of the patients were categorized to NYHA classes II (44.4 %) and III (40.7 %). SDB severity was not determined in 44 patients, and SDB was not detected or was mild in 27 patients. In at least 71 patients (61.7 %), therefore, ASV therapy was not applied for the treatment of SDB. CHF was more severe, i.e., greater NYHA class, lower LVEF, and higher CTR, in 87 ASV-continued patients (75.7 %) than in 28 ASV-discontinued patients (24.3 %). However, SDB severity was not related to continuity of ASV. The combined proportion of NYHA classes III and IV (P = 0.012) and LVEF (P = 0.009) improved significantly after ASV therapy. CTR and BNP did not improve significantly after ASV therapy but showed significant beneficial changes in their time-course analysis (P < 0.05, respectively). Improvements in LVEF and NYHA class after ASV therapy were not influenced by SDB severity at onset. The present study suggests that ASV therapy would improve the symptoms and hemodynamics of CHF patients, regardless of SDB severity. A randomized clinical study to verify these effects is warranted.

Background: Intermittent hypoxemia is a fundamental pathophysiological consequence of sleep-disordered breathing and may alter glucose metabolism. To characterize the association between sleep-related intermittent hypoxemia and glucose metabolism, overnight pulse-oximetry and an oral glucose tolerance test were completed in a cohort of middle-aged and older Japanese adults., Methods: The study sample consisted of 1836 community-dwelling Japanese (age, 30-79 years; women, 65.5%; mean body mass index, 23.1 kg/m(2)). The oxygen desaturation index (ODI) was quantified during sleep using a ≥3% oxygen desaturation threshold and categorized as normal (<5.0 events/h), mild (5.0-15.0 events/h), and moderate to severe (≥15.0 events/h). The independent associations between the ODI and the prevalence of impaired fasting glucose, impaired glucose tolerance, diabetes, and two metrics of insulin resistance [homeostasis model assessment index for insulin resistance (HOMA-IR) and Matsuda index] were examined., Results: Compared with subjects with an ODI < 5 events/h, the adjusted odds ratio for prevalent impaired fasting glucose, glucose intolerance, and diabetes for subjects with an ODI ≥15.0 events/h were 1.27 (95% confidence interval, 0.72-2.23), 1.69 (1.03-2.76), and 1.28 (0.59-2.79), respectively. Both HOMA-IR and Matsuda index were significantly associated with the severity of sleep-related intermittent hypoxemia as assessed by the ODI (P for trend = 0.03 and 0.007, respectively)., Conclusion: Among middle-aged and older Japanese adults, sleep-related intermittent hypoxemia is associated with glucose intolerance and insulin resistance, and may contribute to the development of type 2 diabetes mellitus., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: Continuous positive airway pressure (CPAP) is used for the management of sleep-disordered breathing in patients with multiple system atrophy (MSA). However, the long-term outcome after CPAP treatment is yet to be ascertained., Methods: A retrospective study was performed to investigate the frequency and causes of CPAP treatment discontinuation, and to ascertain the determinations of CPAP treatment duration in Japanese patients diagnosed with probable MSA based upon the consensus diagnostic criteria, who were admitted to our hospital from 2001 to 2012., Results: Twenty-nine consecutive patients treated with CPAP were analyzed. During the observation period, 19 patients (66%) discontinued CPAP treatment. The median CPAP treatment duration was 13.0 months (range, 1-53 months). The major causes for discontinuation were pulmonary infection, respiratory insufficiency of undetermined origin, and CPAP intolerance. On comparing the clinical characteristics of the groups subjected to short- and long-term CPAP treatment, floppy epiglottis was more frequently observed in the short-term group than in the long-term group (64% vs. 15%; P = 0.015)., Conclusion: The CPAP treatment duration in MSA patients was not long, and floppy epiglottis may be a determinant of the duration of CPAP treatment., (Copyright © 2014 Elsevier B.V. All rights reserved.)