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Sleep medicine
Elsevier Science
Sleep medicine

Elsevier Science

1389-9457

Sleep medicine/Journal Sleep medicineSCIISTPBSCIAHCI
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    Meta-analysis of the association between obstructive sleep apnea and postoperative complications

    Sun, XiaYu, JintaoLuo, JiaXu, Shan...
    11页
    查看更多>>摘要：Objective: To clarify the association between obstructive sleep apnea (OSA) and postoperative outcomes, investigate whether preoperative diagnosis and continuous positive airway pressure (CPAP) therapy reduce the risks and examine the impact of OSA severity on postoperative outcomes. Methods: The PubMed, Cochrane Library and Embase databases were searched from inception until April 2021 for studies evaluating the association between OSA and postoperative adverse events. A random effects model was used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results. Results: In total, 46 studies were eligible for further analysis. OSA was significantly associated with higher risks of postoperative respiratory complications (OR = 1.91; 95% CI = 1.54 to 2.36) and cardiac complications (OR = 1.74; 95% CI = 1.25 to 2.42), and the risks increased with OSA severity. OSA also increased the risk of intensive care unit (ICU) transfer (OR = 1.92; 95% CI = 1.32 to 2.80), increased the risk of postoperative delirium (OR = 1.83; 95% CI = 1.26 to 2.66) and prolonged the length of hospital stay (WMD = 0.48; 95% CI = 0.15 to 0.82). Subgroup analysis indicated that preoperative diagnosis and use of CPAP decrease the risk of postoperative respiratory complications (OR = 1.87; 95% CI = 1.43 to 2.43) and cardiac complications (OR = 1.17; 95% CI = 0.91 to 1.51). Conclusions: Patients with OSA have a higher risk of postoperative cardiopulmonary complications, ICU transfer, delirium, pneumonia, bleeding and prolonged length of hospital stay. OSA severity is an important risk modifier for postoperative complications, preoperative diagnosis and CPAP therapy may attenuate the occurrence of postoperative complications. The conclusions need to be interpreted with caution due to the limitations in the data, despite this, the results indicate and inform the need for further and larger trials. Prospero: CRD42021254374. (c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Brain regional homogeneity changes after short-term positive airway pressure treatment in patients with obstructive sleep apnea

    Aysola, Ravi S.Kumar, RajeshSong, XiaopengRoy, Bhaswati...
    9页
    查看更多>>摘要：Patients with obstructive sleep apnea (OSA) reveal functional changes in brain sites involved in autonomic, cognitive, and mood regulations. However, it is unclear whether these brain changes reverse with short-term positive airway pressure (PAP) treatment. Our aim was to examine brain functional changes in response to 3-months of PAP treatment using regional homogeneity (ReHo) measures, where increased and decreased ReHo value indicates hyper-and hypo-local neural activities, respectively, and considered as functional deficits. We collected brain magnetic resonance imaging data as well as mood, cognitive, and sleep variables from 17 treatment-naive OSA at baseline and after 3-months of PAP treatment and 25 age-and gender-matched healthy controls. Whole-brain ReHo maps were calculated and compared between OSA and controls and OSA subjects before and after PAP treatment. At baseline, treatment-naive OSA subjects showed higher ReHo in the bilateral thalamus, putamen, postcentral gyrus, paracentral lobule, supplementary motor area, and right insula, and lower ReHo in the frontal and parietal cortices, compared to controls. After 3-months of PAP treatment, abnormal sleep and mood scores decreased significantly to normal levels. ReHo decreased in the autonomic and somatosensory control areas, including the thalamus, putamen, postcentral gyrus, and insula, and increased in the cognitive and affective regulatory parietal regions. The normalized ReHo was correlated with improved sleep quality and reduced anxiety symptoms. These findings suggest that 3-months of PAP use can improve sleep, mood issues, and partly recover brain activities, however, longer PAP treatment may be required to fully and permanently reverse brain functional deficits. (c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Association between risk of obstructive sleep apnea, inflammation and cognition after 45 years old in the Canadian Longitudinal Study on Aging

    Legault, JulieMoullec, GregoryMartineau-Dussault, Marie-EveBaltzan, Marc...
    10页
    查看更多>>摘要：Background: The association between obstructive sleep apnea and cognitive functioning is not yet fully understood and could be influenced by factors such as sex, age and systemic inflammation. We deter-mined the sex-and age-specific association between obstructive sleep apnea risk and cognitive per-formance, and the influence of systemic inflammation on this association. Methods: We included 25,899 participants from the Canadian Longitudinal Study of Aging compre-hensive cohort, aged 45-85 years (51% women). We conducted sex-and age-specific (45-59; 60-69; >70) general linear models between obstructive sleep apnea risk and cognitive scores, and tested the moderating and mediating effects of high-sensitivity C-reactive protein levels. Obstructive sleep apnea risk was estimated by combining the STOP and whole-body fat percentage. Cognitive tests assessed episodic verbal memory, executive functions and psychomotor speed. Levels of high-sensitivity C-reactive protein were obtained through blood samples. Results: Higher obstructive sleep apnea risk was associated with poorer episodic memory in women aged 45-59 years, and poorer executive function (p < 0.05 on multiple tests) in women aged 45-59 and 60-69 years. No such association was found in men. High-sensitivity C-reactive protein levels mediated some associations between obstructive sleep apnea risk and executive function in women and men aged <70 years.Conclusions: Being at high-risk for obstructive sleep apnea is associated with poorer cognition in women aged <70 years. These associations were partly mediated by systemic inflammation. These results un-derscore the importance of obstructive sleep apnea diagnosis, treatment and appropriate follow-up, particularly in middle-aged women who might already show signs of early cognitive impairments.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Restless Legs Syndrome in X-linked adrenoleukodystrophy

    Winkelman, John W.Grant, Natalie R.Molay, FrancineStephen, Christopher D....
    4页
    查看更多>>摘要：Objective/background: X-linked adrenoleukodystrophy (ALD) is a neurodegenerative disease that causes progressive gait and balance problems. Leg discomfort, sleep disturbances, and pain contribute to daily disability. We sought to investigate the prevalence and severity of Restless Legs Syndrome (RLS) in patients with ALD. Patients/methods: We administered questionnaires and conducted diagnostic telephone interviews to assess RLS severity. We retrospectively extracted data from neurological examinations, functional gait measures, and laboratory assessments.Results and conclusions: Thirty-two adults with ALD (21 female, 11 male) were recruited to participate. Thirteen patients (40.6%) had RLS (10/21 females and 3/11 males). The median age of RLS onset was 35 years [IQR 1/4 22-54]. Patients with RLS had more signs and symptoms related to myelopathy, but not the brain demyelination seen in ALD. This pilot study suggests a high prevalence of RLS in adults with ALD, which may contribute to sleep problems and impair quality of life.(c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
      原文链接:
    • NSTL
    • Elsevier

    Association between sleep-disordered breathing and prostate cancer

    Campos-Rodriguez, FranciscoSantos-Morano, JuanJurado-Gamez, BernabeOsman-Garcia, Ignacio...
    8页
    查看更多>>摘要：Background: Sleep-disordered breathing (SDB) has been associated with a greater aggressiveness of melanoma tumors, but the association with other cancers is unknown. This study investigates the relationship between the severity of SDB and the aggressiveness of prostate cancer (PC).Methods: 165 patients under 66 years consecutively diagnosed with PC in three University Hospitals underwent a home respiratory polygraphy. SDB severity was assessed by means of the apnea-hypopnea index (AHI) as well as several oximetric parameters. The primary marker of the aggressiveness of PC was the Gleason score, while secondary markers included the tumor stage and metastatic spreading.Results: The patients had a median (P 25-75) age of 60 (56-63) years, AHI of 13.3 (5.7-25.8), and 4% oxygen desaturation index of 8.7 (2.9-17.8). The prevalence of an AHI>5 and AHI>15 was 78.2% and 46.7%, respectively. The median AHI was similar in patients with Gleason 6 and > 6 [13.7 (5.6-28.7) vs 12.2 (5.7-23.2), p = 0.44], tumor stage I-II and III-IV [13.5 (5.3-26.5) vs 11.7 (7.8-21.1), p = 0.67], and presence or absence of metastasis [14.2 (9.6-31.8) vs 13.3 (5.2-24.6), p = 0.46]. The prevalence of an AHI>5 and AHI>15 was similar in patients with Gleason 6 and > 6 (79.2% vs 77.2%; p = 0.85, and 49.3% vs 44.33%; p = 0.53, respectively). These results did not change when different oximetric variables were analyzed instead of the AHI.Conclusions: Despite the high prevalence of SDB in patients with PC, our results do not support any association between the severity of SDB and PC aggressiveness.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Prevalence of upper airway resistance syndrome in the Sa~o Paulo Epidemiologic Sleep Study

    Tufik, Sergio BrasilPires, Gabriel NatanPalombini, LucianaAndersen, Monica Levy...
    8页
    查看更多>>摘要：Objective: To establish the prevalence of upper airway resistance syndrome (UARS) according to different diagnostic criteria and evaluate its epidemiological characteristics in a representative sample of a large urban center.Methods: This was a single-center evaluation involving volunteers from EPISONO, an epidemiological study focused on sleep disturbances and related factors in adults from Sa~o Paulo, Brazil in 2007.Results: Considering the diagnostic criteria for UARS to be an apnea-hypopnea index of < 5 events/h, minimum SpO2 >= 92%, the presence of airflow limitation during sleep for >= 5% of total sleep time, and daytime symptoms (sleepiness and/or fatigue), we observed a prevalence of the condition of 3.1% (4.4% in women and 1.5% in men).Conclusions: Although the diagnostic criteria for UARS, or even its existence as a syndrome, are still a subject of debate in the literature, the findings from this epidemiological study highlights UARS as a non-hypoxic sleep-disordered breathing condition with a significant prevalence in the general population, being more frequent among female young adults.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis

    Xu, JiahuanWei, ZhijingLi, WenyangWang, Wei...
    8页
    查看更多>>摘要：Objective: To perform a systematic review and network meta-analysis to provide comparative evidence and quantitative hierarchies of the effectiveness of positive airway pressure (PAP) treatment on obesity hypoventilation syndrome (OHS).Methods: We searched PubMed, Embase, and Cochrane Library databases for relevant articles about the treatment of OHS published from the time of database creation to February 2021. Two independent reviewers performed the study search and screening, quality assessment and data extraction. The network meta-analysis within the frequentist framework was performed using Stata 15.0. The outcomes included changes in arterial blood gases, sleep quality, and polysomnography parameters.Results: Ten articles were included in the study. The results of the network meta-analysis showed that PAP treatment could decrease the partial pressure of carbon dioxide, bicarbonate level, apnea-hypopnea index, Epworth sleepiness scale score, and percentage of light sleep, and increase the partial pressure of oxygen, oxygen saturation, and percentage of rapid eye movement sleep and deep sleep when compared with control group in OHS patients. In addition, the results of the derived hierarchy showed that BPAPAVAPS and BPAP-ST were the first two modes of PAP treatment that reduced the partial pressure of carbon dioxide and percentage of light sleep and improved the percentage of rapid eye movement sleep and deep sleep. However, there was no difference in the quality of life, total sleep time, and sleep effi-ciency between any mode of PAP treatment and the control group.Conclusions: PAP treatment is beneficial for OHS patients, and the modes of BPAP-AVAPS and BPAP-ST demonstrated the largest improvement in hypercapnia and objective sleep structure.0 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Postural instability and backward leaning in a patient of familial fatal insomnia with positive SOX1 antibodies

    Gong, MinWang, SuobinLin, Hua
    3页
      原文链接:
    • NSTL
    • Elsevier

    A psychological view on the effectiveness of psychosocial interventions on positive airway pressure treatment adherence and sleep quality in patients with obstructive sleep apnea

    Bertrand, M.Bastien, C. H.Boutin, IVallieres, A....
    13页
    查看更多>>摘要：Positive airway pressure treatment (CPAP) is the gold standard for obstructive sleep apnea syndrome (OSAS). CPAP is highly effective, but its issue lays in poor adherence rates mainly caused by its invasive nature and related stigma. In accordance with a biopsychosocial model of CPAP adherence, psychosocial interventions have been implemented to alleviate low rates of adherence with promising results. The increase in the number of psychosocial interventions has highlighted the need to systematically evaluate their effectiveness. This review aims to identify psychosocial interventions used to increase CPAP adherence, to compile available data on their effectiveness, and the reasons why they are effective. Moreover, the review evaluates the impact of the interventions on sleep quality. Experimental and quasi-experimental studies testing psychosocial interventions (excluding educational only interventions) that aimed to increase CPAP adherence in adults with obstructive sleep apnea vs. no intervention or control group were included. A literature search in PsycINFO, MEDLINE, COCHRANE, EMBASE, CINAHL, and Web of Science was performed for studies published in English and French between 1980 and January 2020. Risk of bias and methodological quality were assessed using the Joanna Briggs Institute Critical Appraisal Tools. Fourteen studies were included involving 1923 participants, six trials tested a motivational intervention, three trials tested a cognitive behavioral intervention and five others tested one of the following: relaxation, exposition therapy, phone coaching, audiotape or stage-matched intervention. Thirteen studies reported a positive effect of the intervention on CPAP adherence, while one reported no effect. Psychosocial interventions for CPAP adherence appear effective at increasing sleep quality, but more studies are needed to test this hypothesis. Reasons for the effectiveness of the interventions were pooled into five categories: time related, the intervention's adaptability, the patient's characteristics, the intervention's nature and characteristics and the intervention's specifics and target. The current review raises a significant gap between the biomedical and psychosocial domains. In fact, even in a psychosocial intervention study, the interpretation of the results revolves around biomedical models and very little consideration is given to biopsychosocial models. Our findings demonstrate the importance of examining the relationship between psychosocial variables and CPAP adherence to better tailor interventions to increase CPAP adherence.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Isolated rapid eye movement sleep behavior disorder combined with obstructive sleep apnea: response to treatment and its associated factors

    Lee, Woo-JinSunwoo, Jun-SangByun, Jung-IckKim, Han-Joon...
    9页
    查看更多>>摘要：Objective/Background: When isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is combined with obstructive sleep apnea (OSA), the pattern of temporal association between REM without atonia (RWA) and apnea-hypopnea events may be related to improvements in RBD symptoms after positive airway pressure (PAP) treatment. We evaluated the frequency of improvement in RBD symptoms after PAP and the relationship of the degree of co-occurrence between RWA and apnea-hypopnea events to RBD symptom improvement after PAP treatment. Patients/methods: In an institutional cohort with sleep disorders, 31 patients with video-polysomnography confirmed iRBD and concomitant OSA with an apnea-hypopnea index (AHI) of >= 15/h who received PAP treatment were included. Along with gross video-polysomnography parameters such as AHI and electromyography activity index during REM sleep, a mini-epoch-based parameter apnea-hypopnea-electromyography activity ratio (AH EMG activity ratio) was used to evaluate the co-occurrence between RWA and apnea-hypopnea events. Improvement in RBD symptoms after PAP treat-ment was designated as a clinical global impression-improvement (CGI-I) score of 0-3 at three-month. Results: Twenty-three (74.2%) patients exhibited improvement in RBD symptoms after PAP treatment. No patient was taking an antidepressant medication. An AH EMG activity ratio of >= 15% (Odds ratio [OR] 10.146, 95% CI 1.302-79.032, P 1/4 0.027) was significantly associated with clinical improvement after PAP treatment in a regression model adjusted for age, sex, AHI, and electromyography activity index during REM. Conclusions: Treatment of concomitant OSA with PAP can improve symptoms of iRBD. Respiratory events that co-occur with RWA may predict improvement in RBD symptoms after PAP treatment. (c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier