Search

STUDY OBJECTIVE: Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (spinal cord injury [SCI]/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. METHODS: Randomized controlled trial comparing a behavioral Intervention (n = 32) and educational control (n = 31), both including one face-to-face and five telephone sessions over 3 months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. RESULTS: Primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p = .578; -1.1 [-2.8, 0.6] points for PSQI; p = .219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p = .025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue, and depression at some time points. CONCLUSIONS: PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients. CLINICAL TRIALS INFORMATION: Title: Treatment of Sleep Disordered Breathing in Patients with SCI. Registration number: NCT02830074. Website: https://clinicaltrials.gov/study/NCT02830074?cond=Sleep%20Apnea&term=badr&rank=5.

Objective: To assess the effectiveness and acceptability of a pillow‐like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep‐disordered breathing (SDB) and foetal well‐being. Design: Randomised cross‐over study. Setting and Population: Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia. Methods: Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week. Main Outcome Measures: Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile. Results: Forty‐one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = −0.45, p = 0.007) and lower birthweight centile (rs = −0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side‐sleeping recommendations. Conclusions: We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy. Trial Registration: Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998 [ABSTRACT FROM AUTHOR]

Sleep-disordered breathing is common among patients with heart failure with preserved ejection fraction (HFpEF), and might impact their quality of life due to nighttime hypoxemia and awakenings. However, the factors contributing to deterioration in quality of life remain unclear. This study investigated the factors associated with quality of life deterioration in patients with HFpEF and sleep-disordered breathing. This prospective cross-sectional study included inpatients with HFpEF (left ventricular ejection fraction of ≥ 50%). Sleep-disordered breathing and quality of life were evaluated using polysomnography and the Short Form-8 Health Survey, respectively. The patients were grouped based on thei median physical and mental component summary Short Form-8 Health Survey scores. Among the 31 patients with HFpEF (aged 73.7 ± 10.9 years; 67.7% women; left ventricular ejection fraction, 65.3% ± 8.1%), the median apnea–hypopnea index was 11.5 per hour. Although no differences in parameters related to sleep-disordered breathing were found among the physical component summary-stratified groups, the low mental component summary group exhibited significantly lower nadir oxygen saturation than those exhibited by the high mental component summary group (84.3 ± 5.7% vs. 88.5 ± 3.9%; p = 0.02); this difference remained significant even when adjusted for potential confounders (β = 0.43; p = 0.02). Nocturnal hypoxemia may be a contributing factor to the decline in the mental health aspect of quality of life in patients with HFpEF. Thus, clinicians should consider hypoxemia when managing HFpEF and sleep-disordered breathing. [ABSTRACT FROM AUTHOR]

Objective: To identify and characterize sex differences in collapse patterns on drug‐induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA). Study Design: Retrospective cohort analysis. Setting: An outpatient tertiary care academic medical center. Methods: A retrospective cohort study at a single tertiary care institution was performed from 2020 to 2023. All adult patients who underwent a DISE were included in this study. Univariate and multivariate analyses were used to compare differences between males and females on DISE. Results: 117 patients who underwent DISE were included in this study, including 30% females (n = 35). The average age was 54.7 years (SD 15.2), mean BMI was 28.6 kg/m2 (SD 4.1), and mean apnea‐hypopnea index (AHI) was 32.3 events per hour (SD 21.3). Most patients had severe OSA (48.7%). There was no difference in palatine or lingual tonsil size between sexes. On DISE, a significantly lower proportion of females demonstrated complete oropharyngeal lateral wall collapse (25.7% females vs 51.2% males, P =.008). Multivariate analysis revealed that male sex was independently associated with the presence of complete collapse at the oropharynx (odds ratio [OR] 2.55, 95% confidence interval [CI] [0.005‐1.868], P =.048) but not at other levels. Additionally, higher BMI was associated with any collapse (partial or complete) at the oropharynx (OR 1.30, 95% CI [0.131‐0.392], P <.001). Conclusion: This study demonstrates that a lower proportion of females have complete oropharyngeal lateral wall collapse even when controlling for BMI and AHI. Additional studies are needed to better understand the differences in OSA physiology between the sexes. [ABSTRACT FROM AUTHOR]

Rationale: Adherence to positive airway pressure (PAP) therapy is a common and challenging issue. Although some studies have looked at the impact of initial mask selection, there is a lack of data regarding the impact of a change in mask on adherence to PAP therapy. Objectives: This study investigated the impact of a mask change or renewal on midterm PAP adherence. Methods: German homecare provider data were retrospectively analyzed. Patients aged ≥18 years who started PAP therapy in 2014–2019, had data on the type of device and interface (mask) used, and had mask change/renewal within ≤1 year after starting PAP were eligible. Mask change was defined as switching to a different mask type, whereas mask renewal referred to supply of a replacement mask of the same type. The primary endpoint was change in PAP use after mask change/renewal, overall and in patient subgroups based on previous PAP use (<4 and ≥4 h/night). Results: A total of 12,551 patients were included (71% male; age, 62 ± 12 yr), and previous PAP use was <4 h/night (n = 3,510) or ≥4 h/night (n = 9,041). After mask change/renewal, there was no change in device use overall or in patients with previous use ≥4 h/night. However, in those with PAP use <4 h/night, mask change/renewal was associated with increased device use (+55 min [+57 min for change, +39 min for renewal), and it increased the proportion of days with PAP use ≥4 h/night by 19% (+20% for change, +12% for renewal). In this patient subgroup, early mask change/renewal (within 90 d), higher levels of previous device use, and older age were significant predictors of improving device usage to ≥4 h/night after mask change/renewal. Conclusions: For patients with low PAP adherence on their existing mask system, early intervention to change or renew the mask was associated with clinically relevant improvements in device use. [ABSTRACT FROM AUTHOR]

Objective: Little is known about age‐related variations in sites and grade of sleep‐dependent airway obstruction in children with obstructive sleep apnea (OSA) or obstructive sleep‐disordered breathing (oSDB). The objective was to compare sites and grade of obstruction on drug‐induced sleep endoscopy (DISE) across different age groups of surgically naïve children with OSA or oSDB. Methods: A retrospective chart review was performed for surgically naïve children aged 0–18 years with OSA/oSDB who underwent DISE from July 2021 to August 2023. Participants were categorized into: infants (aged 0–1 years), younger toddlers (aged 1–2 years), older toddlers (aged 2–3 years), preschool (aged 3–5 years), younger school‐aged (aged 5–10 years), and older school‐aged (aged 10–18 years). On DISE, obstruction was rated 0 = none/mild, 1 = moderate, 2 = severe for inferior turbinates, adenoid, velum, palatine tonsils/lateral pharyngeal wall, lingual tonsils, tongue base, epiglottis, and supra‐arytenoid tissue. A series of multiple regression analyses were used to identify age differences in the grade of obstruction across all sites combined and at each individual site separately. Results: The sample consisted of 252 children aged 1 month to 17 years with 57.9% males. Older patients had greater total obstruction scores (B = 0.42, SE = 0.10, p < 0.01) and greater number of sites that were severely obstructed (B = 0.11, SE = 0.05, p = 0.03). Older age groups had more obstruction at inferior turbinates (p = 0.02), adenoid (p < 0.01), palatine tonsils/lateral pharyngeal wall (p < 0.01), lingual tonsil (p < 0.01), and base of tongue (p < 0.01). Younger age groups had more obstruction at the supra‐arytenoid tissue (p < 0.01). Conclusion: Varying patterns of sleep‐dependent airway obstruction should be expected across different age groups in children with OSA or oSDB. Level of Evidence: 3 Laryngoscope, 135:463–468, 2025 [ABSTRACT FROM AUTHOR]

Background/Introduction: Cardiac implantable electronic devices and their integrated thoracic impedance sensors have been used to detect sleep apnea for over a decade now. Despite their usage in daily clinical practice, there are only limited data on their diagnostic accuracy. Methods: AIRLESS and UPGRADE were prospective investigator-driven trials meant to validate the AP scan® (Boston Scientific, Marlborough, MA, USA) in heart failure cohorts. Patients, who either fulfilled the criteria for implantation of an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), or upgrading to CRT according to most recent guidelines at the time of study conduction, were eligible for enrolment. Sleep apnea and its severity, measured by apnea–hypopnea index (AHI), were assessed by polysomnography. For direct comparison, the apnea sensor-derived AP scan® was used from the identical night. Results: Overall, 80 patients were analyzed. Median AHI was 21.6 events/h (7.1–34.7), while median AP scan® was 33.0 events/h (26.0–43.0). In the overall cohort, the sensor-derived AP scan® correlated significantly with the AHI (r = 0.61, p < 0.001) with a mean difference (MD) of −12.6 (95% confidence interval (CI) −38.2 to 13.0). Furthermore, the AP scan® was found to correlate well with the AHI in patients with obstructive sleep apnea r = 0.73, p = 0.011, MD −5.2, 95% CI −22.7 to 12.3), but not central sleep apnea (r = 0.28, p = 0.348, MD −10.4, 95% CI −35.4 to 14.6). Conclusions: In an exclusive heart failure cohort, the AP scan® correlated well with the PSG-derived AHI. A similar correlation was found in most subgroups except for patients suffering from central sleep apnea. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Methods Results Conclusions Trial Registration Class II occlusion is associated with narrow dimensions of the maxillary dental arch and hard palate (maxillary dimensions), which may increase the risk of narrow upper airways and sleep‐disordered breathing (SDB).The aim was to compare maxillary dental arch and hard palate dimensions in children with Class II and large overjet ≥ 6 mm (study group) to a control group with neutral occlusion and to examine the relation between SDB and maxillary dimensions.The study group included 37 children (19 boys; 18 girls; median age 12.3 years) and the control group included 32 children (16 boys; 16 girls; median age 12.2 years). SDB was assessed by respiratory polygraphy, the distances between maxillary canines and first permanent molars were measured by intraoral scans and the general relation between SDB and maxillary dimensions was analysed.Significantly smaller distances between both canines and first molars (p ≤ 0.001) were found in the study group. No significant differences in dimensions of the hard palate or SDB were found between the groups but the snore index tended to be higher in the study group (p = 0.051). No general significant associations between SDB measurements and maxillary dimensions were found in the total group of participants.Significantly reduced transversal dimensions of the maxillary dental arch were found in the study group with Class II occlusion compared to controls. No significant difference regarding dimensions of the hard palate or SDB between the groups was found nor between SDB and maxillary dimensions. However, intraoral scans may be useful in risk assessment of early signs of paediatric SDB in orthodontic patients.ClinicalTrials.gov identifier: NCT04964830 [ABSTRACT FROM AUTHOR]

Background: Recent studies have investigated the epidemiological burden of sleep-disordered breathing (SDB) in patients with stroke; however, the results have been inconsistent, and the temporal trends of SDB after stroke remain unclear. Objective: To perform a systematic review and meta-analysis of the prevalence and incidence of post-stroke SDB, evaluate demographic and clinical characteristic predictors of post-stroke SDB, and examine temporal trends in the overall burden of post-stroke SDB. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library for studies reporting the burden of SDB in stroke patients published between 1 January 2010 and 30 December 2023. Two researchers independently screened the records for eligibility, extracted the data, and assessed the quality of the studies. Data were analyzed using random effects meta-analyses, and sources of heterogeneity were explored using subgroup analyses and meta-regression analyses. Results: Out of the 8,799 references retrieved, none examined the incidence of SDB after stroke. However, 85 studies from 26 countries examined the prevalence of SDB and were included. The overall prevalence of SDB, mild SDB, and moderate to severe SDB were 60.0% (95% CI, 60.0–70.0%), 30.0% (95% CI, 23.0–37.0%), and 45.0% (95% CI, 33.0–57.0%), respectively. Meta-regression revealed that sex (p < 0.0001) and sample size (p < 0.01) were sources of heterogeneity among the studies. The pooled overall prevalence of SDB remained stable over time. Conclusion: SDB is common in patients with stroke, and no reduction in the high prevalence of SDB has been observed over time, suggesting that early screening and prevention of post-stroke SDB still have not received sufficient attention. Moreover, additional studies investigating the incidence of this disease are needed to inform clinical practice. [ABSTRACT FROM AUTHOR]

Background: Impairment in autonomic activity is a prognostic marker in patients with heart failure (HF), and its involvement has been suggested in cardiovascular complications of obstructive sleep apnea syndrome (OSAS) and Cheyne–Stokes respiration (CSR). This prospective observational study aims to investigate the implications of sleep-disordered breathing (SDB) on hemodynamic regulation and autonomic activity in chronic HF patients. Methods: Chronic HF patients, providing confirmation of reduced ejection fraction (≤35%), underwent polysomnography, real-time hemodynamic, heart rate variability (HRV), and baroreceptor reflex sensitivity (BRS) assessments using the Task Force Monitor. BRS was assessed using the sequencing method during resting conditions and stress testing. Results: Our study population (n = 58) was predominantly male (41 vs. 17), with a median age of 61 (±11) yrs and a median BMI of 30 (±5) kg/m2. Patients diagnosed with CSR were 13.8% (8/58) and 50.0% (29/58) with OSAS. No differences in the real-time assessment of hemodynamic regulation, heart rate variability, or baroreceptor reflex function were found between patients with OSAS, CSR, and patients without SDB. A subgroup analysis of BRS and HRV in patients with severe SDB (AHI > 30/h) and without SDB (AHI < 5) revealed numerically reduced BRS and increased LF/HF-RRI values under resting conditions, as well as during mental testing in patients with severe SDB. Patients with moderate-to-severe SDB had a shorter overall survival, which was, however, dependent upon age. Conclusions: Chronic HF patients with severe SDB may exhibit lower baroreceptor function and impaired cardiovascular autonomic function in comparison with HF patients without SDB. [ABSTRACT FROM AUTHOR]

Sleep bruxism (SB) and sleep-disordered breathing (SDB) are two prevalent conditions that significantly impact overall health. Studies suggest that up to 49.7% of individuals with SDB also exhibit symptoms of SB. This review aims to provide a comprehensive analysis of the role of genetic background and neurotransmission in the pathogenesis of the co-occurrence of SB and SDB. It seeks to synthesize current knowledge, highlight gaps in the existing literature, and propose a new perspective that integrates genetic and neurobiological factors. This review shows that both SB and SDB may be influenced by a combination of genetic, neurochemical, and environmental factors that contribute to their shared pathophysiology. The key neurotransmitters—dopamine, serotonin, and GABA—may play a significant role in their co-occurrence by regulating motor activity, sleep architecture, and respiratory control. Understanding genetic and neurochemical mechanisms may allow for more precise diagnostic tools and more personalized treatment approaches regarding SB and SDB. Clinically, there is a need for interdisciplinary collaboration between sleep specialists, dentists, neurologists, and geneticists. There is also a need to conduct large-scale genetic studies, coupled with neuroimaging and neurophysiological research, uncovering additional insights into the shared mechanisms of SB and SDB. [ABSTRACT FROM AUTHOR]

Background: Nocturnal hypoxia is common, under‐diagnosed and is found in the same demographic at risk of age‐related macular degeneration (AMD). The objective of this study was to determine any association between nocturnal hypoxia and AMD, its severity, and the high‐risk sub‐phenotype of reticular pseudodrusen (RPD). Methods: This cross‐sectional study included participants aged ≥50 years with AMD, or normal controls, exclusive of those on treatment for obstructive sleep apnoea. All participants had at home, overnight (up to 3 nights) pulse oximetry recordings and multimodal imaging to classify AMD. Classification of Obstructive Sleep Apnea (OSA) was determined based on oxygen desaturation index [ODI] with mild having values of 5–15 and moderate‐to‐severe >15. Results: A total of 225 participants were included with 76% having AMD, of which 42% had coexistent RPD. Of the AMD participants, 53% had early/intermediate AMD, 30% had geographic atrophy (GA) and 17% had neovascular AMD (nAMD). Overall, mild or moderate‐to‐severe OSAwas not associated with an increased odds of having AMD nor AMD with RPD (p ≥ 0.180). However, moderate‐to‐severe OSA was associated with increased odds of having nAMD (odds ratio = 6.35; 95% confidence interval = 1.18 to 34.28; p = 0.032), but not early/intermediate AMD or GA, compared to controls (p ≥ 0.130). Mild OSA was not associated with differences in odds of having AMD of any severity (p ≥ 0.277). Conclusions: There was an association between nocturnal hypoxia as measured by the ODI and nAMD. Hence, nocturnal hypoxia may be an under‐appreciated important modifiable risk factor for nAMD. [ABSTRACT FROM AUTHOR]

Central sleep apnea syndromes comprise a heterogeneous group of central breathing disturbances that often occur in the context of other underlying diseases. Pathophysiologically, it is important to distinguish between hypo-/normocapnic central sleep apnea (CSA) with high loop gain and hypercapnic CSA with reduced ventilatory drive. The classification of CSA in adults includes CSA with Cheyne–Stokes respiration (CSR) in heart failure, CSA in another underlying disease, altitude-induced CSA/periodic breathing, opioid-induced central breathing disturbance, treatment-emergent CSA, and idiopathic CSA. The prevalence of CSA is significantly lower than that of obstructive sleep apnea (OSA), although both forms of sleep-related breathing disorders often occur together. The most common form is CSA/CSR in heart failure, and as it is associated with an unfavorable prognosis and is often symptomatic, evidence-based treatment options to improve symptoms and outcome are particularly important for this group. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a common disease with significant implications for individual physical and mental wellbeing. Though in theory, OSA can be effectively treated with positive airway pressure therapy (PAP), many patients cannot adhere chronically and require alternative treatment. With sleep physicians being relevant stakeholders in the process of allocation of OSA treatments, this research aims to study their knowledge and perceptions of alternative therapies available in routine care in Germany. Methods: This work is part of a larger research project which aims to assess the state of sleep medical care in Germany. Items relevant to this study included self-reported knowledge, indication volumes, and perceptions of five alternative treatments for OSA, which are available for routine care in Germany. Results: A total of 435 sleep physicians from multiple medical disciplines and both care sectors participated in the study. Self-reported knowledge on alternative OSA treatments was moderate and correlated with the consultation volume. Self-reported adoption of alternative therapies was higher in nonsurgical methods, and only 1.1% of participants reported not utilizing any of the alternative treatments. The most relevant perceived barriers to indication were "reimbursement issues" for mandibular advancement devices and positional therapy; "evidence insufficient" for upper airway surgery, and "no demand from patients" for hypoglossal nerve stimulation and maxillomandibular Advancement. Conclusion: Self-reported knowledge of alternative OSA treatments is moderate and indication of alternative OSA therapies varies substantially. Sleep physicians often perceive barriers that limit provision or referrals for provision of these treatments. Additional research is required to further understand barriers and factors influencing creation of those perceptions and decision-making among physicians. [ABSTRACT FROM AUTHOR]

Summary: Obesity is the primary risk factor for the development of obstructive sleep apnea, and physical inactivity plays an important role. However, most studies have either only evaluated physical activity subjectively or objectively in obstructive sleep apnea. The objectives of this study were: (i) to assess the relationship between obstructive sleep apnea severity (both apnea–hypopnea index and desaturation parameters) and both objectively and subjectively measured physical activity after adjustment for anthropometry and body composition parameters; and (ii) to assess the relationship between objective and subjective physical activity parameters and whether obstructive sleep apnea severity has a modulatory effect on this relationship. Fifty‐four subjects (age 47.7 ± 15.0 years, 46% males) were categorized into groups according to obstructive sleep apnea severity: no obstructive sleep apnea; mild obstructive sleep apnea; and moderate‐to‐severe obstructive sleep apnea. All subjects were evaluated with subjective and objective physical activity, anthropometric and body composition measurements, and 3‐night self‐applied polysomnography. A one‐way ANOVA was used to evaluate the differences between the three obstructive sleep apnea severity groups and multiple linear regression to predict obstructive sleep apnea severity. Differences in subjectively reported sitting time (p ≤ 0.004) were found between participants with moderate‐to‐severe obstructive sleep apnea, and those with either mild or no obstructive sleep apnea (p = 0.004). Age, body mass index and neck circumference explained 63.3% of the variance in the apnea–hypopnea index, and age, body mass index and visceral adiposity explained 67.8% of the variance in desaturation parameters. The results showed that the person's physical activity does not affect obstructive sleep apnea severity. A weak correlation was found between objective and subjective physical activity measures, which could be relevant for healthcare staff encouraging patients with obstructive sleep apnea to increase their physical activity. [ABSTRACT FROM AUTHOR]

Both obstructive and central sleep apnea (CSA) may contribute to nocturnal cardiac arrhythmias (NCAs). Data are scarce regarding the prevalence of clinically important nocturnal atrial and ventricular arrythmias in patients with heart failure with reduced ejection fraction (HFrEF) and OSA or CSA. In a cohort of patients with HFrEF, how does the prevalence of NCA compare among those with OSA, CSA, and those with no to mild sleep apnea? Is the severity of OSA or CSA associated with atrial and ventricular NCAs? This cross-sectional analysis is an ancillary study of the Effect of Adaptive Servo Ventilation on Survival and Hospital Admissions in Heart Failure (ADVENT-HF) trial. We compared the prevalence of NCAs (excessive supraventricular ectopic activity [ESVEA], defined as premature atrial complexes ≥ 30/h or supraventricular tachycardia ≥ 20 beats); atrial fibrillation/flutter [AF]; and > 10 premature ventricular complexes [PVCs/h]) on ECGs from polysomnograms of patients with HFrEF between those with OSA (apnea-hypopnea index [AHI ≥ 15 events/h]), those with CSA (AHI ≥ 15 events/h), and those with no to mild sleep apnea (AHI < 15 events/h [control]). The prevalence of ESVEA was higher in patients with OSA (n = 430) and CSA (n = 150) compared with control participants (n = 76): 0%, 9%, and 12%, respectively. The prevalence of AF in the control, OSA, and CSA groups was 9%, 17%, and 27%; the prevalence of > 10 PVCs/h was 45%, 59%, and 63%. In multivariable regression analyses, premature atrial complexes/h was associated with OSA severity (obstructive AHI: 22.4% increase per 10 events/h [95% CI, 5.2-42.3; P =.009), although neither obstructive nor central AHI was associated with AF or > 10 PVC/h. In patients with HFrEF, the prevalences of nocturnal ESVEA, AF, and PVC > 10/h were higher in those with OSA or CSA than in those without OSA or CSA, and OSA severity was related to the burden of nocturnal atrial ectopy. Severity of OSA or CSA was not significantly related to AF or > 10 PVC/h. ClinicalTrials.gov ; No.: NCT01128816 ; URL: www.clinicaltrials.gov [ABSTRACT FROM AUTHOR]

Background: Half of patients with heart failure are estimated to have sleep‐disordered breathing (SDB). However, many are undiagnosed as they do not report typical symptoms. This study aims to evaluate the implantable cardiac defibrillator (ICD) sleep‐disordered breathing algorithm in a cohort of multi‐racial Asian patients for detection of SDB against polysomnography (PSG). Methods: In this prospective pilot study, participants who fulfill the American College of Cardiology (ACC) indication for ICD were recruited. The ICD algorithm uses transthoracic impedance sensing to calculate respiratory disturbance index (RDI). Results: Twenty‐four patients were enrolled between August 2020 and December 2021. All patients underwent PSG exams and were followed up for up to 12 months. Eighteen participants completed the PSG study as of August 23, 2022. Severe SDB (defined as PSG‐AHI ≥30 episodes/h) was diagnosed in 66.7% of the patients. No significant direct linear correlation was found between the PSG‐AHI measurements and the RDI measurements (adjusted r2 =.224, r =.473, p =.027). Applying a binary threshold cut‐off RDI value of 32 episodes/h for the detection of severe SDB yielded a sensitivity of 91.7% and specificity of 16.7%. Conclusions: Transthoracic impedance sensing with an advanced inbuilt algorithm may be helpful as a screening test in detecting severe SDB in patients with heart failure and cardiomyopathy, potentially by applying a binary threshold cut‐off value. This is the first study known to validate the algorithm in an exclusively multi‐ethnic Asian population with heart failure. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies indicate children who pass an Asleep Room Air Challenge (AsRAC) do not have significant postoperative adverse respiratory events after adenotonsillectomy (T&A). Subsequently, we revised our overnight monitoring (OM) criteria, allowing patients with an obstructive apnea/hypopnea index (OAHI) ≤20 or nonsevere obesity (Class I) to be considered for same‐day surgery (SDS) if they passed an AsRAC. Our hypothesis is that our modified OM criteria would not increase the return visits or readmission rates for patients undergoing SDS within 48 h or 15 days of T&A. Methods: A retrospective review of all children aged ≥3 and <21 years who underwent T&A at a tertiary children's hospital and its satellite locations was performed from January 2017 to September 2022. Descriptive statistics and outcome measures were compared using a 3% margin noninferiority test before and after the new criteria implementation. Results: Before intervention, 3,266 (58%) T&As were performed as SDS. Afterward, 74% of T&As were performed as SDS (p‐value <0.05). There was no difference in the ED revisit rate for SDS within the 3% noninferiority margin. Following intervention, 29% more children with Class I obesity (62% vs. 33%) underwent SDS (p‐value <0.001). Afterward, 19% more children with polysomnography underwent SDS (39% vs. 20%), p‐value <0.001. After intervention, within 48 h of SDS, six (0.9%) children had revisits for bleeding and seven (1.2%) for vomiting. There were no perioperative respiratory events. Conclusion: Our revised monitoring criteria did not demonstrate an increase in ED visit or readmissions rates within 48 h or 15 days of T&A. Additionally, we found a 29% increase in Class I obese children undergoing SDS T&A. Level of Evidence: 3 Laryngoscope, 134:5223–5230, 2024 [ABSTRACT FROM AUTHOR]

Study objectives: Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population. Methods: A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects. Results: The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57–90% before cancer treatment and 12–94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent. Conclusions: There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required. [ABSTRACT FROM AUTHOR]

Summary Sleep‐disordered breathing is common in stroke and may negatively affect its outcome. Screening for sleep‐disordered breathing in this setting is of interest but poorly studied. We aimed to evaluate the performance of eight obstructive sleep apnea screening questionnaires to predict sleep‐disordered breathing in acute stroke or transient ischaemic attack patients, and to assess the impact of stroke/transient ischaemic attack‐specific factors on sleep‐disordered breathing prediction. We analysed acute stroke/transient ischaemic attack patients (N = 195) from a prospective cohort (“Sleep Deficiency and Stroke Outcome study”). Assessments included anthropometrics, stroke‐specific parameters, sleep history, an in‐hospital respiratory polygraphy within the first week after stroke, and obstructive sleep apnea screening questionnaires (Berlin Questionnaire, Epworth Sleepiness Scale, STOP‐BANG, NoSAS, Sleep Apnea Clinical Score, No‐Apnea, Sleep Obstructive apnea score optimized for Stroke, SLEEP‐IN). In a binary classification task for respiratory event index ≥ 15 per hr, we evaluated the performance of the above‐mentioned questionnaires. We used logistic regression to identify predictors for sleep‐disordered breathing in this cohort. The areas under the curve for respiratory event index ≥ 15 per hr were: Berlin Questionnaire 0.60; STOP‐BANG 0.72; NoSAS 0.69; No‐Apnea 0.69; Sleep Apnea Clinical Score 0.75; Epworth Sleepiness Scale 0.50; Sleep Obstructive apnea score optimized for Stroke 0.58; and SLEEP‐IN 0.67. The No‐Apnea had the lowest false omission rate (0.13), a sensitivity of 0.97 and a specificity of 0.12. In multiple logistic regression analysis (respiratory event index ≥ 15 per hr), age, neck circumference, National Institutes of Health Stroke Scale at admission, prior stroke, cardioembolic stroke aetiology and observed apneas were associated with sleep‐disordered breathing. The logistic regression model performed similar (area under the curve 0.80) to Sleep Apnea Clinical Score (p = 0.402) and STOP‐BANG (p = 0.127), but outperformed the other questionnaires. Neither existing questionnaires nor our statistical model are sufficient to accurately diagnose sleep‐disordered breathing after stroke, thus requiring sleep study evaluation. The No‐Apnea questionnaire may help to identify patients amenable to sleep testing. [ABSTRACT FROM AUTHOR]

Background and Objectives: Sleep-disordered breathing (SDB) is characterized by pauses or shallow breathing during sleep. It is linked to poorer outcomes and increased stroke recurrence in stroke patients. We aimed to evaluate the proportion, severity, type, and evolution of SDB and arousals in ischemic stroke patients. Methods: Ischemic stroke patients were recruited to evaluate SDB. Patients underwent overnight polysomnography (PSG) twice – within 1 month of stroke onset and again after 3 months. Clinical outcomes were evaluated at 6, 18, and 24 months. Results: Of 141 acute ischemic stroke patients screened, 111 patients recruited in the study and 105 patients had technically adequate polysomnography. The mean age of patients was 50.5 years (standard deviation [SD]: 12.30), 78.4% of the patients were males, and the mean body mass index was 26 (SD: 5.4). Results showed that 81.9% had an apnea–hypopnea index (AHI) ≥5, with 12.5% having an AHI >30. The median arousal index (ArI) was 15.4 (interquartile range [IQR]: 0.5–50.5), which increased as the apnea increased. During follow-up, 56.8% patients had an AHI ≥5, with 12.5% having severe apnea. The median ArI decreased from 15.4 (IQR: 0.5–50.5) initially to 11.54 (IQR: 0.5-21.1) at follow-up. Numerical change in AHI severity categories were noted during the follow-up (mild: 8 vs 15; moderate: 17 vs 11; severe 19vs 7). For AHI >30, ArI decreased from 24.63 (IQR: 0.7-50.05) to 10.54 (IQR: 7.1-15.07) at follow-up. Sleep efficiency and rapid eye movement (REM) sleep duration increased on follow-up. Conclusions: The study showed a high proportion of SDB in acute ischemic stroke patients. In the follow-up, SDB improved, as reflected in AHI and ArI changes. [ABSTRACT FROM AUTHOR]

Baclofen is a common muscle relaxant agent used in a number of neurological disorders acting at central level and potentially causing adverse respiratory events, still largely unknown at therapeutic doses. We present the case of a young woman with spastic tetraparesis secondary to perinatal asphyxia treated with a standard dose of intrathecal baclofen who developed nocturnal symptoms, somnolence and memory loss during the day. Nocturnal cardio‐respiratory sleep monitoring showed a high number of central sleep apneas (CSA). The patient was adapted and treated with a positive air pressure device, Adaptative Servo‐Ventilator, specific designed to treat CSA particularly in patients with heart failure. The treatment was well tolerated and within few days CSA was reversed. The patient reported a feeling of restful sleep and disappearance of morning tiredness. The efficacy of the treatment was verified with nocturnal cardio‐respiratory monitoring after 2 months and complete resolution of all symptoms was also confirmed. [ABSTRACT FROM AUTHOR]

Background: Sleep‐disordered breathing (SDB; including stridor and sleep apnea syndromes) is frequent in multiple system atrophy (MSA), but the immediate effect of continuous positive airway pressure (CPAP) therapy is incompletely determined. Objective: We sought to evaluate the acute effect and safety of CPAP therapy on SDB and sleep architecture, as well as the clinical characteristics of nonresponders to CPAP therapy. Methods: The measures of 63 consecutive patients with MSA who underwent a video‐polysomnography during two consecutive nights (a first night in ambient air, a second night with or without CPAP, depending on the presence of SDB and availability of CPAP) in routine care were retrospectively collected. Linear mixed models assessed the two‐night change in sleep and respiratory measures, comparing those with and without the CPAP therapy on the second night. Results: SDB was frequent and mainly associated with the cerebellar phenotype. The introduction of CPAP had immediate benefits, including the normalization of the apnea–hypopnea index and a resolution of stridor in more than two‐thirds of the cases, decreased arousal index, and increased rapid eye movement sleep. CPAP therapy was well tolerated, and only two patients had emergent central apneas. Nonresponse to CPAP was generally associated with more severe motor disease. Conclusions: CPAP seems a well‐tolerated and effective therapy in patients with MSA and SDB in the short term. This treatment shows remarkable immediate benefits by objectively improving both respiratory disturbances and sleep architecture. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Dyspnea is a common symptom in neuromuscular disorders and, although multifactorial, it is usually due to respiratory muscle involvement, associated musculoskeletal changes such as scoliosis or, in certain neuromuscular conditions, cardiomyopathy. Clinical history can elicit symptoms such as orthopnea, trepopnea, sleep disruption, dysphagia, weak cough, and difficulty with secretion clearance. The examination is essential to assist with the diagnosis of an underlying neurologic disorder and determine whether dyspnea is from a cardiac or pulmonary origin. Specific attention should be given to possible muscle loss, use of accessory muscles of breathing, difficulty with neck flexion/extension, presence of thoraco‐abdominal paradox, conversational dyspnea, cardiac examination, and should include a detailed neurological examination directed at the suspected differential diagnosis. Pulmonary function testing including sitting and supine spirometry, measures of inspiratory and expiratory muscle strength, cough peak flow, sniff nasal inspiratory pressure, pulse oximetry, transcutaneous CO2, and arterial blood gases will help determine the extent of the respiratory muscle involvement, assess for hypercapnic or hypoxemic respiratory failure, and qualify the patient for noninvasive ventilation when appropriate. Additional testing includes dynamic imaging with sniff fluoroscopy or diaphragm ultrasound, and diaphragm electromyography. Polysomnography is indicated for sleep related symptoms that are not otherwise explained. Noninvasive ventilation alleviates dyspnea and nocturnal symptoms, improves quality of life, and prolongs survival. Therapy targeted at neuromuscular disorders may help control the disease or favorably modify its course. For patients who have difficulty with secretion clearance, support of expiratory function with mechanical insufflation‐exsufflation, oscillatory devices can reduce the aspiration risk. [ABSTRACT FROM AUTHOR]

Abstract Background and aims This observational study examined the association of snoring and growth during early childhood and the cardiovascular and metabolic risk factors based on blood samples at the age of two years. Methods and results The sample comprised 78 children from the CHILD-SLEEP birth cohort with full-night polysomnography (PSG) and a questionnaire consisting of parts concerning the child's sleep and environmental factors at 24 months. The growth charts were collected from well-baby clinics. Metabolic blood samples were drawn from 31 children. There were no statistically significant differences in the growth parameters of snoring children compared to controls during the first two years of life. However, in linear regression models, snoring time in PSG significantly predicted lower levels of HDL (β = -0.484, p = 0.007) and ApoA1 (β = -0.451, p = 0.049) and higher levels of hs-CRP (β = 0.410, p = 0.019). Conclusion In conclusion, in Finnish children the levels of HDL and ApoA1 were inversely related to the snoring time in PSG. In addition, the snoring time in PSG significantly predicted higher levels of hs-CRP. These results suggest that snoring in early childhood could negatively alter the serum metabolic profile, adding to the risk of cardiovascular diseases in adulthood.

Abstract Background Half of patients with heart failure are estimated to have sleep‐disordered breathing (SDB). However, many are undiagnosed as they do not report typical symptoms. This study aims to evaluate the implantable cardiac defibrillator (ICD) sleep‐disordered breathing algorithm in a cohort of multi‐racial Asian patients for detection of SDB against polysomnography (PSG). Methods In this prospective pilot study, participants who fulfill the American College of Cardiology (ACC) indication for ICD were recruited. The ICD algorithm uses transthoracic impedance sensing to calculate respiratory disturbance index (RDI). Results Twenty‐four patients were enrolled between August 2020 and December 2021. All patients underwent PSG exams and were followed up for up to 12 months. Eighteen participants completed the PSG study as of August 23, 2022. Severe SDB (defined as PSG‐AHI ≥30 episodes/h) was diagnosed in 66.7% of the patients. No significant direct linear correlation was found between the PSG‐AHI measurements and the RDI measurements (adjusted r2 = .224, r = .473, p = .027). Applying a binary threshold cut‐off RDI value of 32 episodes/h for the detection of severe SDB yielded a sensitivity of 91.7% and specificity of 16.7%. Conclusions Transthoracic impedance sensing with an advanced inbuilt algorithm may be helpful as a screening test in detecting severe SDB in patients with heart failure and cardiomyopathy, potentially by applying a binary threshold cut‐off value. This is the first study known to validate the algorithm in an exclusively multi‐ethnic Asian population with heart failure.

STUDY OBJECTIVES: Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans. METHODS: Veterans were screened from a single VA medical center who had polysomnography (PSG) study from 2017 to 2021 to ascertain the presence, severity, and type of SDB by measuring the apnea-hypopnea index (AHI) and central apnea index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/hour. Diagnostic CSA only was defined as AHI ≥ 10 events/hour and CAI ≥ 50% of AHI. OSA only was defined if AHI ≥ 10 events/hour and CAI  5 events/hour but

Qian Wang,1,2,&ast; Guimin Huang,3,&ast; Ruikun Wang,4 Zhilong Cao,5 Jieqiong Liang,1 Mengyao Li,1 Qinglong Gu1,2 1Department of Otolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 2Graduate School of Peking Union Medical College, Beijing, People’s Republic of China; 3Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 4Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, People’s Republic of China; 5School of Software, Beihang University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qinglong Gu, Department of Otolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-13146836613, Email gql71@163.comPurpose: This study investigates the prevalence, risk factors, and clinical characteristics of positional obstructive sleep apnea (POSA) among pediatric patients diagnosed with obstructive sleep apnea (OSA).Patients and Methods: A total of 1,236 children aged 0 to 17 years who underwent nocturnal polysomnography (PSG) and completed the Sleep Questionnaire were included. After excluding those with an AHI < 1, neurological or muscular disorders, or insufficient sleep time in specific positions, 908 patients remained: 158 with POSA and 750 with non-positional OSA (NPOSA). Propensity score matching (PSM) was applied at a 1:2 ratio, resulting in a final sample of 153 POSA and 306 NPOSA patients. Data analyses were performed using R software (version 4.2.3).Results: The prevalence of POSA was 12.8%. After PSM, patients with POSA had a lower overall AHI (8.66 vs 10.30), REM-AHI (14.30 vs 17.40), and NREM-AHI (7.43 vs 8.77) compared to those with NPOSA. POSA patients also had a shorter total sleep time (411 vs 427 minutes), spent less time in the supine position (168 vs 225 minutes), and more time in non-supine positions (241 vs 202 minutes) than NPOSA patients. Additionally, while the supine AHI was higher in POSA patients (15.60 vs 10.30), the non-supine AHI was lower (5.00 vs 11.00) compared to NPOSA patients. The minimum oxygen saturation was slightly higher in POSA patients (0.88 vs 0.87). All differences were statistically significant (P < 0.05). Risk factors for POSA included mild OSA, allergic rhinitis, non-allergic rhinitis, and obesity.Conclusion: The prevalence of POSA in children is lower than in adults, and its severity is less than that of NPOSA. Compared to NPOSA patients, POSA patients had significantly higher AHI during supine sleep and lower AHI during non-supine sleep. POSA patients also spent more time in non-supine positions, suggesting that avoiding supine sleep may help reduce apnea events. These findings highlight the importance of monitoring and managing sleep posture in POSA patients.Keywords: obstructive sleep apnea, pediatric patients, risk factors, polysomnography, sleep position, sleep-disordered breathing

Obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome, is a combination of obesity (body mass index (BMI) >30 kg/m2), daytime hypercapnia (arterial carbon dioxide tension >45 mm Hg) and sleep-disordered breathing, after exclusion of other disorders that may cause alveolar hypoventilation. Management of OHS requires a multifaceted approach in the form of weight loss, treatment of existing co-illnesses, pulmonary rehabilitation, and Bi-level positive airway pressure (Bi-PAP) therapy. A 58-year-old lady with a BMI of 50 kg/m2 with symptoms of obstructive sleep apnea (OSA) and OHS presented to the hospital with respiratory distress. She gave a history of breathlessness, snoring, and sleep disturbances for the last 7 years. She was managed by a physician with a diagnosis of obstructive airway disease without further evaluation of sleep disturbance. On admission, she was started on non-invasive ventilation during her initial management. After 72 hours of admission, the patient became stable, and overnight polysomnography was performed to confirm the diagnosis of OHS. After confirmation of the diagnosis, she was started on Bi-PAP therapy along with other supportive therapy for 7 days. She was discharged after 10 days of admission with nocturnal Bi-PAP therapy at home and was enrolled in a comprehensive pulmonary rehabilitation program. Patient is on regular follow-up and has been doing well since then.

Sleep apnea is regarded as an important risk factor in the pathogenesis of Alzheimer disease (AD). Chronic intermittent hypoxia treatment (IHT) given during the sleep period of the circadian cycle in experimental animals is a well-established sleep apnea model. Here we report that transient IHT for 4 days on AD model mice causes Aβ overproduction 2 months after IHT presumably via upregulation of synaptic BACE1, side-by-side with tau hyperphosphorylation. These results suggest that even transient IHT may be sufficient to cause long-lasting changes in the molecules measured as AD biomarkers in the brain.

(1) Background: Sleep-disordered breathing and asthma are often interrelated. Children and adults with asthma are more susceptible to sleep apnea. Inhaled corticosteroids effectively reduce inflammation and prevent structural changes in the airways. Objective: to explore the existing literature to determine whether inhaled corticosteroids play a role in sleep-disordered breathing in patients with asthma. (2) Methods: We conducted a thorough search of the PubMed, Scopus, and Web of Science databases for English-language articles published up to 12 May 2024. We utilized the ROBINS-E tool to assess the risk of bias. (4) Conclusions: 136 articles were discerned upon conducting the literature search. A total of 13 articles underwent exhaustive full-text scrutiny, resulting in 6 being considered non-relevant. The remaining seven articles, assessed for eligibility, were incorporated into the final analysis. Five studies were identified in adults and two in children. In adult patients, inhaled corticosteroids, especially at high doses, appear to increase the risk of sleep apnea in a dose-dependent manner. Moreover, the properties of inhaled corticosteroids, such as particle size, may impact the risk of developing sleep apnea. In children, the severity of asthma is a key factor affecting the prevalence of sleep apnea, whereas inhaled corticosteroids appear to be a less significant risk factor compared to adults. All of the studies reviewed were classified as having a high risk of bias or some concerns regarding bias. Each study revealed at least one type of bias that raised notable concerns. This research highlights a complex interaction between the use of inhaled corticosteroids, the severity of asthma, and the onset of sleep apnea. Additional research is necessary to investigate these relationships further.

Background/Objectives: A well-established association exists between the development of hypertension and sleep quality. The connection between self-reported sleep quality and the onset of hypertension is particularly significant in populations with metabolic deterioration, such as in Mexico. Methods: The Tlalpan 2020 Cohort was analyzed to explore this association. Clinical and anthropometric characteristics, along with the Medical Outcomes Study Sleep Scale (MOS-SS), were compared between participants who developed hypertension and those who did not over a follow-up period of 30.8 months. The potential role of poor sleep quality in the development of hypertension was assessed. Results: Among 1520 participants, 12% developed hypertension. These individuals had higher anthropometric and laboratory values and reported poorer sleep quality. An elevated sleep problems index was associated with a 50% higher relative risk of developing hypertension (OR: 1.5; 95% CI: 1.087 to 2.069). Additionally, self-reported snoring was associated with hypertension onset (36.3 vs. 43.3; p = 0.019). Conclusions: Poor sleep quality and respiratory disturbances during sleep increase the risk of developing hypertension. Furthermore, hypertension was associated with snoring, highlighting the importance of early interventions to improve sleep quality. [ABSTRACT FROM AUTHOR]

Summary To explore the association between the severity of sleep‐disordered breathing, different types of respiratory events, peripheral oxygen saturation (SpO2), age and sleep stage on cerebral oxygen saturation (rSO2) in children. We enrolled children aged 4–14 years who were treated for snoring or mouth breathing at the Sleep Center of Beijing Children's Hospital, from February 2022 to July 2022. All children completed polysomnography, and SpO2, rSO2, and heart rate (HR) were recorded synchronously. A total of 70 children were included, including 16 (22.9%) with primary snoring, 38 (54.3%) with mild obstructive sleep apnea (OSA), and 16 (22.9%) with moderate‐to‐severe OSA. There were no significant differences in the mean rSO2 or minimum rSO2 among the primary snoring, mild OSA, and moderate‐to‐severe OSA groups (all p > 0.05). A total of 1119 respiratory events were included in the analysis. Regardless of the type of respiratory event, rSO2 and HR changes occur prior to fluctuations in SpO2. A mixed‐effects model showed that ΔrSO2 was positively correlated with ΔSpO2, duration of respiratory event, mixed and obstructive apnea, central apnea, while negatively correlated with age and rapid eye movement (REM) sleep stage (all p < 0.05). Larger rSO2 fluctuations were impacted by a greater ΔSpO2, longer duration of respiratory events, younger age, apnea‐related respiratory events and non‐REM sleep stage. Thus, sleep disordered breathing in younger children warrants more attention. More research is needed to determine whether REM sleep has special protective effects on rSO2. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease associated with sleep disturbance, namely insomnia and sleep-disordered breathing. This study aims to evaluate the overall sleep characteristics of ALS patients, their association with lung function tests, and possible predictive survival factors. We conducted a retrospective observation study among ALS patients monitored during a pulmonology consultation. Type one polysomnography (PSG) and lung function tests were performed once the patients presented with sleep-related symptoms, and the relationship between their parameters was assessed, as well as a survival analysis. We included 35 patients, with an overall diminished sleep efficiency, a partially conserved forced vital capacity (FVC), and low maximal inspiratory pressure (MIP). A positive correlation between FVC and REM sleep percentage was observed. A survival analysis showed that a normal rapid eye movement (REM) sleep percentage and respiratory disturbance index (RDI) ≥ 15/h were independent predictors of survival. We observed a trend for higher sleep quality in patients with conserved lung function. A better sleep quality was associated with a higher survival. Obstructive events (reduced or absence of airflow associated with continued or increased inspiratory effort) did not seem to impact survival. [ABSTRACT FROM AUTHOR]

Stroke is the second-leading cause of death worldwide. OSA is an independent risk factor for stroke and is associated with multiple vascular risk factors. Poststroke OSA is prevalent and closely linked with various stroke subtypes, including cardioembolic stroke and cerebral small vessel disease. Observational studies have shown that untreated poststroke OSA is associated with an increased risk of recurrent stroke, mortality, poorer functional recovery, and longer hospitalizations. Poststroke OSA tends to be underdiagnosed and undertreated, possibly because patients with stroke and OSA present atypically compared with the general population with OSA. Objective testing, such as the use of ambulatory sleep testing or in-laboratory polysomnography, is recommended for diagnosing OSA. The gold standard for treating OSA is CPAP therapy. Randomized controlled trials have shown that treatment of poststroke OSA using CPAP improves nonvascular outcomes such as cognition and neurologic recovery. However, findings from randomized controlled trials that have evaluated the effect of CPAP on recurrent stroke risk and mortality have been largely negative. There is a need for high-quality randomized controlled trials in poststroke OSA that may provide evidence to support the utility of CPAP (and/or other treatment modalities) in reducing recurrent vascular events and mortality. This goal may be achieved by examining treatment strategies that have yet to be trialed in poststroke OSA, tailoring interventions according to poststroke OSA endotypes and phenotypes, selecting high-risk populations, and using metrics that reflect the physiologic abnormalities that underlie the harmful effects of OSA on cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Obstructive Sleep Apnoea Syndrome (OSA) in children disrupts normal breathing patterns and sleep architecture, potentially leading to severe consequences. Early identification and intervention are crucial to prevent these issues. This study explored the relationships between waiting times for polysomnography (PSG), clinical history, patient age at the time of PSG, and PSG outcomes in children. Methods: Two hundred and fourteen children were prospectively enrolled. Data were extracted from medical records regarding the patients' age at the time of a referral for PSG and their age at the time of its execution. Information on the waiting times for PSG, a diagnosis (primary snoring, mild, moderate, and severe OSA), and a history of snoring and apnoea were also collected. Additional data included medications, surgical interventions, passive smoke exposure, and allergies. The records also included the Paediatric Sleep Questionnaire (PSQ). Results: The patient age at the time of a PSG prescription was lower for patients with a short history of sleep apnoeas (≤12 months; 4.6 (SD 2.6) years) compared to those with a long history (>12 months; 5.5 (SD 2.7) years; p = 0.027). The waiting time from prescription to PSG execution was shorter for patients with a short history of sleep apnoea (4.1 (SD 3.8) months) compared to those with a longer history (5.9 (SD 3.8) months; p = 0.001). A higher frequency of having an adenotonsillectomies before a PSG prescription was observed in the long-history group compared to the short-history group (13.3% vs. 6.9%). Conversely, a higher frequency of adenoidectomies before a PSG prescription was noted in the short-history group compared to the long-history group (9.7% vs. 1.3%). Conclusions: This study found that younger children with a shorter history of OSA are diagnosed and evaluated earlier than older children with a longer history of the condition, suggesting that prolonged symptoms may delay a diagnosis. ENT surgeries also vary among patients, with less invasive procedures (adenoidectomy) being more common in younger children with shorter histories of OSA. The increasing awareness of OSA highlights the need for improved access to diagnostic and treatment resources. [ABSTRACT FROM AUTHOR]

Purpose: To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms. Methods: Patients with ACI within 48 h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated. Results: 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1–2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05). Conclusion: Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient's sleep circadian rhythm and increase its IV. [ABSTRACT FROM AUTHOR]

Purpose: Patients with syndromic hemifacial microsomia (SHFM) are at risk of obstructive sleep apnea (OSA). The aim of the study was to describe the prevalence of OSA and its management, especially in patients with Goldenhar syndrome (GS). Methods: The respiratory polygraphies and clinical management of 15 patients, aged 2 to 23 years, evaluated at a national reference center, were analyzed. Results: Four (27%) patients had no OSA, 4 (27%) had mild OSA, and 7 (46%), of whom 5 were ≤ 2 years old, had severe OSA. None of the patients had central apneas. Only one patient had alveolar hypoventilation, and another one had nocturnal hypoxemia. Two patients had severe OSA despite prior adenoidectomy or mandibular distraction osteogenesis. Median duration of follow-up was 3.5 years (range 0.5—9 years). None of the patients without OSA or with mild OSA at baseline respiratory polygraphy developed OSA during the follow up. Among the 7 patients with severe OSA, 3 required continuous positive airway pressure or noninvasive ventilation, and one patient required a tracheostomy. Conclusion: In conclusion, patients with SHFM are at high risk of severe OSA at any age, underlining the importance of systematic sleep studies to diagnose and evaluate the severity of OSA. Individualized treatment should be privileged, based on a careful examination of the entire upper airway, taking in account potential associated risk factors. All patients with SHFM should be managed by a pediatric expert multidisciplinary medical/surgical team until the end of post pubertal growth. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to assess the risk of sleep-disordered breathing (SDB) in orthodontic patients and to evaluate the influence of sex, age, and orthodontic treatment in a cohort of subjects using the Pediatric Sleep Questionnaire (PSQ) screening tool. Methods Parents of 245 patients aged 5–18 years (11.4 ± 3.3 years) were invited to participate in the study by answering the PSQ, which has 22 questions about snoring, sleepiness, and behavior. The frequency of high and low risk was calculated for the full sample. Multiple logistic regression was used to assess the association among sex, age, orthodontic treatment, rapid maxillary expansion (RME), and body mass index (BMI) with SDB. A significance level of 5% (P  < .05) was adopted in all tests. Results A high risk of SDB was found in 34.3% of the sample. No sex and BMI difference was found for the risk of SDB. The high risk of SDB was significantly associated with younger ages (OR = 1.889, P  = .047), pre-orthodontic treatment phase (OR = 3.754, P  = .02), and RME (OR = 4.157, P  = .001). Limitations Lack of ear, nose and throat-related medical history. Conclusion Children showed a 1.8 higher probability of having a high risk of SDB compared with adolescents. Patients before orthodontic treatment and patients submitted to RME showed a high risk of SDB. [ABSTRACT FROM AUTHOR]

Objectives: Evidence shows that obstructive sleep apnea (OSA) is associated with the development of stroke. This study investigates the relationship between OSA and post-stroke complications, addressing the limited data on how OSA influences the severity and development of these complications through a systematic review of existing literature. Methods: Data was collected from PubMed, Web of Science, and Scopus databases up to December 2023. Studies meeting the inclusion criteria were selected, and statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used for pooling data with heterogeneity, and findings were presented using standard ratios with 95% confidence intervals. Results: The analysis included nine studies. Stroke patients with OSA did not show a significantly higher risk of post-stroke complications, which include mild cognitive impairment, dementia, insomnia, fatigue, reduced sleep quality, depression, anxiety, recurrent strokes, and death, compared with those without OSA (RR = 1.05, 95% CI 0.97 to 1.13). However, patients with high stroke severity and OSA had a slightly higher risk of post-stroke complications (RR = 1.06, 95% CI 1.01 to 1.12). Conclusions: This systematic review and meta-analysis suggests that OSA confers a higher risk of post-stroke complications in patients with high stroke severity. Further studies are required to explore the impact of OSA on post-stroke complications. [ABSTRACT FROM AUTHOR]

Objectives: Understanding the long-term consequences of sleep-disordered breathing (SDB) in neonates is crucial. A lack of consensus on diagnostic and treatment thresholds has resulted in limited research in this area. Our study aims to describe the trajectory of SDB in a cohort of high-risk neonates and their respiratory and neurodevelopmental outcomes at 3 years of age, and explore the relationship between SDB during early infancy and neurocognitive outcomes. Methods: A retrospectively identified cohort of neonates with moderate–severe SDB were prospectively followed at 3 years of age. Data collected included last polysomnography (PSG) parameters up to the age of 3 years and sleep physician's recommendations, duration of CPAP use, compliance with treatment, timing of SDB resolution, and neurodevelopmental outcomes. Univariate and multivariate logistic regression analyses were performed to evaluate the association between important respiratory and sleep breathing parameters with the developmental outcomes. Results: Eighty neonates were included. Respiratory and developmental outcomes were available for 58 (72.5%) and 56 (70%) patients, respectively. In most patients (47/58, 81%), SDB had resolved by 3 years of age. Survival without major developmental delay was seen in 32/56 (57%), but a significant proportion (21/56, 37.5%) demonstrated global developmental delay. Following univariate analysis, primary diagnosis, apnoea–hypopnoea index (AHI) at the time of last PSG and SDB outcome was significantly associated with developmental delay. However, these associations were not seen in multivariate analysis. Conclusions: Despite severity at baseline, SDB resolved in the majority of patients with time and treatment. Although statistically insignificant, logistic regression analysis identified some clinically important associations between neonatal SDB and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Iron deficiency (ID) and restlessness are associated with sleep/wake-disorders (e.g., restless legs syndrome (RLS)) and neurodevelopmental disorders (attention deficit/hyperactivity and autism spectrum disorders (ADHD; ASD)). However, a standardized approach to assessing ID and restlessness is missing. We reviewed iron status and family sleep/ID history data collected at a sleep/wake behavior clinic under a quality improvement/quality assurance project. Restlessness was explored through patient and parental narratives and a 'suggested clinical immobilization test'. Of 199 patients, 94% had ID, with 43% having a family history of ID. ADHD (46%) and ASD (45%) were common conditions, along with chronic insomnia (61%), sleep-disordered breathing (50%), and parasomnias (22%). In unadjusted analysis, a family history of ID increased the odds (95% CI) of familial RLS (OR: 5.98, p = 0.0002, [2.35–15.2]), insomnia/DIMS (OR: 3.44, p = 0.0084, [1.37–8.64]), and RLS (OR: 7.00, p = 0.01, [1.49–32.93]) in patients with ADHD, and of insomnia/DIMS (OR: 4.77, p = 0.0014, [1.82–12.5]), RLS/PLMS (OR: 5.83, p = 0.009, [1.54–22.1]), RLS (OR: 4.05, p = 0.01, [1.33–12.3]), and familial RLS (OR: 2.82, p = 0.02, [1.17–6.81]) in patients with ASD. ID and restlessness were characteristics of ADHD and ASD, and a family history of ID increased the risk of sleep/wake-disorders. These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors. [ABSTRACT FROM AUTHOR]

Summary Sleep‐disordered breathing (SDB) is linked to cognitive dysfunction. Although SDB is common in stroke patients, the impact of SDB and its early treatment on cognitive functioning after stroke remains poorly investigated. Therefore, we explored the association between SDB and post‐stroke cognitive functioning, including the impact of early SDB treatment with adaptive servo‐ventilation (ASV) on cognitive recovery from acute event to 3 months post‐stroke. We used data from two studies, which included ischaemic stroke patients (n = 131) and no‐stroke controls (n = 37) without SDB (apnea–hypopnea index, AHI <5/h) and with SDB (AHI≥20/h). Cognitive functioning was assessed within 7 days and 3 months post‐stroke in stroke patients, or at study inclusion in no‐stroke control group, respectively. Stroke patients with SDB were randomized to ASV treatment (ASV+) or usual care (ASV‐). Linear regression adjusted for main confounders assessed the impact of SDB and its treatment on cognitive recovery. The intention‐to‐treat analysis did not show significant associations of SDB ASV+ (n = 30) versus SDB ASV‐ (n = 29) with cognitive recovery. In an exploratory subanalysis, compliant SDB ASV+ (n = 14) versus SDB ASV‐ showed improvements with ASV in visual memory and cognitive flexibility. Combining the stroke and non‐stroke datasets, SDB (n = 85) versus no‐SDB (n = 83) was associated with deficits in visual memory and response inhibition independently of stroke. SDB ASV‐ versus no‐SDB (n = 51) was associated with less improvement in visual memory. There was no substantial evidence for benefits of intention‐to‐treat ASV on cognitive recovery. Exploratory analysis indicated that compliant ASV treatment could benefit visual memory and cognitive flexibility, whereas untreated SDB could contribute to a poor recovery of visual memory. [ABSTRACT FROM AUTHOR]