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Purpose: To determine whether menstrual-cycle symptoms are associated with sleep in elite female athletes. Methods: Sleep was assessed for a minimum of 25 nights (range = 25–31) using activity monitoring and sleep diaries. Menstrual-cycle symptoms were collected over the same duration in 12 elite female professional soccer players. Generalized estimating equations were used to examine the relationship between the day of the menstrual cycle (from day 1) and total menstrual-cycle symptoms on sleep characteristics. Results: There was a significant relationship between sleep duration and the day of the menstrual cycle (P =.042) and total symptoms reported that day (P <.001), with sleep duration increasing by 21 minutes for every symptom reported. There was a negative day × symptom interaction on sleep duration (P =.004), indicating that with increased symptoms, the day of the menstrual cycle had a smaller relationship with sleep duration. Sleep efficiency (P =.950), wake after sleep onset (P =.217), and subjective sleep quality (P =.080) were not related to the day of the menstrual cycle. The total symptoms reported had no relationship with sleep efficiency (P =.220), subjective sleep quality (P =.502), or sleep latency (P =.740) but did significantly relate to wake after sleep onset (P <.001), with a significant day × symptom interaction (P <.001). Conclusions: Sleep duration increased from day 1 of the menstrual cycle and was associated with the number of menstrual-cycle symptoms reported. All other sleep metrics remained unchanged; however, total symptoms reported were related to wake after sleep onset. Monitoring and managing menstrual-cycle symptoms should be encouraged due to a potential relationship with sleep characteristics. [ABSTRACT FROM AUTHOR]

Narcolepsy is mainly associated with excessive daytime sleepiness, but the characteristic feature is abnormal rapid eye movement (REM) sleep phenomena. REM sleep disturbances can manifest as cataplexy (in narcolepsy type 1), sleep paralysis, sleep-related hallucinations, REM sleep behavior disorder, abnormal dreams, polysomnographic evidence of REM sleep disruption with sleep-onset REM periods, and fragmented REM sleep. Characterization of REM sleep and related symptoms facilitates the differentiation of narcolepsy from other central hypersomnolence disorders and aids in distinguishing between narcolepsy types 1 and 2. A circuit comprising regions within the brainstem, forebrain, and hypothalamus is involved in generating and regulating REM sleep, which is influenced by changes in monoamines, acetylcholine, and neuropeptides. REM sleep is associated with brainstem functions, including autonomic control, and REM sleep disturbances may be associated with increased cardiovascular risk. Medications used to treat narcolepsy (and REM-related symptoms of narcolepsy) include stimulants/wake-promoting agents, pitolisant, oxybates, and antidepressants; hypocretin agonists are a potential new class of therapeutics. The role of REM sleep disturbances in narcolepsy remains an area of active research in pathophysiology, symptom management, and treatment. This review summarizes the current understanding of the role of REM sleep and its dysfunction in narcolepsy.

STUDY OBJECTIVES: Recently, criteria have been drawn up for large muscle group movements during sleep (LMM), defined as movements lasting for 3-45 seconds in adults, which are often accompanied by changes in sleep stage, arousals, and increases in heart rate. The aim of this study was to characterize LMM in restless legs syndrome (RLS) in order to better evaluate their impact on the neurophysiology of the disorder and, therefore, the possible clinical implications. METHODS: Consecutive, drug-free patients diagnosed with RLS and controls, aged 18 years or more, were retrospectively enrolled. Leg movement activity-short-interval (SILMS), periodic (PLMS), and isolated (ISOLMS) leg movements during sleep-and LMM were detected and scored. RESULTS: In total, 100 patients and 67 controls were recruited. All movement measures were significantly higher in RLS. A significant positive correlation was found between LMM and ISOLMS index but not PLMS index in both groups. LMM index showed a significant negative correlation with total sleep time, sleep efficiency, and percentage of sleep stages N3 and R, as well as a significant positive correlation with the number of awakenings, and percentage of sleep stages N1 and N2 only in patients with RLS. No significant correlation was found between either LMM or PLMS index and RLS severity. CONCLUSIONS: Different types of movements, including SILMS, ISOLMS, and LMM, play somewhat distinct roles in sleep neurophysiology in RLS. Notably, LMM, a newly recognized category of movements, demonstrates associations with sleep architecture instability and fragmentation, arousals, and awakenings, suggesting potential clinical implications.

BACKGROUND: Obstructive sleep apnea (OSA) increases risk for cognitive decline and Alzheimers disease (AD). While the underlying mechanisms remain unclear, hypoxemia during OSA has been implicated in cognitive impairment. OSA during rapid eye movement (REM) sleep is usually more severe than in non-rapid eye movement (NREM) sleep, but the relative effect of oxyhemoglobin desaturation during REM versus NREM sleep on memory is not completely characterized. Here, we examined the impact of OSA, as well as the moderating effects of AD risk factors, on verbal memory in a sample of middle-aged and older adults with heightened AD risk. METHODS: Eighty-one adults (mean age:61.7 ± 6.0 years, 62% females, 32% apolipoprotein E ε4 allele (APOE4) carriers, and 70% with parental history of AD) underwent clinical polysomnography including assessment of OSA. OSA features were derived in total, NREM, and REM sleep. REM-NREM ratios of OSA features were also calculated. Verbal memory was assessed with the Rey Auditory Verbal Learning Test (RAVLT). Multiple regression models evaluated the relationships between OSA features and RAVLT scores while adjusting for sex, age, time between assessments, education years, body mass index (BMI), and APOE4 status or parental history of AD. The significant main effects of OSA features on RAVLT performance and the moderating effects of AD risk factors (i.e., sex, age, APOE4 status, and parental history of AD) were examined. RESULTS: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxyhemoglobin desaturation index (ODI) during REM sleep were negatively associated with RAVLT total learning and long-delay recall. Further, greater REM-NREM ratios of AHI, RDI, and ODI (i.e., more events in REM than NREM) were related to worse total learning and recall. We found specifically that the negative association between REM ODI and total learning was driven by adults 60 + years old. In addition, the negative relationships between REM-NREM ODI ratio and total learning, and REM-NREM RDI ratio and long-delay recall were driven by APOE4 carriers. CONCLUSION: Greater OSA severity, particularly during REM sleep, negatively affects verbal memory, especially for people with greater AD risk. These findings underscore the potential importance of proactive screening and treatment of REM OSA even if overall AHI appears low.

Rationale: Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. Objectives: To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA. Methods: This observational, prospective study included 135 patients with OSA eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. Additionally, MJM monitoring at home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was revaluated using Bland-Altman analysis. Changes in AHI during the home-based oral appliance titration process were evaluated using a generalized linear mixed model and a generalized estimating equation model. Results: The automated MJM analysis demonstrated strong agreement with PG in assessing AHI at the end of titration, with a median bias of 0.24/h (limits of agreement, -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across three evaluation conditions: in-laboratory PG (-59.6%; 95% confidence interval, -59.8% to -59.5%), in-laboratory automated MJM analysis (-59.2%; -65.2% to -52.2%), and at-home automated MJM analysis (-59.7%; -67.4% to -50.2%). Conclusions: Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.

ObjectiveDrug induced sleep endoscopy (DISE) is often performed for pediatric obstructive sleep apnea (OSA) when initial diagnostic studies do not provide adequate information for therapy. However, DISE scoring is subjective and with limitations. This proof-of-concept study demonstrates the use of a novel long-range optical coherence tomography (LR-OCT) system during DISE of two pediatric patients.MethodsLR-OCT was used to visualize the airway of pediatric patients during DISE. At the conclusion of DISE, the OCT probe was guided in the airway under endoscopic visual guidance, and cross-sectional images were acquired at the four VOTE locations. Data processing involved image resizing and alignment, followed by rendering of three-dimensional (3D) volumetric models of the airways.ResultsTwo patients were included in this study. Patient one had 18.4%, 20.9%, 72.3%, and 97.3% maximal obstruction at velum, oropharynx, tongue base, and epiglottis, while patient two had 40.2%, 41.4%, 8.0%, and 17.5% maximal obstruction at these regions, respectively. Three-dimensional reconstructions of patients' airways were also constructed from the OCT images.ConclusionThis proof-of-concept study demonstrates the successful evaluation of pediatric airway during DISE using LR-OCT, which accurately identified sites and degrees of obstruction with respective 3D airway reconstruction.

Sleep disturbance is a prevalent and disabling comorbidity in Parkinsons disease (PD). We performed multi-night (n = 57) at-home intracranial recordings from electrocorticography and subcortical electrodes using sensing-enabled Deep Brain Stimulation (DBS), paired with portable polysomnography in four PD participants and one with cervical dystonia (clinical trial: NCT03582891). Cortico-basal activity in delta increased and in beta decreased during NREM (N2 + N3) versus wakefulness in PD. DBS caused further elevation in cortical delta and decrease in alpha and low-beta compared to DBS OFF state. Our primary outcome demonstrated an inverse interaction between subcortical beta and cortical slow-wave during NREM. Our secondary outcome revealed subcortical beta increases prior to spontaneous awakenings in PD. We classified NREM vs. wakefulness with high accuracy in both traditional (30 s: 92.6 ± 1.7%) and rapid (5 s: 88.3 ± 2.1%) data epochs of intracranial signals. Our findings elucidate sleep neurophysiology and impacts of DBS on sleep in PD informing adaptive DBS for sleep dysfunction.

Importance: Obstructive sleep apnea (OSA) in children is linked with alterations in the gut microbiome. The influence of adenotonsillectomy (AT), a primary intervention for OSA, on gut microbiota dynamics relative to disease severity remains to be elucidated. Objective: This study aimed to investigate the impact of OSA severity and AT on the gut microbiome in pediatric patients. Design: A prospective observational study. Setting: Tertiary referral center. Participants: A cohort of 55 pediatric patients treated with AT for OSA. Intervention: Total tonsillectomy and adenoidectomy procedures. Main Outcome Measures: Comprehensive evaluations included in-laboratory polysomnography and 16S rRNA gut microbiome profiling at baseline, and again at 3rd and 12thmonth following surgery. Results: Initial findings showed uniform α-diversity across different severities of OSA, while β-diversity was significantly elevated in the severe OSA subgroup. Certain gut microbiota taxa (Lachnospiraceae NK4A136 group, Ruminococcaceae UCG-002, Ruminococcaceae UCG-014, Alloprevotella, Christensenellaceae R-7 group, Ruminococcaceae UCG-005, Lactobacillus murinus, and Prevotella nigrescens) were found to inversely correlate with the apnea-hypopnea index (AHI). Significant post-AT improvements in AHI and other polysomnographic metrics were observed. Notably, AHI changes post-AT were positively associated with microbial α-diversity (species richness), β-diversity, and specific bacterial taxa (Enterobacter, Parasutterella, Akkermansia, Roseburia, and Bacteroides plebeius DSM 17135), but negatively with other taxa (Fusicatenibacter, Bifidobacterium, UBA1819, Ruminococcus gnavus group, Bifidobacterium longum subsp. Longum, and Parabacteroides distasonis) and specific metabolic pathways (purine metabolism, transcription factors, and type II diabetes mellitus). The postoperative patterns of α- and β-diversity mirrored baseline values. Conclusions and Relevance: This study documents significant changes in the gut microbiome of pediatric patients after AT, including variations in α- and β-diversities, bacterial communities, and inferred metabolic functions. These changes suggest a potential association between the surgical intervention and microbiome alterations, although further studies are necessary to discern the specific contributions of AT amidst possible confounding factors such as antibiotic use. [ABSTRACT FROM AUTHOR]

Summary Differential diagnosis of narcolepsy type 2 and idiopathic hypersomnia relies on the frequency of sleep‐onset rapid eye movement periods observed on the Multiple Sleep Latency Test. This study investigated whether variations in sleep schedules, particularly delayed sleep–wake patterns, contribute to the diagnostic distinction between narcolepsy type 2 and idiopathic hypersomnia. The study included 871 patients aged 18–39 years (316 with narcolepsy type 2, 555 with idiopathic hypersomnia). These patients were diagnosed based on MSLT results following polysomnography from November 2013 to November 2017. Patients' sleep habits, including bedtime and wake‐up times on weekdays and weekends during the 2 weeks preceding the polysomnography/Multiple Sleep Latency Test, were assessed using self‐reported sleep logs. A multivariate logistic regression analysis was conducted to identify factors associated with narcolepsy type 2 diagnosis. The analysis revealed that being male (p < 0.001), younger age (p < 0.001), shorter weekday sleep duration (p < 0.05), and a delayed weekday sleep midpoint time (p < 0.01) were significantly associated with a diagnosis of narcolepsy type 2. The study suggests that the conventionally fixed schedule of polysomnography and Multiple Sleep Latency Test administration may have contributed to the increased occurrence of sleep‐onset rapid eye movement periods particularly in individuals with a delayed sleep–wake schedule. [ABSTRACT FROM AUTHOR]

Introduction: Insomnia is associated with mild cognitive impairment, although the mechanisms of this impairment are not well-understood. Timing of slow-wave and rapid eye movement sleep may help explain cognitive impairments common in insomnia. This investigation aimed to determine whether cognitive changes following continuous theta-burst stimulation (cTBS) are attributable to active stimulation, polysomnographic parameters of sleep, or both. Method: Data presented here are part of a pilot clinical trial aiming to treat insomnia by targeting a node in the default mode network using an inhibitory 40-s (cTBS). A double-blind counterbalanced sham-controlled crossover design was conducted. Participants (N = 20) served as their own controls on two separate in-laboratory visits—one with active cTBS and the other with sham cTBS. Each visit included cognitive assessments before and after stimulation and following a night of sleep in the lab monitored with polysomnography. Results: Slow wave sleep duration influenced working memory in the active cTBS condition, with shorter duration predicting improvements in working memory post sleep (B = −0.003, p = 0.095). Onset latency to rapid eye movement sleep predicted subsequent working memory, regardless of treatment condition (B = −0.001, p = 0.040). Results suggest that changes in attention and processing speed were primarily due to slow wave sleep onset (B = −0.001, p = 0.017) and marginally predicted by slow wave sleep duration (B = 0.002, p = 0.081) and sleep efficiency (B = 0.006, p = 0.090). Conclusions: Findings emphasize the important role that timing of slow-wave and rapid eye movement sleep have on information processing. Future work using larger sample sizes and more stimulation sessions is needed to determine optimal interactions between timing and duration of slow wave and rapid eye movement throughout the sleep period. Clinical trial registration: This study is registered on ClinicalTrials.gov (NCT04953559). https://clinicaltrials.gov/study/NCT04953559?locStr=Arizona&country=United%20States&state=Arizona&cond=insomnia&intr=tms%20&rank=1 [ABSTRACT FROM AUTHOR]

Summary Obstructive sleep apnea diagnosis is based on the manual scoring of respiratory events. The agreement in the manual scoring of the respiratory events lacks an in‐depth investigation as most of the previous studies reported only the apnea–hypopnea index or overall agreement, and not temporal, second‐by‐second or event subtype agreement. We hypothesized the temporal and subtype agreement to be low because the event duration or subtypes are not generally considered in current clinical practice. The data comprised 50 polysomnography recordings scored by 10 experts. The respiratory event agreement between the scorers was calculated using kappa statistics in a second‐by‐second manner. Obstructive sleep apnea severity categories (no obstructive sleep apnea/mild/moderate/severe) were compared between scorers. The Fleiss' kappa value for binary (event/no event) respiratory event scorings was 0.32. When calculated separately within N1, N2, N3 and R, the Fleiss' kappa values were 0.12, 0.23, 0.22 and 0.23, respectively. Binary analysis conducted separately for the event subtypes showed the highest Fleiss' kappa for hypopneas to be 0.26. In 34% of the participants, the obstructive sleep apnea severity category was the same regardless of the scorer, whereas in the rest of the participants the category changed depending on the scorer. Our findings indicate that the agreement of manual scoring of respiratory events depends on the event type and sleep stage. The manual scoring has discrepancies, and these differences affect the obstructive sleep apnea diagnosis. This is an alarming finding, as ultimately these differences in the scorings affect treatment decisions. [ABSTRACT FROM AUTHOR]

Purpose: Soluble vascular adhesion protein-1 (sVAP-1) and adropin are 2 biomarkers of endothelial dysfunction. The main purpose of this study was to evaluate the levels of sVAP-1 in patients with moderate and severe obstructive sleep apnea (OSA) compared to healthy controls, and to further determine the relationship between sVAP-1 and adropin levels, as well as inflammatory biomarkers and sleep parameters. Methods: In this study, we included 50 male patients with OSA (25 moderate and 25 severe) and 20 age- and sex-matched control subjects. Patients with OSA underwent polysomnography. All subjects underwent fasting peripheral blood sampling for laboratory analysis. Results: Serum sVAP-1 and inflammatory biomarkers (IL-6, TNF-α, and hsCRP) levels were significantly higher in patients with severe OSA compared to those with moderate OSA and control groups, while plasma levels of adropin showed the opposite trend. Furthermore, sVAP-1 levels had a significant positive correlation with AHI, ODI, TNF-α, IL-6, and hsCRP levels and a significant negative correlation with adropin levels. The receiver operating characteristic analysis showed an Area Under Curve (AUC) of.876 (P <.001) for sVAP-1 levels predicting OSA. Serum sVAP-1 threshold of > 445.5 ng/mL had an 88% sensitivity and 80% specificity for detecting OSA status. Multivariate regression analysis demonstrated that sVAP-1 remained a significant positive predictor of OSA severity. Conclusions: Increased sVAP-1 levels in OSA patients are significantly correlated with indices of OSA severity, adropin levels, and inflammatory biomarkers, suggesting that sVAP-1 plays a vital role in the pathophysiology of OSA and may become a potential screening tool in the evaluation of OSA severity. [ABSTRACT FROM AUTHOR]

Hypoxia at high altitude facilitates changes in ventilatory control that can lead to nocturnal periodic breathing (nPB). Here, we introduce a placebo‐controlled approach to prevent nPB by increasing inspiratory CO2 and used it to assess whether nPB contributes to the adverse effects of hypoxia on sleep architecture. In a randomized, single‐blinded, crossover design, 12 men underwent two sojourns (three days/nights each, separated by 4 weeks) in hypobaric hypoxia corresponding to 4000 m altitude, with polysomnography during the first and third night of each sojourn. During all nights, subjects' heads were encompassed by a canopy retaining exhaled CO2, and CO2 concentration in the canopy (i.e. inspiratory CO2 concentration) was controlled by adjustment of fresh air inflow. Throughout the placebo sojourn inspiratory CO2 was ≤0.2%, whereas throughout the other sojourn it was increased to 1.76% (IQR, 1.07%–2.44%). During the placebo sojourn, total sleep time (TST) with nPB was 54.3% (37.4%–80.8%) and 45.0% (24.5%–56.5%) during the first and the third night, respectively (P = 0.042). Increased inspiratory CO2 reduced TST with nPB by an absolute 38.1% (28.1%–48.1%), the apnoea–hypopnoea index by 58.1/h (40.1–76.1/h), and oxygen desaturation index ≥3% by 56.0/h (38.9.1–73.2/h) (all P < 0.001), whereas it increased the mean arterial oxygen saturation in TST by 2.0% (0.4%–3.5%, P = 0.035). Increased inspiratory CO2 slightly increased the percentage of N3 sleep during the third night (P = 0.045), without other effects on sleep architecture. Increasing inspiratory CO2 effectively prevented hypoxia‐induced nPB without affecting sleep macro‐architecture, indicating that nPB does not explain the sleep deterioration commonly observed at high altitudes. Key points: Periodic breathing is common during sleep at high altitude, and it is unclear how this affects sleep architecture.We developed a placebo‐controlled approach to prevent nocturnal periodic breathing (nPB) with inspiratory CO2 administration and used it to assess the effects of nPB on sleep in hypobaric hypoxia.Nocturnal periodic breathing was effectively mitigated by an increased inspiratory CO2 fraction in a blinded manner.Prevention of nPB did not lead to relevant changes in sleep architecture in hypobaric hypoxia.We conclude that nPB does not explain the deterioration in sleep architecture commonly observed at high altitude. [ABSTRACT FROM AUTHOR]

Patients with OSA are at increased risk of postoperative cardiorespiratory complications and death. Attempts to stratify this risk have been inadequate, and predictors from large, well-characterized cohort studies are needed. What is the relationship between OSA severity, defined by various polysomnography-derived metrics, and risk of postoperative cardiorespiratory complications or death, and which metrics best identify such risk? In this cohort study, 6,770 consecutive patients who underwent diagnostic polysomnography for possible OSA and a procedure involving general anesthesia within a period of 2 years before and at least 5 years after polysomnography. Participants were identified by linking polysomnography and health databases. Relationships between OSA severity measures and the composite primary outcome of cardiorespiratory complications or death within 30 days of hospital discharge were investigated using univariable and multivariable analyses. The primary outcome was observed in 5.3% (n = 361) of the cohort. Although univariable analysis showed strong dose-response relationships between this outcome and multiple OSA severity measures, multivariable analysis showed its independent predictors were: age older than 65 years (OR, 2.67 [95% CI, 2.03-3.52]; P <.0001), age 55.1 to 65 years (OR, 1.47 [95% CI, 1.09-1.98]; P =.0111), time between polysomnography and procedure of ≥ 5 years (OR, 1.32 [95% CI, 1.02-1.70]; P =.0331), BMI of ≥ 35 kg/m2 (OR, 1.43 [95% CI, 1.13-1.82]; P =.0032), presence of known cardiorespiratory risk factor (OR, 1.63 [95% CI, 1.29-2.06]; P <.0001), > 4.7% of sleep time at an oxygen saturation measured by pulse oximetry of < 90% (T90; OR, 1.91 [95% CI, 1.51-2.42]; P <.0001), and cardiothoracic procedures (OR, 7.95 [95% CI, 5.71-11.08]; P <.0001). For noncardiothoracic procedures, age, BMI, presence of known cardiorespiratory risk factor, and percentage of sleep time at an oxygen saturation of < 90% remained the significant predictors, and a risk score based on their ORs was predictive of outcome (area under receiver operating characteristic curve, 0.7 [95% CI, 0.64-0.75]). These findings provide a basis for better identifying high-risk patients with OSA and determining appropriate postoperative care. [Display omitted] [ABSTRACT FROM AUTHOR]

The article "To Home-Routine-Sleep, or Not to Home-Routine-Sleep: That Is the Intensive Care Question" discusses the impact of sleep disruptions on critically ill children in the Pediatric Intensive Care Unit (PICU). Factors such as chaotic surroundings, pain, medications, and caregiving can disrupt circadian rhythms and inhibit melatonin production, leading to cognitive impairment. The study highlights the importance of maintaining consistent sleep routines and identifies modifiable factors like sound pollution and nutrition timing that can impact sleep quality in the PICU. While the study provides valuable insights, methodological weaknesses limit the robustness of its conclusions, emphasizing the need for further research to develop effective sleep-promoting interventions for critically ill children. [Extracted from the article]

Purpose: To investigate the nasal cycle (NC) during sleep in healthy individuals without nasal obstruction or obstructive sleep apnoea via a flexible wearable respiratory monitoring system in a continuous and real-time manner. Methods: NC during sleep was continuously measured in 30 healthy individuals (15 women, 15 men) via long-term sleep respiratory monitoring system, while sleep stage and body position were simultaneously recorded via polysomnography (PSG). The number of NC transitions and positional changes were documented each night. Additionally, time intervals between NC transitions and their closest positional changes during sleep were meticulously recorded to investigate potential correlations between them. Results: A total of 86.7% of the participants displayed the classic NC, with a mean duration of 6.43 ± 2.33 h. Nightly observations revealed an average occurrence of 2.19 ± 0.40 NC transitions, predominantly occurring during REM stage (68.4%), and 9.15 ± 7.77 postural changes. Analysis of the intervals between NC transitions and positional changes revealed an average absolute value of 27.72 ± 10.85 min, with a substantial 56.4% exceeding 30 min, indicating a non-obvious sequence order among them. Conclusion: NC can be measured in a continuous and real-time manner, the transitions occur mainly during the REM stage. However, we have not identified a clear correlation between NC transition and positional change. [ABSTRACT FROM AUTHOR]

Introduction: Sleep disturbances are being increasingly recognized in association with autoimmune encephalitis (AIE). We investigated the prevalence of sleep-related symptoms and polysomnographic features of patients with AIE and the long-term outcomes in these patients in a multi-center, prospective study from Turkey. Methods: We prospectively evaluated patients with definite AIE in a common database including demographics, AIE-related and sleep-related symptomatology. Maximum and latest modified Rankin scores (mRS) and Liverpool Outcome Score (LOS) were noted. Results: Of 142 patients, 87 patients (61.3%) fulfilled the criteria for definite AIE (mean age, 46.8+18.8 years; 51.7% women; mean disease duration, 21.0+38.4 months). 78.9% of patients had at least one or more new onset or worsened sleep-related symptomatology: insomnia (55.3%), excessive daytime sleepiness (EDS, 28.0%), sleep apnea (18.7%), REM sleep behavior disorder (RBD, 17.3%), restless legs syndrome (10.7%) and oneiric stupor (9.3%). Sleep efficiency, N3 and REM sleep were decreased and N1 sleep was increased in patients with Ab[+] AIE. LOS points were highest in those with insomnia and sleep apnea, and lowest in those with EDS, RBD and oneiric stupor. RBD and sleep apnea were more common in anti-LG1 Ab[+] group than anti-NMDAR Ab[+] group. Index of periodic leg movements was highest in anti-LG1 Ab[+] group. Patients with EDS and oneiric stupor had more common memory problems. Maximum and latest mRS scores were positively correlated with EDS and oneiric stupor. EDS, RBD and oneiric stupor were negatively correlated with LOS points. Conclusion: Our study emphasizes the presence and importance of early diagnosis of sleep disturbances in AIE in regard to their deteriorative influences on disease prognosis. [ABSTRACT FROM AUTHOR]

Increased arterial stiffness is independently associated with cardiovascular risk. Obstructive sleep apnea (OSA) and sleep duration (SDUR) may contribute to increased arterial stiffness, but it is unclear whether this association is modulated by gender. We aimed to evaluate the potential impact of gender in modulating the association of OSA and SDUR with arterial stiffness. Participants from the ELSA-Brasil study performed sleep assessments with portable polygraph to define OSA severity and SDUR by 1-week wrist actigraphy. Pulse wave velocity (PWV) was measured using a standard technique without access to the sleep data. We studied 1863 participants (42.2% male, age: 49±8 years, respiratory disturbance index (RDI): 9.9 (4.5–19.4) events/h, SDUR: 6.5 (5.9–7.1) hours, mean PWV: 7.3 ± 1.2 m/s). We found that men had higher PWV, higher frequency of diabetes, and higher blood pressure when compared to women. The regression analysis showed an independent association between increased RDI and PWV in men (ß: 0.007; 95% CI: 0.001–0.012), but not in women. In contrast, an independent association between SDUR and increased arterial stiffness was observed only in women (ß: 0.068; 95% CI: 0.002–0.134). In conclusion, the association of sleep disorders with arterial stiffness showed a distinct gender pattern depending on the sleep variable studied. [ABSTRACT FROM AUTHOR]

• We systemically examined the link between sleep and blood pressure variability (BPV). • There were mixed results on the associations between sleep and increased BPV. • Poor sleep quality and longer sleep duration may have a positive association with BPV. • Further research is warranted to assess sleep and BPV under free-living conditions. Blood pressure variability (BPV) is a prognostic marker of cardiovascular disease (CVD). Sleep is recognized as a significant risk factor for CVD; however, little is known about the relationship between sleep characteristics and BPV. In this systematic review, we aimed to (1) describe methods used to measure BPV and sleep and (2) describe the current evidence in the literature on the association between sleep and BPV. A systematic search was conducted using the search terms "sleep" AND ("blood pressure variability" OR "ambulatory blood pressure monitor") in CINAHL, PubMed, Web of Science, and PsycINFO databases. Twenty-two studies were included in this systematic review. Sleep was measured using various methods, including polysomnography, actigraphy, sleep diaries, and questionnaires, while BPV was measured over various time intervals using different monitoring devices such as a beat-to-beat blood pressure (BP) monitoring device, a 24-h ambulatory BP monitor, or an automatic upper arm BP monitor. The studies demonstrated mixed results on the associations between sleep parameters (sleep quality, architecture, and duration) and increased BPV. Although the mechanisms that explain the relationship between sleep and BPV are still unclear, accumulating evidence suggests potential associations between increased BPV with poor sleep quality and longer sleep duration. Given the recent development of sleep and BP monitoring technologies, further research is warranted to assess sleep and BPV under free-living conditions. Such studies will advance our understanding of complex interactions between sleep and CVD risk. [ABSTRACT FROM AUTHOR]

In clinical practice, sleep stage classification (SSC) is a crucial step for physicians in sleep assessment and sleep disorder diagnosis. However, traditional sleep stage classification relies on manual work by sleep experts, which is time-consuming and labor-intensive. Faced with this obstacle, computer-aided diagnosis (CAD) has the potential to become an intelligent assistant tool for sleep experts, aiding doctors in the assessment and decision-making process. In fact, in recent years, CAD supported by artificial intelligence, especially deep learning (DL) techniques, has been widely applied in SSC. DL offers higher accuracy and lower costs, making a significant impact. In this paper, we will systematically review SSC research based on DL methods (DL-SSC). We explores DL-SSC from several important perspectives, including signal and data representation, data preprocessing, deep learning models, and performance evaluation. Specifically, this paper addresses three main questions: (1) What signals can DL-SSC use? (2) What are the various methods to represent these signals? (3) What are the effective DL models? Through addressing on these questions, this paper will provide a comprehensive overview of DL-SSC. [ABSTRACT FROM AUTHOR]

Hypoxia at high altitude facilitates changes in ventilatory control that can lead to nocturnal periodic breathing (nPB). Here, we introduce a placebo‐controlled approach to prevent nPB by increasing inspiratory CO2 and used it to assess whether nPB contributes to the adverse effects of hypoxia on sleep architecture. In a randomized, single‐blinded, crossover design, 12 men underwent two sojourns (three days/nights each, separated by 4 weeks) in hypobaric hypoxia corresponding to 4000 m altitude, with polysomnography during the first and third night of each sojourn. During all nights, subjects' heads were encompassed by a canopy retaining exhaled CO2, and CO2 concentration in the canopy (i.e. inspiratory CO2 concentration) was controlled by adjustment of fresh air inflow. Throughout the placebo sojourn inspiratory CO2 was ≤0.2%, whereas throughout the other sojourn it was increased to 1.76% (IQR, 1.07%–2.44%). During the placebo sojourn, total sleep time (TST) with nPB was 54.3% (37.4%–80.8%) and 45.0% (24.5%–56.5%) during the first and the third night, respectively (P = 0.042). Increased inspiratory CO2 reduced TST with nPB by an absolute 38.1% (28.1%–48.1%), the apnoea–hypopnoea index by 58.1/h (40.1–76.1/h), and oxygen desaturation index ≥3% by 56.0/h (38.9.1–73.2/h) (all P < 0.001), whereas it increased the mean arterial oxygen saturation in TST by 2.0% (0.4%–3.5%, P = 0.035). Increased inspiratory CO2 slightly increased the percentage of N3 sleep during the third night (P = 0.045), without other effects on sleep architecture. Increasing inspiratory CO2 effectively prevented hypoxia‐induced nPB without affecting sleep macro‐architecture, indicating that nPB does not explain the sleep deterioration commonly observed at high altitudes. Key points: Periodic breathing is common during sleep at high altitude, and it is unclear how this affects sleep architecture.We developed a placebo‐controlled approach to prevent nocturnal periodic breathing (nPB) with inspiratory CO2 administration and used it to assess the effects of nPB on sleep in hypobaric hypoxia.Nocturnal periodic breathing was effectively mitigated by an increased inspiratory CO2 fraction in a blinded manner.Prevention of nPB did not lead to relevant changes in sleep architecture in hypobaric hypoxia.We conclude that nPB does not explain the deterioration in sleep architecture commonly observed at high altitude. [ABSTRACT FROM AUTHOR]

Objectives: To determine the cause of obstructive sleep-disordered breathing using drug-induced sleep endoscopy (DISE) in infants without co-morbidities and with normal clinical examination. Methods: This prospective study was conducted between December 2019 and June 2022 (31 mo). All infants referred for obstructive sleep-disordered breathing with normal clinical examination and flexible laryngoscopy were included and underwent DISE. The location of the obstructive sites was scored similarly according to the NAVOTEL scoring system, previously established and validated by authors' team. Results: Thirty-two infants were included. DISE identified an obstructive site in 94% of cases. The mean age was 16.4 mo, and the median was 16.7 mo. The obstructive sites found were isolated sleep laryngomalacia (37.4%), adenotonsillar hypertrophy (21.8%), isolated adenoidal hypertrophy (6.3%), adenotonsillar hypertrophy associated with sleep laryngomalacia (6.3%), circumferential upper airway narrowing (6.3%), glossoptosis (6.3%), isolated inferior turbinate hypertrophy (3.1%), adenoidal and tongue base hypertrophy (3.1%), and adenoidal hypertrophy with sleep laryngomalacia (3.1%). No obstructive causes could be found in 2 cases (6.3%). DISE identified an obstructive site in 30/32 patients (93.8%) and guided the surgical management in 26/32 cases (81.3%) during the same general anesthesia. The infants without surgical obstacles were referred for medical treatment. Conclusions: DISE is an excellent diagnostic and pre-therapeutic tool in infants with no apparent cause at the awake examination to identify the obstructive sites and guide the treatment. [ABSTRACT FROM AUTHOR]

Introduction: Little was known about the relationship between sleep disturbances and depressive and anxiety disorders, as well as the efficacy of treatment regimens. Methods: During 2021 to 2023, a total of 417 participants were screened by Hamilton Depression Rating Scale (HAMD-17) and Hamilton Anxiety Rating Scale (HAMA-14) for psychological status, and Pittsburgh sleep quality index (PSQI) assessment. 409 participants were finally enrolled, of which 188 (45.97%) were suffered from sleep disorders. All participants were received polysomnography (PSG) followed by six-week pharmacological treatment of escitalopram and zopiclone, and finally assessed by HAMD-17 and HAMA-14 for treatment efficacy. Result: PSG monitoring indicated that participants with depression experienced prolonged rapid eye movement sleep latency (REMSL) and increased wakefulness after sleep onset (WASO) (P=0.030 and P=0.002, respectively). Those with anxiety disorders demonstrated a significantly higher percentage of non-rapid eye movement sleep (NREM%) and reduced WASO (P=0.013 and P=0.001, respectively). After six-weeks pharmacological treatment, participants with or without sleep disorders exhibited with similar efficacy outcomes of depression and anxiety disorders (P>0.05). However, every point of PSQI increment at baseline would decrease 0.78 and 0.85 times of probability of effective pharmacological treatment of depression and anxiety disorders. Moreover, participants with both effective outcomes of depression and anxiety disorders were found significant shorter sleep onset latency (SOL) (P<0.001). Discussion: The insights gained underscore the necessity of considering sleep disturbances in enhancing the overall effectiveness of pharmacological treatments for depression and anxiety disorders. [ABSTRACT FROM AUTHOR]

Summary Obstructive sleep apnea is a heterogeneous sleep disorder with varying phenotypes. Several studies have already performed cluster analyses to discover various obstructive sleep apnea phenotypic clusters. However, the selection of the clustering method might affect the outputs. Consequently, it is unclear whether similar obstructive sleep apnea clusters can be reproduced using different clustering methods. In this study, we applied four well‐known clustering methods: Agglomerative Hierarchical Clustering; K‐means; Fuzzy C‐means; and Gaussian Mixture Model to a population of 865 suspected obstructive sleep apnea patients. By creating five clusters with each method, we examined the effect of clustering methods on forming obstructive sleep apnea clusters and the differences in their physiological characteristics. We utilized a visualization technique to indicate the cluster formations, Cohen's kappa statistics to find the similarity and agreement between clustering methods, and performance evaluation to compare the clustering performance. As a result, two out of five clusters were distinctly different with all four methods, while three other clusters exhibited overlapping features across all methods. In terms of agreement, Fuzzy C‐means and K‐means had the strongest (κ = 0.87), and Agglomerative hierarchical clustering and Gaussian Mixture Model had the weakest agreement (κ = 0.51) between each other. The K‐means showed the best clustering performance, followed by the Fuzzy C‐means in most evaluation criteria. Moreover, Fuzzy C‐means showed the greatest potential in handling overlapping clusters compared with other methods. In conclusion, we revealed a direct impact of clustering method selection on the formation and physiological characteristics of obstructive sleep apnea clusters. In addition, we highlighted the capability of soft clustering methods, particularly Fuzzy C‐means, in the application of obstructive sleep apnea phenotyping. [ABSTRACT FROM AUTHOR]

Summary State‐of‐the‐art automatic sleep staging methods have demonstrated comparable reliability and superior time efficiency to manual sleep staging. However, fully automatic black‐box solutions are difficult to adapt into clinical workflow due to the lack of transparency in decision‐making processes. Transparency would be crucial for interaction between automatic methods and the work of sleep experts, i.e., in human‐in‐the‐loop applications. To address these challenges, we propose an automatic sleep staging model (aSAGA) that effectively utilises both electroencephalography and electro‐oculography channels while incorporating transparency of uncertainty in the decision‐making process. We validated the model through extensive retrospective testing using a range of datasets, including open‐access, clinical, and research‐driven sources. Our channel‐wise ensemble model, trained on both electroencephalography and electro‐oculography signals, demonstrated robustness and the ability to generalise across various types of sleep recordings, including novel self‐applied home polysomnography. Additionally, we compared model uncertainty with human uncertainty in sleep staging and studied various uncertainty mapping metrics to identify ambiguous regions, or “grey areas”, that may require manual re‐evaluation. The validation of this grey area concept revealed its potential to enhance sleep staging accuracy and to highlight regions in the recordings where sleep experts may struggle to reach a consensus. In conclusion, this study provides a technical basis and understanding of automatic sleep staging uncertainty. Our approach has the potential to improve the integration of automatic sleep staging into clinical practice; however, further studies are needed to test the model prospectively in real‐world clinical settings and human‐in‐the‐loop scoring applications. [ABSTRACT FROM AUTHOR]

Introduction: There is a high prevalence of sleep disturbances and disorders such as obstructive sleep apnea (OSA) in children with attention-deficit hyperactivity disorder (ADHD), though this relationship remains poorly characterized by objective measures. Polysomnographic studies (PSGs) on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated vs. non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA. Methods: Medical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019 to 2022. ADHD diagnosis was determined by ICD code F90, andOSA was defined by apnea-hypopnea indices (AHI)≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA alone, children with ADHD alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest. Results: 4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA alone (29.8%), 333 with ADHD alone (8.3%), and 111 with ADHD and OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD alone. However, they exhibited significantly better sleep efficiency (SE), than children with OSA alone, and SE did not significantly differ from the other groups. No significant difference in periodic limbmovements (PLMs) was found across all groups. The above results held true even after correcting for stimulant prescription. Conclusion: The increased frequency of clinical insomnia diagnoses in children with ADHD is not associated with any traditional parameters on polysomnogram. Innovative subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with both ADHDandOSA, PSG results do not reveal any distinctive sleep disturbances which cannot be better explained by OSA alone. These findings underscore the importance of screening for OSA in patients with ADHD and clinically assessing for other sleep concerns. [ABSTRACT FROM AUTHOR]

Summary The ‘first night effect’ (FNE) is a well‐known phenomenon in polysomnographic (PSG) sleep studies, resulting in significant variations in the macrostructure of wakefulness and sleep states, particularly between the initial and subsequent sleep recording sessions. The FNE phenomenon during sleep has been studied in various species, revealing complex variations between several sessions of sleep recording. The present study used a non‐invasive PSG method to examine differences between various vigilance states in four adult female dromedary camels during 4 consecutive nights and days of sleep recording. The results indicate the presence of a FNE in the architecture of the dromedary camel's vigilance states. On the first night, the proportions of wakefulness and light non‐rapid eye movment (NREM) sleep (drowsiness) were higher, at a mean (standard error of the mean [SEM]) of 40.92% (0.88%) and 14.93% (0.37%), respectively; while the proportion of rumination (mean [SEM] 29.55% [0.92%]) was lower compared to consecutive nights. No FNE was found on deep NREM sleep, while night‐time REM sleep had a shorter proportion during the first night compared to subsequent consecutive nights. A significantly lower REM/total sleep time (TST) ratio was observed on the first night. Daytime comparisons did not show any significant differences for the different vigilance states. The increase in wakefulness and light NREM sleep and the reduction in REM sleep and REM/TST sleep on the first night indicate a decline in sleep quality in the dromedary camel due to the FNE. Thus, we recommend excluding from a PSG sleep study at least the first session/night of the recordings to ensure accurate results. [ABSTRACT FROM AUTHOR]

Background: Snoring is an inspiratory noise due to partialobstruction of the upper airways. It is commonly linked to a sleep problem known as obstructive sleep apnea (OSA). The clinical criteria of OSA in non-obese patients are distinct and warrant more investigation, despite being well-studied in the obese population. Objective: The aim of this study is to provide a diagnostic profile of snoring and OSA in non-obese patients using various assessment tools in order to identify upper airway obstruction patterns and potential risk factors in these patients to improve their management and prevent related comorbidities. Methodology: An observational cross-sectional study of 30 non-obese (BMI < 29.9) snorers (18 males and 12 females) with a mean age of 38.13 ± 8.4 years. All patients underwent polysomnography and thorough clinical examination, including searching for possible risk factors/co-morbidity, Epworth Sleepiness Score (ESS), Mallampati score, awake upper airway endoscopy combined with Muller maneuver, and drug-induced sleep endoscopy (DISE). Results: OSA presented in 80% of our patients, the age range of 17–58 years, apnea–hypopnea index (AHI) mean 20.63 ± 17.8 event/h, and its severity was mild 7 (23.3%), moderate 6 (20%), and severe 11 (36.7%). Findings of oral and nasal examination showed no association with AHI. Also, sleep endoscopy findings regarding specific structures causing upper airway obstruction showed no significant association. A positive correlation was found between the extent of retropalatal airway collapse and AHI. A notable association was found between smoking and AHI as a risk factor for OSA in non-obese individuals. No significant relationship was found between ESS, concomitant diseases, and AHI. Conclusion: OSA is common in non-obese patients and probably may be attributed to retropalatal/oropharyngeal airway collapse and associated with smoking as a risk factor. Further studies are warranted to reveal other pathophysiological aspects in this group of patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Obstructive sleep apnea (OSA) and obstructive lung diseases (OLD) are common and interdependent respiratory disorders, where one condition may contribute to the development and worsening of the other (OLDOSA syndrome). The term OLDOSA syndrome includes two different conditions: Overlap syndrome (OVS: OSA + chronic obstructive pulmonary disease, COPD) and Alternative Overlap syndrome (aOVS: OSA + Asthma). Data on the interactions between lung function and respiratory monitoring during sleep in OLDOSA patients are few and controversial. Our study aims to evaluate the impact of lung function impairment on sleep breathing disorders, paying attention to the lack of literature about comparisons between OVS, aOVS, and the impact of small airways disease (SAD) in these patients. Methods: In total, 101 patients with a diagnosis of OSA and asthma or COPD underwent pulmonary function tests (PFTs) and nocturnal home sleep cardiorespiratory monitoring (HSCM). Exclusion criteria: Obesity hypoventilation syndrome (OHS) and other non-respiratory sleep disorders. Results: Sleep time with oxygen saturation below 90% (T90) was negatively correlated with forced expiratory volume in the first second, % of predicted (%FEV1), forced vital capacity, % of predicted (%FVC), forced expiratory flow at 25–75% of the pulmonary volume, % of predicted (%FEF25–75), and, after multivariable linear regression analysis, %FEF25–75 remained an independent factor for T90 with a negative correlation in mild and moderate OSA. Obstructive apnea index (oAI) and FEV1/FVC were negatively correlated in mild and moderate OSA. OVS presented with more severe OSA (higher AHI, oAI, and T90) and SAD (lower FEF25–75) compared to aOVS. Conclusions: This study highlights a possible interdependence between OLD and OSA; obstruction of the large and small airways at PFTs contributes to the worsening of these patients' nocturnal hypoxemia and obstructive events of the upper airway during sleep. Furthermore, this study shows that patients with OVS should be carefully monitored, as they present worse data at HSCM and have greater small airways involvement compared to aOVS. [ABSTRACT FROM AUTHOR]

Sleep tracking by consumers is becoming increasingly prevalent; yet, few studies have evaluated the accuracy of such devices. We sought to evaluate the accuracy of three devices (Oura Ring Gen3, Fitbit Sense 2, and Apple Watch Series 8) compared to the gold standard sleep assessment (polysomnography (PSG)). Thirty-five participants (aged 20–50 years) without a sleep disorder were enrolled in a single-night inpatient study, during which they wore the Oura Ring, Fitbit, and Apple Watch, and were monitored with PSG. For detecting sleep vs. wake, the sensitivity was ≥95% for all devices. For discriminating between sleep stages, the sensitivity ranged from 50 to 86%, as follows: Oura ring sensitivity 76.0–79.5% and precision 77.0–79.5%; Fitbit sensitivity 61.7–78.0% and precision 72.8–73.2%; and Apple sensitivity 50.5–86.1% and precision 72.7–87.8%. The Oura ring was not different from PSG in terms of wake, light sleep, deep sleep, or REM sleep estimation. The Fitbit overestimated light (18 min; p < 0.001) sleep and underestimated deep (15 min; p < 0.001) sleep. The Apple underestimated the duration of wake (7 min; p < 0.01) and deep (43 min; p < 0.001) sleep and overestimated light (45 min; p < 0.001) sleep. In adults with healthy sleep, all the devices were similar to PSG in the estimation of sleep duration, with the devices also showing moderate to substantial agreement with PSG-derived sleep stages. [ABSTRACT FROM AUTHOR]

Background: Excessive daytime sleepiness (EDS) is a common complication of stroke that has a detrimental effect on patients' daily life and functional recovery. The clinical characteristics and risk factors for poststroke EDS may differ between males and females. Methods: A retrospective study based on hospital medical records was conducted on patients with a diagnosis of stroke who participated in polysomnographic monitoring at the Affiliated Hospital of Yangzhou University from February 2022 to May 2024. Baseline data, laboratory test data, polysomnographic data, and related scale scores were retrospectively collected. The Epworth Sleepiness Scale (ESS) score was used to assess EDS after stroke. Binary logistic regression was used to determine the risk factors for daytime sleepiness. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed via IBM SPSS 26.0. Results: ESS scores were higher in males than in females, whereas females had higher Pittsburgh Sleep Quality Index (PSQI) scores and Hospital Anxiety and Depression Scale (HADS) scores. Male sex and higher depression scores were risk factors for EDS; among male patients, higher anxiety scores were a risk factor for EDS, whereas smoking was a protective factor. Depression, a higher arousal index and a reduced proportion of N3 sleep periods were risk factors for EDS in females. Conclusions: The characteristics and influencing factors of EDS differ between the sexes in patients with mild and moderate ischaemic stroke. Our study may provide evidence and guidance for clinical diagnosis and treatment. Interventional studies are needed to assess the impact of treating these risk factors in the future. [ABSTRACT FROM AUTHOR]

Changes in sleep and circadian function are leading candidate markers for the detection of relapse in Major Depressive Disorder (MDD). Consumer-grade wearable devices may enable remote and real-time examination of dynamic changes in sleep. Fitbit data from individuals with recurrent MDD were used to describe the longitudinal effects of sleep duration, quality, and regularity on subsequent depression relapse and severity. Data were collected as part of a longitudinal observational mobile Health (mHealth) cohort study in people with recurrent MDD. Participants wore a Fitbit device and completed regular outcome assessments via email for a median follow-up of 541 days. We used multivariable regression models to test the effects of sleep features on depression outcomes. We considered respondents with at least one assessment of relapse (n = 218) or at least one assessment of depression severity (n = 393). Increased intra-individual variability in total sleep time, greater sleep fragmentation, lower sleep efficiency, and more variable sleep midpoints were associated with worse depression outcomes. Adjusted Population Attributable Fractions suggested that an intervention to increase sleep consistency in adults with MDD could reduce the population risk for depression relapse by up to 22 %. Limitations include a potentially underpowered primary outcome due to the smaller number of relapses identified than expected. Our study demonstrates a role for consumer-grade activity trackers in estimating relapse risk and depression severity in people with recurrent MDD. Variability in sleep duration and midpoint may be useful targets for stratified interventions. • High intraindividual variability in sleep parameters is associated with worse depression outcomes over time. • An intervention targeting sleep consistency in MDD could reduce the risk of relapse by up to 20 %. • Wearable technologies can collect information that is useful for predicting depression outcomes. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes. Objectives: To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA. Design: A pilot randomized, double-blind, placebo-controlled trial. Setting: A tertiary university hospital in Beijing, China. Patients: One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28  mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022. Intervention: After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02  μg/kg/h) or placebo. We monitored polysomnogram from 9:00  pm to 6:00  am during the first night. Main outcome measures: Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0–100 score range, higher score better). Results: All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p  =  0.029); it also decreased the percentage of stage N1 sleep (median difference, −10%; 95% CI, −20% to −1%; p  =  0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p  =  0.060). Adverse events were similar between groups. Conclusion: Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance is prevalent among cancer patients. The quantification of this sleep disturbance is missing, especially in palliative care settings. Aim: The aim of this study was to study the sleep patterns of the patients undergoing palliative chemotherapy and radiotherapy for head and neck cancer (HNC) using a Fitbit Charge 4 sleep-tracking device. Design: Prospective observational study. Setting: A total of 110 HNC patients undergoing palliative chemotherapy and radiotherapy at a tertiary care teaching hospital in Central India. Results: Forty-four percent of patients had a poor sleep score (less than 60). Average sleep duration was 218.66 ± 139.05 min; non-rapid eye movement (NREM) sleep duration 197.7 ± 115.91 (light NREM 171.36 ± 104 and deep NREM 23.36 ± 16.73); REM sleep duration was 30.44 ± 34.14 min. The Pittsburgh Sleep Quality Index was 10.23 ± 3.45, which indicated sleep deprivation over the past 1 month. Moderate levels of anxiety, depression, confusion, and distress existed in the cohort. Statistically significant but weak correlation existed between sleep score, anxiety, and depression. Strong correlation existed between distress score and sleep score. Confusion score did not have a significant correlation with sleep score. Conclusion: HNC patients in palliative care settings were chronically sleep deprived. Sleep architecture was also disturbed. Moderate levels of anxiety, depression, confusion, and distress existed in the studied cohort; these psychosocial disturbances had a weak correlation with the sleep score and are likely to be multifactorial. Trial registration: Institutional Ethics Committee number: IHEC-LOP/2020/IM0349. The study has been registered with clinical trial registry of India with registration number CTRI/2021/03/032400 (http://www.ctri.in). [ABSTRACT FROM AUTHOR]

We used numerical methods to define the normative structure of the different stages of sleep and wake (W) in a pilot study of 19 participants without pathology (18–64 years old) using a double-banana bipolar montage. Artefact-free 120–240 s epoch lengths were visually identified and divided into 1 s windows with a 10% overlap. Differential channels were grouped into frontal, parieto-occipital, and temporal lobes. For every channel, the power spectrum (PS) was calculated via fast Fourier transform and used to compute the areas for the delta (0–4 Hz), theta (4–8 Hz), alpha (8–13 Hz), and beta (13–30 Hz) bands, which were log-transformed. Furthermore, Pearson's correlation coefficient and coherence by bands were computed. Differences in logPS and synchronization from the whole scalp were observed between the sexes for specific stages. However, these differences vanished when specific lobes were considered. Considering the location and stages, the logPS and synchronization vary highly and specifically in a complex manner. Furthermore, the average spectra for every channel and stage were very well defined, with phase-specific features (e.g., the sigma band during N2 and N3, or the occipital alpha component during wakefulness), although the slow alpha component (8.0–8.5 Hz) persisted during NREM and REM sleep. The average spectra were symmetric between hemispheres. The properties of K-complexes and the sigma band (mainly due to sleep spindles—SSs) were deeply analyzed during the NREM N2 stage. The properties of the sigma band are directly related to the density of SSs. The average frequency of SSs in the frontal lobe was lower than that in the occipital lobe. In approximately 30% of the participants, SSs showed bimodal components in the anterior regions. qEEG can be easily and reliably used to study sleep in healthy participants and patients. [ABSTRACT FROM AUTHOR]

Objective: Levodopa‐induced dyskinesia (DYS) adversely affects the quality of life of Parkinson's disease (PD) patients. However, few studies have focused on the relationship between DYS and sleep and electroencephalography (EEG). Our study aimed to establish the objective physiological indicators assessed by polysomnography (PSG) that are associated with DYS in PD patients. Method s : We enrolled 122 patients with PD, divided into two groups: PD with DYS (n = 27) and PD without DYS group (non‐DYS, n = 95). The demographics and clinical characteristics and sleep assessment in the two groups were collected. More importantly, overnight six‐channel PSG parameters were compared in the two groups. We also compared different bands and brain regions of average power spectral density within each group. Results: Compared with the non‐DYS group, the DYS group tended to have a significantly higher percentage of nonrapid eye movement sleep (NREM). Gender, levodopa equivalent daily dose (LEDD), rapid eye movement (REM) sleep (min), and the NREM percentage were positively correlated with the occurrence of DYS. After adjusting for gender, disease duration, LEDD, taking amantadine or not, and Montreal Cognitive Assessment (MoCA), NREM%, N3%, and REM (min), the percentage of NREM sleep (p = 0.035), female (p = 0.002), and LEDD (p = 0.005), and REM sleep time (min) (p = 0.012) were still associated with DYS. There was no significant difference in whole‐night different bands of average power spectral density between two groups. There was no significant difference in normalized average power spectral density of slow wave activity (SWA) (0.5–2 Hz, 0.5–4 Hz, and 2–4 Hz) of early and late NREM sleep in the DYS group. Dynamic normalized average power spectral density of SWA of low‐frequency (0.5–2 Hz) reduction in the frontal region (p = 0.013) was associated with DYS in logistic regression after adjusting for confounding factors. Conclusion: PD patients with DYS have substantial sleep structure variations. Higher NREM percentage and less REM percentage were observed in PD patients with DYS. Dynamic normalized average power spectral density of low‐frequency (0.5–2 Hz) SWA reduction in the frontal area could be a new electrophysiological marker of DYS in PD. [ABSTRACT FROM AUTHOR]

Study objective: The aim of our study was to elucidate differences in brain activity patterns among obstructive sleep apnea (OSA) patients, OSA patients with depressive symptoms, and healthy controls (HCs). We also investigated the relationship between brain function and depression in OSA patients. Methods: A total of 95 subjects were included in the study, including 34 OSA patients without depressive symptoms, 31 OSA patients with depressive symptoms, and 30 HCs. The 53‐channel functional near‐infrared spectroscopy (fNIRS) was used to monitor the concentration of oxy‐hemoglobin (Oxy‐Hb) in the brain, whereas the participants performed the verbal fluency task, and the degree of depression was scored using the 17‐item Hamilton Rating Scale for Depression (HAMD‐17). Hierarchical regression models were conducted to analyze the association of fNIRS features with depressive symptom. Results: The Oxy‐Hb changes of the three groups were significantly different in Channels 25 (H = 9.878, p =.007) and 43 (H = 6.957, p =.031). Inter‐group comparisons showed that the Oxy‐Hb change of Channel 25 (located in the dorsolateral prefrontal cortex [DLPFC]) in OSA group was less than that in HC group (p =.006), and the Oxy‐Hb change of Channel 43 (located in the right frontal polar region) in OSA group with depression was less than that in OSA group (p =.025). Spearman's test showed that there was a significant negative correlation between HAMD‐17 scores and mean Oxy‐Hb changes in Channel 43 (r = −.319, p <.05) in the OSA patients. Using hierarchical regression, Oxy‐Hb changes in Channel 43 accounted for a significant proportion of the variation in outcome variables, even when accounting for other polysomnography features. Conclusions: Changes in the hemodynamic response of DLPFC may be a potential mechanism of executive dysfunction in OSA patients. And the right frontal polar region may be significant in assessing depressive symptoms in patients with OSA. [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]

Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea. The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter. [ABSTRACT FROM AUTHOR]

Summary: Electroencephalograms can capture brain oscillatory activities during sleep as a form of electrophysiological signals. We analysed electroencephalogram recordings from full‐night in‐laboratory polysomnography from 100 patients with Down syndrome, and 100 age‐ and sex‐matched controls. The ages of patients with Down syndrome spanned 1 month to 31 years (median 4.4 years); 84 were younger than 12 years, and 54 were male. From each electroencephalogram, we extracted relative power in six frequency bands or rhythms (delta, theta, alpha, slow sigma, fast sigma, and beta) from six channels (frontal F3 and F4, central C3 and C4, and occipital O1 and O2) during five sleep stages (N3, N2, N1, R and W)—180 features in all. We examined differences in relative power between Down syndrome and control electroencephalograms for each feature separately. During wake and N1 sleep stages, alpha rhythms (8.0–10.5 Hz) had significantly lower power in patients with Down syndrome than controls. Moreover, the rate of increase in alpha power with age during rapid eye movement sleep was significantly slower in Down syndrome than control subjects. During wake and N1 sleep, delta rhythms (0.25–4.5 Hz) had higher power in patients with Down syndrome than controls. During N2 sleep, slow sigma rhythms (10.5–12.5 Hz) had lower power in patients with DS than controls. These findings extend previous research from routine electroencephalogram studies demonstrating that patients with Down syndrome had reduced circadian amplitude—the difference between wake alpha power and deep sleep delta power was smaller in Down syndrome than control subjects. We envision that these brain oscillatory activities may be used as surrogate markers for clinical trials for patients with Down syndrome. [ABSTRACT FROM AUTHOR]

Summary: The accuracy of actigraphy for sleep staging is assumed to be poor, but examination is limited. This systematic review aimed to assess the performance of actigraphy in sleep stage classification of adults. A systematic search was performed using MEDLINE, Web of Science, Google Scholar, and Embase databases. We identified eight studies that compared sleep architecture estimates between wrist‐worn actigraphy and polysomnography. Large heterogeneity was found with respect to how sleep stages were grouped, and the choice of metrics used to evaluate performance. Quantitative synthesis was not possible, so we performed a narrative synthesis of the literature. From the limited number of studies, we found that actigraphy‐based sleep staging had some ability to classify different sleep stages compared with polysomnography. [ABSTRACT FROM AUTHOR]

Summary: The current study determined the extent to which sleep–wake state discrepancy impairs the efficacy of cognitive behavioural therapy for insomnia in a real‐world clinical sample. Sleep–wake state discrepancy occurs when there is an inconsistency between a person's subjective and objective sleep, and is a common phenomenon amongst patients with insomnia. Limited information is available on the effectiveness of cognitive behavioural therapy for insomnia in treating patients who experience significant sleep–wake state discrepancy in "real‐world" samples. In the present study, all patients with insomnia received cognitive behavioural therapy for insomnia through an outpatient insomnia program (N = 386; mean age = 51.96 years, SD = 15.62; 65.97% [N = 254] female). Prior to treatment, participants completed a polysomnography sleep study and sleep diary, which was used to calculate sleep–wake state discrepancy. At pre‐treatment, post‐treatment and 3‐month follow‐up, participants completed the Insomnia Severity Index and other questionnaires, and 1 week of sleep diaries from which sleep‐onset latency, wake after sleep onset and other sleep variables were calculated. There were no differences in self‐reported sleep‐onset latency, wake after sleep onset or Insomnia Severity Index scores at post‐treatment or 3‐month follow‐up between quintiles of sleep–wake state discrepancy. These results indicate that sleep–wake state discrepancy at pre‐treatment does not predict treatment response to cognitive behavioural therapy for insomnia. Future research could examine multi‐night assessments of sleep–wake state discrepancy to determine whether variations in discrepancy may relate to pre‐treatment insomnia severity and cognitive behavioural therapy for insomnia outcomes. [ABSTRACT FROM AUTHOR]

Background: Sleep‐related bruxism (SB) is the habit of grinding or clenching the teeth during sleep, mediated by the non‐peripheral central nervous system. Purpose: The objectives of this cross‐sectional study were to evaluate associations between SB, microarousals and oxyhaemoglobin desaturations and to compare the frequency of SB and microarousals in sleep stages, in an apnoeic population. Methods: Two hundred and forty individuals composed the sample, who underwent a single full‐night polysomnography. Self‐reports and clinical inspections were not considered for assessing SB. The polysomnographic assessment of SB was performed using electrodes placed on masseter muscles and chin. SB was defined as more than two events of rhythmic masticatory muscle activity per hour of sleep. Microarousals were considered when there were abrupt changes in electroencephalogram frequencies, without complete awakening, lasting from 3 to 15 s. Oxyhaemoglobin desaturations were defined as significant drops (≥3%) in basal oxygen saturations. With these data, SB, microarousals and oxyhaemoglobin desaturations were evaluated and submitted to statistical analysis. Results: Statistically significant differences were observed between bruxers and non‐bruxers when comparing the rates of microarousals (p <.001) and oxyhaemoglobin desaturations (p =.038). There was a higher number of SB and microarousals in NREM (non‐rapid eye movement) two sleep stage (p < 0.001). Bruxers had a greater risk of higher numbers of microarousals (OR = 1.023; p =.003), which did not occur for oxyhaemoglobin desaturations (OR = 0.998; p =.741). Conclusions: A higher number of microarousals presents relationship with SB; associations between SB and oxyhaemoglobin desaturations remained inconclusive; higher frequency of SB and microarousals was observed in NREM 2 sleep stage. [ABSTRACT FROM AUTHOR]

Background: Little is known about the characteristics and occurrence frequencies of rapid eye movements (REMs) during REM sleep in movement disorders. Objectives: The aim of this study was to detect and characterize REMs during polysomnographically defined REM sleep as recorded by electro‐oculography (EOG) in 12 patients with progressive supranuclear palsy (PSP), 13 patients with Parkinson's disease (PD) and 12 healthy controls. Methods: Using a modified EOG montage, we developed an algorithm that automatically detects and characterizes REMs during REM sleep based on their presumptive saccadic kinematics. Results: Compared to PD and healthy controls, REM densities and REM peak velocities were significantly reduced in PSP. These effects were most pronounced in vertical REMs. Conclusion: Ocular motor dysfunction, one of the cardinal features of PSP, seems to be equally at play during REM sleep and wakefulness. For future studies, we provide a novel tool for the unbiased analysis of REMs during REM sleep in movement disorders. [ABSTRACT FROM AUTHOR]

Sleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea. Polysomnography (PSG) represents the gold standard for SA diagnosis. This laboratory-based procedure is complex and costly, and less cumbersome wearable devices have been proposed for SA detection and monitoring. A novel textile multi-sensor monitoring belt recording electrocardiogram (ECG) and breathing frequency (BF) measured by thorax excursion was developed and tested in a sleep laboratory for validation purposes. The aim of the current study was to evaluate the diagnostic performance of ECG-derived heart rate variability and BF-derived breathing rate variability and their combination for the detection of sleep apnea in a population of patients with a suspicion of SA. Fifty-one patients with a suspicion of SA were recruited in the sleep laboratory of the Cantonal Hospital St. Gallen. Patients were equipped with the monitoring belt and underwent a single overnight laboratory-based PSG. In addition, some patients further tested the monitoring belt at home. The ECG and BF signals from the belt were compared to PSG signals using the Bland-Altman methodology. Heart rate and breathing rate variability analyses were performed. Features derived from these analyses were used to build a support vector machine (SVM) classifier for the prediction of SA severity. Model performance was assessed using receiver operating characteristics (ROC) curves. Patients included 35 males and 16 females with a median age of 49 years (range: 21 to 65) and a median apnea-hypopnea index (AHI) of 33 (IQR: 16 to 58). Belt-derived data provided ECG and BF signals with a low bias and in good agreement with PSG-derived signals. The combined ECG and BF signals improved the classification accuracy for SA (area under the ROC curve: 0.98; sensitivity and specificity greater than 90%) compared to single parameter classification based on either ECG or BF alone. This novel wearable device combining ECG and BF provided accurate signals in good agreement with the gold standard PSG. Due to its unobtrusive nature, it is potentially interesting for multi-night assessments and home-based patient follow-up. [ABSTRACT FROM AUTHOR]

Background/Objectives: Given the existence of higher suicidality in apneic individuals, this study aimed to determine the potential role played by subtypes of the comorbid insomnia disorder (CID) in the occurrence of suicidal ideation for this specific subpopulation. Methods: To perform our analyses, 1488 apneic individuals were retrospectively extracted from the Sleep Laboratory hospitalization register. Only apneic individuals with suicidal ideation highlighted during the psychiatric interview and/or with a score ≥1 on item G of the Beck Depression Inventory confirmed during the clinical interview were included in the group with suicidal ideation. The likelihood of suicidal ideation associated with CID subtypes was investigated using logistic regression analyses. Results: The prevalence of suicidal ideation was 9.3% in our sample of apneic individuals. After hierarchically introducing the significant confounders for adjustment, multivariate logistic regression analyses demonstrated that unlike short sleep duration alone and CID without short sleep duration, the likelihood of suicidal ideation was only higher for CID with short sleep duration in apneic individuals. Conclusions: Thus, we highlighted in this study that CID with short sleep duration could play a major role in higher suicidality for apneic individuals, which seems to require systematic screening and appropriate treatment of this comorbid sleep disorder to enable better management of suicidal risk in this specific subpopulation. [ABSTRACT FROM AUTHOR]

Summary Sleep is vital for health. It has regenerative and protective functions. Its disruption reduces the quality of life and increases susceptibility to disease. During sleep, there is a cyclicity of distinct phases that are studied for clinical purposes using polysomnography (PSG), a costly and technically demanding method that compromises the quality of natural sleep. The search for simpler devices for recording biological signals at home addresses some of these issues. We have reworked a single‐channel in‐ear electroencephalography (EEG) sensor grounded to a commercially available memory foam earplug with conductive tape. A total of 14 healthy volunteers underwent a full night of simultaneous PSG, in‐ear EEG and actigraphy recordings. We analysed the performance of the methods in terms of sleep metrics and staging. In another group of 14 patients evaluated for sleep‐related pathologies, PSG and in‐ear EEG were recorded simultaneously, the latter in two different configurations (with and without a contralateral reference on the scalp). In both groups, the in‐ear EEG sensor showed a strong correlation, agreement and reliability with the ‘gold standard’ of PSG and thus supported accurate sleep classification, which is not feasible with actigraphy. Single‐channel in‐ear EEG offers compelling prospects for simplifying sleep parameterisation in both healthy individuals and clinical patients and paves the way for reliable assessments in a broader range of clinical situations, namely by integrating Level 3 polysomnography devices. In addition, addressing the recognised overestimation of the apnea‐hypopnea index, due to the lack of an EEG signal, and the sparse information on sleep metrics could prove fundamental for optimised clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Obstructive Sleep Apnea Hypopnea (OSAHS) Syndrome is defined by repetitive episodes of apneas or hypopneas, excessive daytime somnolence; waking up during sleep with gasping, choking, or breath holding; or witnessed reports of apneas, loud snoring, or both. The current gold standard diagnostic test for OSAS is polysomnography. Material and Methods: A total of 30 patients diagnosed with stroke and OSA at tertiary care hospital were included in this study. They underwent clinical evaluation and investigations including polysomnography. They were then subjected to drug induced sleep endoscopy and findings were noted according to VOTE classification. Result: Patients belonged to age groups ranging from 3 to 8 decade of life. Mean BMI was found to be 33.02 (+/-8.37) where 73.33% patients were overweight and obese category. Multilevel obstruction was present in 96.67% of patients Oropharynx was most common site of obstruction in our study. Velum(86.6%) was 2nd most common site of obstruction. This was the most common type of obstruction in our study was multilevel collapse (46.67%) including all 4 sites i.e. velum, oropharynx, tongue base and epiglottis. BMI in this study was found to have insignificant correlation with multi-level severe obstruction (p = 0.306). Conclusion: Obstructive sleep apnoea is a common finding in majority of patients suffering from chronic lifestyle diseases. In our study, we found that DISE is easy to perform, safe and reliable tool for evaluation of OSA with CVA patients as the majority of these patients have multi-level obstruction. The procedure also provides important information about dynamic changes in upper airway during sleep. Multilevel obstruction is the most common obstruction. [ABSTRACT FROM AUTHOR]

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations. [ABSTRACT FROM AUTHOR]

This study investigated the impact of a multiday heatwave on nocturnal physiology, behavior, and sleep under controlled conditions with comprehensive monitoring of environmental factors and participant activities. Seven young healthy males were confined for 10 days in controlled conditions that ranged between hot-to-warm (day: 35.4 °C, night: 26.3 °C) during nights 4–6 and temperate (day: 25.4 °C, night: 22.3 °C) before (nights 1–3) and after (nights 7–10) the heatwave. Measurements included core and skin temperatures, heart rate, sympathovagal balance, vasomotion indicators, urine samples, blanket coverage, subjective sleep assessments, and partial polysomnography. The average nocturnal core temperature was 0.2 °C higher during and after the heatwave compared to the pre-heatwave period, with this difference being more pronounced (+0.3 °C) in the first 2 h of sleep (p < 0.001). For every 0.1 °C rise in overnight core temperature, the total sleep time decreased by 14 min (pseudo-R2 = 0.26, p = 0.01). The elevated core temperatures occurred despite the participants exhibiting evident thermoregulatory behavior, as they covered 30% less body surface during the heatwave compared to pre- and post-heatwave periods (p < 0.001). During the heatwave, mean skin temperature at bedtime was 1.3 °C higher than pre-heatwave and 0.8 °C higher than post-heatwave periods (p < 0.001). No differences in other responses, including heart rate and vasomotion indicators, were observed. The paper details a 20-min sleepwalking episode that was coupled with marked changes in sleepwalker's thermophysiological responses. In conclusion, the simulated heatwave resulted in higher overnight core temperature which was associated with reduced total sleep time. Behavioral thermoregulation during sleep may serve as a defense against these effects, though more research is needed. [ABSTRACT FROM AUTHOR]