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Morelli MS, Giannoni A, Passino C, Landini L, Emdin M, Vanello N. A Cross-Correlational Analysis between Electroencephalographic and End-Tidal Carbon Dioxide Signals: Methodological Issues in the Presence of Missing Data and Real Data Results. SENSORS 2016; 16:s16111828. [PMID: 27809243 PMCID: PMC5134487 DOI: 10.3390/s16111828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
Electroencephalographic (EEG) irreducible artifacts are common and the removal of corrupted segments from the analysis may be required. The present study aims at exploring the effects of different EEG Missing Data Segment (MDS) distributions on cross-correlation analysis, involving EEG and physiological signals. The reliability of cross-correlation analysis both at single subject and at group level as a function of missing data statistics was evaluated using dedicated simulations. Moreover, a Bayesian-based approach for combining the single subject results at group level by considering each subject’s reliability was introduced. Starting from the above considerations, the cross-correlation function between EEG Global Field Power (GFP) in delta band and end-tidal CO2 (PETCO2) during rest and voluntary breath-hold was evaluated in six healthy subjects. The analysis of simulated data results at single subject level revealed a worsening of precision and accuracy in the cross-correlation analysis in the presence of MDS. At the group level, a large improvement in the results’ reliability with respect to single subject analysis was observed. The proposed Bayesian approach showed a slight improvement with respect to simple average results. Real data results were discussed in light of the simulated data tests and of the current physiological findings.
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Affiliation(s)
- Maria Sole Morelli
- Institute of Life Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Research Center "E. Piaggio", University of Pisa, 56122 Pisa, Italy.
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Claudio Passino
- Institute of Life Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Luigi Landini
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56124 Pisa, Italy.
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Nicola Vanello
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56124 Pisa, Italy.
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Abstract
INTRODUCTION Dentists can be the first professionals to recognize a patient's potential sleep problem since they typically have more frequent contact with their patients than do physicians. It is important that dentists have a reasonable understanding of sleep disorders and how to assess their patients if they suspect such a problem so that a timely referral can be made or treatment can be provided as appropriate. OBJECTIVE To review the key literature relevant to sleep-disordered breathing (SDB) characteristics and diagnosis, including history, examination, and investigation with an emphasis on radiographic airway analyses. CONCLUSION The authors present a concise explanation of SDB conditions and an outline for thorough patient examination and evaluation, including radiographic airway analyses. Limited two-dimensional and three-dimensional norms exist for adult patients with no SDB and even less so for children. Much more research is needed, particularly in the pediatric population.
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Affiliation(s)
- Ahmed I Masoud
- a Department of Orthodontics, Faculty of Dentistry , King Abdulaziz University , Jeddah , Saudi Arabia.,b Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA.,c Graduate Program in Neuroscience , University of Illinois , Chicago , IL , USA
| | - Gregory W Jackson
- b Department of Orthodontics , College of Dentistry, University of Illinois , Chicago , IL , USA
| | - David W Carley
- d Departments of Biobehavioral Health Science, Medicine and Bioengineering , University of Illinois , Chicago , IL , USA
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Costanzo MR, Ponikowski P, Javaheri S, Augostini R, Goldberg L, Holcomb R, Kao A, Khayat RN, Oldenburg O, Stellbrink C, Abraham WT. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet 2016; 388:974-82. [PMID: 27598679 DOI: 10.1016/s0140-6736(16)30961-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central sleep apnoea is a serious breathing disorder associated with poor outcomes. The remedé system (Respicardia Inc, Minnetonka, MN, USA) is an implantable device which transvenously stimulates a nerve causing diaphragmatic contraction similar to normal breathing. We evaluated the safety and effectiveness of unilateral neurostimulation in patients with central sleep apnoea. METHODS We recruited patients from 31 hospital-based centres in Germany, Poland, and the USA in this prospective, multicentre, randomised trial. Participants had to have been medically stable for at least 30 days and have received appropriate guideline recommended therapy, be aged at least 18 years, be expected to tolerate study procedures, and willing and able to comply with study requirements. Eligible patients with an apnoea-hypopnoea index (AHI) of at least 20 events per h, tested by a polysomnography, underwent device implantation and were randomly assigned (1:1) by a computer-generated method stratified by site to either stimulation (treatment) or no stimulation (control) for 6 months. The primary effectiveness endpoint in the intention-to-treat population was the comparison of the proportions of patients in the treatment versus control groups achieving a 50% or greater AHI reduction from baseline to 6 months, measured by a full-night polysomnography assessed by masked investigators in a core laboratory. The primary safety endpoint of 12-month freedom from serious adverse events related to the procedure, system, or therapy was evaluated in all patients. This trial is active, but not recruiting, and is registered with ClinicalTrials.gov (NCT01816776). FINDINGS Between April 17, 2013, and May 28, 2015, we randomly assigned 151 eligible patients to the treatment (n=73) or control (n=78) groups. In the analysis of the intention-to-treat population, significantly more patients in the treatment group (35 [51%] of 68) had an AHI reduction from baseline of 50% or greater at 6 months than had those in the control group (eight [11%] of 73; difference between groups 41%, 95% CI 25-54, p<0·0001). 138 (91%) of 151 patients had no serious-related adverse events at 12 months. Seven (9%) cases of related-serious adverse events occurred in the control group and six (8%) cases were reported in the treatment group. Seven patients died (unrelated to implant, system, or therapy), four deaths (two in treatment group and two in control group) during the 6-month randomisation period when neurostimulation was delivered to only the treatment group and was off in the control group, and three deaths between 6 months and 12 months of follow-up when all patients received neurostimulation. 27 (37%) of 73 patients in the treatment group reported non-serious therapy-related discomfort that was resolved with simple system reprogramming in 26 (36%) patients, but was unresolved in one (1%) patient. INTERPRETATION Transvenous neurostimulation significantly reduced the severity of central sleep apnoea, including improvements in sleep metrics, and was well tolerated. The clinically meaningful effects of the therapy are supported by the concordant improvements in oxygenation and quality of life, making transvenous neurostimulation a promising therapeutic approach for central sleep apnoea. FUNDING Respicardia Inc.
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Affiliation(s)
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | | | | | - Lee Goldberg
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andrew Kao
- Mid America Heart Institute, Kansas City, MO, USA
| | | | - Olaf Oldenburg
- Bad Oeynhausen Heart and Diabetes Centre, Bad Oeynhausen, Germany
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154
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Hassamal S, Miotto K, Wang T, Saxon AJ. A narrative review: The effects of opioids on sleep disordered breathing in chronic pain patients and methadone maintained patients. Am J Addict 2016; 25:452-65. [DOI: 10.1111/ajad.12424] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/23/2016] [Accepted: 08/10/2016] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sameer Hassamal
- Department of Addiction Psychiatry; UCLA-Kern; Bakersfield California
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences; David Geffen School of Medicine at UCLA; Semel Institute of Neuroscience and Human Behavior; Los Angeles California
| | - Tisha Wang
- Division of Pulmonary; Critical Care, and Sleep Medicine; Department of Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Andrew J. Saxon
- Center of Excellence in Substance Abuse Treatment and Education; Veteran's Affairs Puget Sound Health Care System; Seattle Washington
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155
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Rumiński J. Analysis of the parameters of respiration patterns extracted from thermal image sequences. Biocybern Biomed Eng 2016; 36:731-741. [PMID: 32287710 PMCID: PMC7127106 DOI: 10.1016/j.bbe.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 12/03/2022]
Abstract
Remote estimation of vital signs is an important and active area of research. The goal of this work was to analyze the feasibility of estimating respiration parameters from video sequences of faces recorded using a mobile thermal camera. Different estimators were analyzed and experimentally verified. It was demonstrated that the respiration rate, periodicity of respiration, and presence and length of apnea periods could be reliably estimated from signals recorded using a portable thermal camera. The size of the camera and efficiency of the methods allow the implementation of this method in smart glasses.
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156
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Drakatos P, Higgins S, Duncan I, Stevens S, Dastagir S, Birdseye A, Lykouras D, Muza R, Gildeh N, Rosenzweig I, Williams AJ, Leschziner GD, Kent BD. Catathrenia, a REM predominant disorder of arousal? Sleep Med 2016; 32:222-226. [PMID: 27539028 DOI: 10.1016/j.sleep.2016.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/26/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Catathrenia is an uncommon and poorly understood disorder, characterized by groaning during sleep occurring in tandem with prolonged expiration. Its classification, pathogenesis, and clinical relevance remain debated, substantially due to the limited number of cases reported to date. We report a series of consecutive cases of catathrenia, their clinical and polysomnographic characteristics, and their subsequent management. METHODS Consecutive patients with catathrenia who had undergone full polysomnography in our institution over a 5.5-year period were included. Catathrenia events (CEs) were examined in clusters, which formulated catathrenia periods (CPs). The relationships between CPs, sleep stage distribution, electroencephalogram (EEG) arousals, and other sleep parameters were assessed, along with the clinical presentation and management of catathrenic patients. RESULTS A total of 427 CPs were identified in 38 patients, 81% arising from rapid eye movement (REM) sleep. EEG arousals preceded or coincided with the onset of 84% of CPs, which were of longer duration than those not associated with an arousal (57.3 ± 56.8 vs. 32.2 ± 29.4 s, p < 0.001). Each CE had a characteristic airflow signal, with inspiration preceding a protracted expiration and a brief more rapid exhalation, followed by deep inspiration. Although the majority of patients were referred on the basis of bed partner complaints, 44.7% complained of daytime sleepiness. Continuous positive airway pressure therapy and sleep-consolidating pharmacotherapy led to subjective improvement, but were limited by poor long-term adherence. CONCLUSIONS In the largest series of catathrenia patients reported to date, we found that this rare disorder is characterized by a distinct breathing pattern and arises predominantly from REM sleep, with arousals almost uniformly preceding or coinciding with the onset of CPs.
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Affiliation(s)
- Panagis Drakatos
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Sean Higgins
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Iain Duncan
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Sara Stevens
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Sakina Dastagir
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Adam Birdseye
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | | | - Rexford Muza
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Nadia Gildeh
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom; King's College London, London, United Kingdom
| | - Adrian J Williams
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom; King's College London, London, United Kingdom
| | - Guy D Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom; King's College London, London, United Kingdom
| | - Brian D Kent
- Sleep Disorders Centre, Guy's and St Thomas' Hospitals, London, United Kingdom.
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157
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Nunn CL, Samson DR, Krystal AD. Shining evolutionary light on human sleep and sleep disorders. EVOLUTION MEDICINE AND PUBLIC HEALTH 2016; 2016:227-43. [PMID: 27470330 PMCID: PMC4972941 DOI: 10.1093/emph/eow018] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/15/2016] [Indexed: 12/22/2022]
Abstract
Sleep is essential to cognitive function and health in humans, yet the ultimate reasons for sleep—i.e. ‘why’ sleep evolved—remain mysterious. We integrate findings from human sleep studies, the ethnographic record, and the ecology and evolution of mammalian sleep to better understand sleep along the human lineage and in the modern world. Compared to other primates, sleep in great apes has undergone substantial evolutionary change, with all great apes building a sleeping platform or ‘nest’. Further evolutionary change characterizes human sleep, with humans having the shortest sleep duration, yet the highest proportion of rapid eye movement sleep among primates. These changes likely reflect that our ancestors experienced fitness benefits from being active for a greater portion of the 24-h cycle than other primates, potentially related to advantages arising from learning, socializing and defending against predators and hostile conspecifics. Perspectives from evolutionary medicine have implications for understanding sleep disorders; we consider these perspectives in the context of insomnia, narcolepsy, seasonal affective disorder, circadian rhythm disorders and sleep apnea. We also identify how human sleep today differs from sleep through most of human evolution, and the implications of these changes for global health and health disparities. More generally, our review highlights the importance of phylogenetic comparisons in understanding human health, including well-known links between sleep, cognitive performance and health in humans.
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Affiliation(s)
- Charles L Nunn
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina 27708, USA Duke Global Health Institute, Durham, North Carolina 27710, USA Triangle Center for Evolutionary Medicine, Durham, NC 27708, USA
| | - David R Samson
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina 27708, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710
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158
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Clinical Use of Loop Gain Measures to Determine Continuous Positive Airway Pressure Efficacy in Patients with Complex Sleep Apnea. A Pilot Study. Ann Am Thorac Soc 2016. [PMID: 26214564 DOI: 10.1513/annalsats.201410-469bc] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Measures of unstable ventilatory control (loop gain) can be obtained directly from the periodic breathing duty ratio on polysomnography in patients with Cheyne-Stokes respiration/central sleep apnea and can predict the efficacy of continuous positive airway pressure (CPAP) therapy. OBJECTIVES In this pilot study, we aimed to determine if this measure could also be applied to patients with complex sleep apnea (predominant obstructive sleep apnea, with worsening or emergent central apneas on CPAP). We hypothesized that loop gain was higher in patients whose central events persisted 1 month later despite CPAP treatment versus those whose events resolved over time. METHODS We calculated the duty ratio of the periodic central apneas remaining on the CPAP titration (or second half of the split night) while patients were on optimal CPAP with the airway open (obstructive apnea index < 1/h). Loop gain was calculated by the formula: LG = 2π/[(2πDR - sin(2πDR)]. Patients were followed on CPAP for 1 month. Post-treatment apnea-hypopnea index and compliance data were recorded from smart cards. MEASUREMENTS AND MAIN RESULTS Thirty-two patients with complex sleep apnea were identified, and 17 patients had full data sets. Eight patients continued to have a total of more than five events per hour (11.8 ± 0.5/h) (nonresponders). The remaining nine patients had an apnea-hypopnea index less than 5/h (2.2 ± 0.4/h) (responders). Loop gain was higher in the nonresponders versus responders (2.0 ± 0.1 vs. 1.7 ± 0.2, P = 0.026). Loop gain and the residual apnea-hypopnea index 1 month after CPAP were associated (r = 0.48, P = 0.02). CPAP compliance was similar between groups. CONCLUSIONS In this pilot study, loop gain was higher for patients with complex sleep apnea in whom central apneas persisted after 1 month of CPAP therapy (nonresponders). Loop gain measurement may enable an a priori determination of those who need alternative modes of positive airway pressure.
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159
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Gupta R, Das S, Shankar Shilpi U, Sindhwani G, Khandoori R. Idiopathic central sleep apnea during REM sleep. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0050-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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160
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Abstract
Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.
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161
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Selvadurai S, Al-Saleh S, Amin R, Zweerink A, Drake J, Propst EJ, Narang I. Utility of brain MRI in children with sleep-disordered breathing. Laryngoscope 2016; 127:513-519. [DOI: 10.1002/lary.26042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/08/2016] [Accepted: 03/25/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah Selvadurai
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Reshma Amin
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Allison Zweerink
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
| | - James Drake
- Division of Neurosurgery; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Evan J. Propst
- Department of Otolaryngology-Head & Neck Surgery; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Indra Narang
- Division of Respiratory Medicine; Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
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Olivier PY, Joyeux-Faure M, Gentina T, Launois SH, d’Ortho MP, Pépin JL, Gagnadoux F. Severe Central Sleep Apnea Associated With Chronic Baclofen Therapy. Chest 2016; 149:e127-31. [DOI: 10.1016/j.chest.2015.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/06/2015] [Accepted: 10/01/2015] [Indexed: 10/21/2022] Open
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163
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Affiliation(s)
- Lee K Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, School of Medicine, and the Department of Electrical and Computer Engineering, School of Engineering, University of New Mexico, Albuquerque, NM.
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164
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Mulchrone A, Shokoueinejad M, Webster J. A review of preventing central sleep apnea by inspired CO2. Physiol Meas 2016; 37:R36-45. [DOI: 10.1088/0967-3334/37/5/r36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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165
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Tung P, Anter E. Atrial Fibrillation And Sleep Apnea: Considerations For A Dual Epidemic. J Atr Fibrillation 2016; 8:1283. [PMID: 27909488 PMCID: PMC5089463 DOI: 10.4022/jafib.1283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 01/01/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and shares many of the same risk factors as another common clinical condition, sleep apnea. The estimated prevalence of sleep apnea has increased over the past decade, and reflects a parallel increase in the most prominent risk factors of obesity and overweight. Both obstructive and central sleep apnea have been associated with AF in multiple studies, with the risk of AF increasing 2-4-fold compared to those without sleep breathing disorder. Continuous positive airway pressure (CPAP) has been shown to reduce the rate of AF recurrence following catheter ablation in patients with sleep apnea. However, the mechanisms by which sleep apnea precipitates AF or vice versa, remain unclear. In this Review, we examine the current date linking AF and sleep apnea, discuss the existing data supporting a mechanistic link between the two conditions, present the existing evidence for the effectiveness of CPAP in this growing population, and suggest approaches to screen AF patients for sleep breathing disorders.
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Affiliation(s)
- Patricia Tung
- Atrius Healthcare, Department of Cardiology, Boston, MA
| | - Elad Anter
- Harvard-Thorndike Electrophysiology Institute Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA
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166
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Abstract
Sleep disorders can be diagnosed in approximately 15 % of the population and have been shown to increase with age. The relationship between sleep disorders and neurological disorders, however, is still insufficiently considered in the clinical practice. Sleep disorders can be an early symptom of the disease, such as the presence of rapid eye movement (REM) sleep behavior disorder (RBD) as an early indicator of neurodegeneration. Sleep disorders have also been shown to be a main symptom of various neurological syndromes, such as in restless legs syndrome (RLS), periodic limb movement disorder (PLMD) and narcolepsy. The international classification of sleep disorders 2nd edition (ICSD 2) describes the main diagnoses, insomnia, circadian rhythm sleep disorders, sleep-related breathing disorders and hypersomnia but all of these can also appear as symptoms in various neurological diseases. Parasomnias are largely considered a differential diagnosis to nocturnal epilepsy. In this review, the main sleep disorders are described with a particular focus on how they relate to neurological diseases; in particular, how they influence disease-related symptoms and how they affect the course of the disease.
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Affiliation(s)
- S Kotterba
- Klinik für Geriatrie, Klinikum Leer gGmbH, Augustenstr. 35-37, 26789, Leer, Deutschland,
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167
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Fu Q, Colgan SP, Shelley CS. Hypoxia: The Force that Drives Chronic Kidney Disease. Clin Med Res 2016; 14:15-39. [PMID: 26847481 PMCID: PMC4851450 DOI: 10.3121/cmr.2015.1282] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/30/2015] [Indexed: 12/15/2022]
Abstract
In the United States the prevalence of end-stage renal disease (ESRD) reached epidemic proportions in 2012 with over 600,000 patients being treated. The rates of ESRD among the elderly are disproportionally high. Consequently, as life expectancy increases and the baby-boom generation reaches retirement age, the already heavy burden imposed by ESRD on the US health care system is set to increase dramatically. ESRD represents the terminal stage of chronic kidney disease (CKD). A large body of evidence indicating that CKD is driven by renal tissue hypoxia has led to the development of therapeutic strategies that increase kidney oxygenation and the contention that chronic hypoxia is the final common pathway to end-stage renal failure. Numerous studies have demonstrated that one of the most potent means by which hypoxic conditions within the kidney produce CKD is by inducing a sustained inflammatory attack by infiltrating leukocytes. Indispensable to this attack is the acquisition by leukocytes of an adhesive phenotype. It was thought that this process resulted exclusively from leukocytes responding to cytokines released from ischemic renal endothelium. However, recently it has been demonstrated that leukocytes also become activated independent of the hypoxic response of endothelial cells. It was found that this endothelium-independent mechanism involves leukocytes directly sensing hypoxia and responding by transcriptional induction of the genes that encode the β2-integrin family of adhesion molecules. This induction likely maintains the long-term inflammation by which hypoxia drives the pathogenesis of CKD. Consequently, targeting these transcriptional mechanisms would appear to represent a promising new therapeutic strategy.
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Affiliation(s)
- Qiangwei Fu
- Kabara Cancer Research Institute, La Crosse, WI
| | - Sean P Colgan
- Mucosal Inflammation Program and University of Colorado School of Medicine, Aurora, CO
| | - Carl Simon Shelley
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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168
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Hoshikawa M, Uchida S, Osawa T, Eguchi K, Arimitsu T, Suzuki Y, Kawahara T. Effects of Five Nights under Normobaric Hypoxia on Sleep Quality. Med Sci Sports Exerc 2016; 47:1512-8. [PMID: 25386712 DOI: 10.1249/mss.0000000000000569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of five nights' sleep under normobaric hypoxia on ventilatory acclimatization and sleep quality. METHODS Seven men initially slept for six nights under normoxia and then for five nights under normobaric hypoxia equivalent to a 2000-m altitude. Nocturnal polysomnograms (PSGs), arterial blood oxygen saturation (SpO2), and respiratory events were recorded on the first and fifth nights under both conditions. RESULTS The hypoxic ventilatory response (HVR), hypercapnic ventilatory response (HCVR), and resting end-tidal CO2 (resting PETCO2) were measured three times during the experimental period. The duration of slow-wave sleep (SWS: stage N3) and the whole-night delta (1-3 Hz) power of nonrapid eye movement (NREM) sleep EEG decreased on the first night under hypoxia. This hypoxia-induced sleep quality deterioration on the first night was accompanied by a lower mean and minimum SpO2, a longer time spent with SpO2 below 90% (<90% SpO2 time), and more episodes of respiratory disturbance. On the fifth night, the SWS duration and whole-night delta power did not differ between the conditions. Although the mean SpO2 under hypoxia was still lower than under normoxia, the minimum SpO2 increased, and the <90% SpO2 time and number of episodes of respiratory disturbance decreased during the five nights under hypoxia. The HVR increased and resting PETCO2 decreased after five nights under hypoxia. CONCLUSIONS The results suggest that five nights under hypoxia improves the sleep quality. This may be derived from improvements of respiratory disturbances, the minimum SpO2, and <90% SpO2 time.
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Affiliation(s)
- Masako Hoshikawa
- 1Department of Sports Sciences, Japan Institute of Sports Sciences, Nishigaoka, Kita-ku, Tokyo, JAPAN; 2Faculty of Sport Sciences, Waseda University, Mitakajima, Tokorozawa, Saitama, JAPAN; 3Director General, Japan Institute of Sports Sciences, Nishigaoka, Kita-ku, Tokyo, JAPAN
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169
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Flinta I, Ponikowski P. Relationship between central sleep apnea and Cheyne-Stokes Respiration. Int J Cardiol 2016; 206 Suppl:S8-12. [PMID: 26961739 DOI: 10.1016/j.ijcard.2016.02.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
Central sleep apnea (CSA) in patients with heart failure (HF) occurs frequently and shows a serious influence on prognosis in this population. The key elements in the pathophysiology of CSA are respiratory instability with chronic hyperventilation, changes of arterial carbon dioxide pressure (pCO2) and elongated circulation time. The main manifestation of CSA in patients with HF is Cheyne-Stokes Respiration (CSR). The initial treatment is the optimization of HF therapy. However, many other options of the therapeutic management have been studied, particularly those based on positive airway pressure methods. In patients with heart failure we often can observe the overlap of CSA and CSR; we will discuss the differences between these forms of breathing disorders during sleep. We will also discuss when CSA and CSR occur independently of each other and the importance of CSR occurring during the daytime in context of CSA during the nighttime.
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Affiliation(s)
- Irena Flinta
- Department of Cardiology, 4th Military Hospital, Wrocław, Poland; Department of Physiology, Medical University, Wrocław, Poland.
| | - Piotr Ponikowski
- Department of Cardiology, 4th Military Hospital, Wrocław, Poland; Clinic of Cardiac Diseases, Department of Heart Diseases, Medical University, Wrocław, Poland
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170
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Pathophysiology of central sleep apneas. Sleep Breath 2016; 20:467-82. [DOI: 10.1007/s11325-015-1290-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/10/2015] [Accepted: 11/23/2015] [Indexed: 11/26/2022]
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171
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Lu Z, Wu X, Jin X, Peng F, Lin J. Apolipoprotein E ɛ2/ɛ3/ɛ4 variant in association with obstructive sleep apnoea and lipid profile: A meta-analysis. J Int Med Res 2016; 44:3-14. [PMID: 26740500 PMCID: PMC5536579 DOI: 10.1177/0300060515611539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022] Open
Abstract
Objective A meta-analysis of the association between haplotypical variants of the apolipoprotein E (APOE) gene (ɛ2/ɛ3/ɛ4) and obstructive sleep apnoea (OSA) risk and changes in lipid profile. Methods Electronic databases were searched to retrieve articles that provided data on APOE gene ɛ2/ɛ3/ɛ4 variants in patients with OSA and healthy controls. Data were extracted from eligible articles and statistical analyses were performed. Results The meta-analysis included 14 articles involving 19 study populations (3198 patients and 6031 controls). There was no significant association between the presence of the ɛ4 allele and OSA risk. The presence of ɛ4 was associated with significantly increased total cholesterol and decreased high-density lipoprotein cholesterol, compared with ɛ4 allele negative individuals. There was a low probability of publication bias but significant heterogeneity. Conclusions There was no association between APOE ɛ2/ɛ3/ɛ4 and OSA susceptibility. The presence of APOE ɛ4 was associated with changes in lipid profile.
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Affiliation(s)
- Zhuoqiang Lu
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xuemei Wu
- Department of Internal Medicine, Fuzhou Children's Hospital of Fujian Province, Teaching Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xueqing Jin
- Department of Internal Medicine (Area 4), The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinxiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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172
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Zhang XB, Lin QC, Zeng HQ, Jiang XT, Chen B, Chen X. Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:235-40. [PMID: 26370402 DOI: 10.1007/s10508-015-0593-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/25/2015] [Accepted: 06/30/2015] [Indexed: 05/28/2023]
Abstract
In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.
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Affiliation(s)
- Xiao-Bin Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China.
| | - Qi-Chang Lin
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Hui-Qing Zeng
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China
| | - Xing-Tang Jiang
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China
| | - Bo Chen
- Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Teaching Hospital of Fujian Medical University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian Province, 361004, People's Republic of China
| | - Xiao Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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173
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Moro M, Gannon K, Lovell K, Merlino M, Mojica J, Bianchi MT. Clinical predictors of central sleep apnea evoked by positive airway pressure titration. Nat Sci Sleep 2016; 8:259-66. [PMID: 27555802 PMCID: PMC4968988 DOI: 10.2147/nss.s110032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%-15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management. METHODS We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split-night; n=306 two-night). Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG) data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI) ≥5 during split-night PSG (SN-PSG) versus full-night PSG (FN-PSG) titrations. RESULTS CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients. CONCLUSION Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the laboratory setting, even as PSG remains the gold standard for characterizing primary central apnea and TECSA.
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Affiliation(s)
| | | | | | | | - James Mojica
- Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matt T Bianchi
- Neurology Department; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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174
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Lutohin GM, Geraskina LA, Fonyakin AV. Sleep-disordered breathing syndrome in acute ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:14-20. [DOI: 10.17116/jnevro201611612214-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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175
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Koo JM, Han SH, Lee SA. Severe Central Sleep Apnea/Hypopnea Syndrome Mimicking Rapid Eye Movement Sleep Behavior Disorder. SLEEP MEDICINE RESEARCH 2015. [DOI: 10.17241/smr.2015.6.2.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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176
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Priou P, d’Ortho MP, Damy T, Davy JM, Gagnadoux F, Gentina T, Meurice JC, Pepin JL, Tamisier R, Philippe C. Adaptive servo-ventilation: How does it fit into the treatment of central sleep apnoea syndrome? Expert opinions. Rev Mal Respir 2015; 32:1072-81. [DOI: 10.1016/j.rmr.2015.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 01/24/2023]
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177
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Braley TJ, Chervin RD. A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis. Ther Adv Neurol Disord 2015; 8:294-310. [PMID: 26600873 DOI: 10.1177/1756285615605698] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Patients with multiple sclerosis (MS) are at increased risk for comorbid sleep disturbances, which can profoundly contribute to poor functional status and fatigue. Insomnia, sleep-disordered breathing, and restless legs syndrome are among the most common sleep disorders experienced by patients with MS. Despite their impact, these underlying sleep disorders may escape routine clinical evaluations in persons with MS, thereby leading to missed opportunities to optimize functional status and quality of life in patients with MS. A practical, systematic approach to the evaluation and treatment of sleep disorders in MS, in the context of MS-specific variables that may influence risk for these conditions or response to therapy, is recommended to facilitate early diagnosis and successful treatment. This review summarizes the most common sleep disorders experienced by persons with MS, and offers a practical approach to diagnosis and management of these conditions.
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Affiliation(s)
- Tiffany J Braley
- Assistant Professor, Department of Neurology, Multiple Sclerosis and Sleep Disorders Centers, University of Michigan, C728 Med-Inn Building, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Ronald D Chervin
- Michael S. Aldrich Professor of Sleep Medicine and Professor of Neurology, Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA
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178
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Martins RT, Currow DC, Abernethy AP, Johnson MJ, Toson B, Eckert DJ. Effects of low‐dose morphine on perceived sleep quality in patients with refractory breathlessness: A hypothesis generating study. Respirology 2015; 21:386-91. [DOI: 10.1111/resp.12681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Rodrigo T. Martins
- Neuroscience Research Australia (NeuRA) Randwick New South Wales Australia
- School of Medical SciencesUniversity of New South Wales Sydney New South Wales Australia
| | - David C. Currow
- Discipline, Palliative and Supportive ServicesFlinders University Bedford Park South Australia Australia
| | - Amy P. Abernethy
- Department of Medicine, Division on Medical Oncology and the Center for Learning Health CareDuke Clinical Research InstituteDuke University Durham North Carolina USA
| | | | - Barbara Toson
- Neuroscience Research Australia (NeuRA) Randwick New South Wales Australia
| | - Danny J. Eckert
- Neuroscience Research Australia (NeuRA) Randwick New South Wales Australia
- School of Medical SciencesUniversity of New South Wales Sydney New South Wales Australia
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179
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Riha RL. Diagnostic approaches to respiratory sleep disorders. J Thorac Dis 2015; 7:1373-84. [PMID: 26380763 DOI: 10.3978/j.issn.2072-1439.2015.08.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/13/2015] [Indexed: 12/18/2022]
Abstract
Sleep disordered breathing (SDB) comprises a number of breathing disturbances occurring during sleep including snoring, the obstructive sleep apnoea/hypopnea syndrome (OSAHS), central sleep apnoea (CSA) and hypoventilation syndromes. This review focuses on sleep disordered breathing and diagnostic approaches in adults, in particular clinical assessment and overnight assessment during sleep. Although diagnostic approaches to respiratory sleep disorders are reasonably straightforward, they do require a degree of clinical acumen when it comes to assessing severity and management options. Diagnosing respiratory sleep disorders on clinical features alone has limitations. Monitoring and measuring respiration during sleep has undergone many advances in the last 40 years in respect of quality and validity, largely regarding OSAHS. Despite the improvement in our diagnostic standards and recognition of sleep disordered breathing, many limitations still need to be overcome. Apart from assessing the individual patient, population screening for sleep disorders continues to preoccupy health professionals and policy makers in many countries. Research in the field is pushing current boundaries in terms of simplifying diagnosis and enhancing screening for sleep disordered breathing in large populations. At present, a number of these newer approaches require further validation.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Scotland, UK
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180
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Bascom AT, Sankari A, Goshgarian HG, Badr MS. Sleep onset hypoventilation in chronic spinal cord injury. Physiol Rep 2015; 3:3/8/e12490. [PMID: 26290534 PMCID: PMC4562576 DOI: 10.14814/phy2.12490] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A high prevalence of sleep-disordered breathing (SDB) after spinal cord injury (SCI) has been reported in the literature; however, the underlying mechanisms are not well understood. We sought to determine the effect of the withdrawal of the wakefulness drive to breathe on the degree of hypoventilation in SCI patients and able-bodied controls. We studied 18 subjects with chronic cervical and thoracic SCI (10 cervical, 8 thoracic SCI; 11 males; age 42.4 ± 17.1 years; body mass index 26.3 ± 4.8 kg/m2) and 17 matched able-bodied subjects. Subjects underwent polysomnography, which included quantitative measurement of ventilation, timing, and upper airway resistance (RUA) on a breath-by-breath basis during transitions from wake to stage N1 sleep. Compared to able-bodied controls, SCI subjects had a significantly greater reduction in tidal volume during the transition from wake to N1 sleep (from 0.51 ± 0.21 to 0.32 ± 0.10 L vs. 0.47 ± 0.13 to 0.43 ± 0.12 L; respectively, P < 0.05). Moreover, end-tidal CO2 and end-tidal O2 were significantly altered from wake to sleep in SCI (38.9 ± 2.7 mmHg vs. 40.6 ± 3.4 mmHg; 94.1 ± 7.1 mmHg vs. 91.2 ± 8.3 mmHg; respectively, P < 0.05), but not in able-bodied controls (39.5 ± 3.2 mmHg vs. 39.9 ± 3.2 mmHg; 99.4 ± 5.4 mmHg vs. 98.9 ± 6.1 mmHg; respectively, P = ns). RUA was not significantly altered in either group. In conclusion, individuals with SCI experience hypoventilation at sleep onset, which cannot be explained by upper airway mechanics. Sleep onset hypoventilation may contribute to the development SDB in the SCI population.
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Affiliation(s)
- Amy T Bascom
- Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA Wayne State University School of Medicine, Detroit, MI, USA
| | - Abdulghani Sankari
- Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA Wayne State University School of Medicine, Detroit, MI, USA
| | | | - M Safwan Badr
- Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA Wayne State University School of Medicine, Detroit, MI, USA
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181
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Abuyassin B, Sharma K, Ayas NT, Laher I. Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship? J Clin Sleep Med 2015; 11:915-24. [PMID: 25845900 PMCID: PMC4513269 DOI: 10.5664/jcsm.4946] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/03/2015] [Indexed: 01/02/2023]
Abstract
Chronic kidney disease (CKD) is associated with high mortality rates and heavy economic and social burdens. Nearly 10% of the United States population suffer from CKD, with fatal outcomes increased by 16-40 times even before reaching end-stage renal disease. The prevalence of obstructive sleep apnea (OSA) is between 3% and 7% in the general population, and has increased dramatically during the last 2 decades along with increased rates of obesity. However, the prevalence of OSA is much greater in patients with CKD. In addition, aggressive dialysis improves OSA. The current literature suggests a bidirectional association between CKD and OSA through a number of potential pathological mechanisms, which increase the possibility of both diseases being possible risk factors for each other. CKD may lead to OSA through a variety of mechanisms, including alterations in chemoreflex responsiveness, pharyngeal narrowing due to fluid overload, and accumulation of uremic toxins. It is also being increasingly recognized that OSA can also accelerate loss of kidney function. Moreover, animals exposed to intermittent hypoxia suffer histopathological renal damage. Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction, activation of the sympathetic nervous system, and increased oxidative stress.
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Affiliation(s)
- Bisher Abuyassin
- Departments of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kumar Sharma
- Institute of Metabolomic Medicine and Center for Renal Translational Medicine, University of California, San Diego, La Jolla, CA
| | - Najib T. Ayas
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ismail Laher
- Departments of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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182
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Böing S, Randerath WJ. Chronic hypoventilation syndromes and sleep-related hypoventilation. J Thorac Dis 2015; 7:1273-85. [PMID: 26380756 PMCID: PMC4561264 DOI: 10.3978/j.issn.2072-1439.2015.06.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/05/2015] [Indexed: 01/21/2023]
Abstract
Chronic hypoventilation affects patients with disorders on any level of the respiratory system. The generation of respiratory impulses can be impaired in congenital disorders, such as central congenital alveolar hypoventilation, in alterations of the brain stem or complex diseases like obesity hypoventilation. The translation of the impulses via spinal cord and nerves to the respiratory muscles can be impaired in neurological diseases. Thoraco-skeletal or muscular diseases may inhibit the execution of the impulses. All hypoventilation disorders are characterized by a reduction of the minute ventilation with an increase of daytime hypercapnia. As sleep reduces minute ventilation substantially in healthy persons and much more pronounced in patients with underlying thoraco-pulmonary diseases, hypoventilation manifests firstly during sleep. Therefore, sleep related hypoventilation may be an early stage of chronic hypoventilation disorders. After treatment of any prevailing underlying disease, symptomatic therapy with non-invasive ventilation (NIV) is required. The adaptation of the treatment should be performed under close medical supervision. Pressure support algorithms have become most frequently used. The most recent devices automatically apply pressure support and vary inspiratory and expiratory pressures and breathing frequency in order to stabilize upper airways, normalize ventilation, achieve best synchronicity between patient and device and aim at optimizing patients' adherence.
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183
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Wang Y, Cao J, Feng J, Chen BY. Cheyne-Stokes respiration during sleep: mechanisms and potential interventions. Br J Hosp Med (Lond) 2015; 76:390-6. [PMID: 26140557 DOI: 10.12968/hmed.2015.76.7.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cheyne-Stokes respiration is characterized by a typical waxing and waning pattern in breathing amplitude, interspersed with central apnoeas or hypopnoeas. This article reviews current knowledge regarding Cheyne-Stokes respiration with a particular emphasis on the mechanisms and latest methods of intervention.
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Affiliation(s)
| | | | | | - Bao-Yuan Chen
- Chief Physician in the Department of Respiratory Diseases, Tianjin Medical University General Hospital, Tianjin, 300052, China
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184
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Li Y, Daniels LB, Strollo PJ, Malhotra A. Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Con. Can J Cardiol 2015; 31:940-4. [PMID: 26112304 PMCID: PMC4506310 DOI: 10.1016/j.cjca.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022] Open
Abstract
Sleep-disordered breathing (SDB) is one of the most common comorbidities in people with congestive heart failure (CHF). Although SDB has major cardiometabolic consequences, the attributable risk of SDB in asymptomatic CHF patients remains unclear. Whether early intervention using positive airway pressure would improve the prognosis in CHF patients is uncertain. As yet, there is insufficient evidence that routine polysomnography screening is cost-effective for asymptomatic CHF patients. Careful clinical risk evaluation and thoughtful use of limited-channel home sleep testing should be considered before the application of routine polysomnography in all CHF patients.
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Affiliation(s)
- Yanru Li
- Beijing Tongren Hospital, Capital Medical University, Department of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Lori B Daniels
- University of California at San Diego, Division of Cardiology, Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Patrick J Strollo
- UPMC Sleep Medicine Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, Pennsylvania, USA
| | - Atul Malhotra
- University of California at San Diego, Chief of Division of Pulmonary, Critical Care and Sleep Medicine, La Jolla, California, USA.
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185
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Affiliation(s)
- Brian D Kent
- 1 Sleep Disorders Centre/Lane Fox Unit Guy's & St Thomas' National Health Service Foundation Trust London, United Kingdom
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186
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Correa D, Farney RJ, Chung F, Prasad A, Lam D, Wong J. Chronic Opioid Use and Central Sleep Apnea. Anesth Analg 2015; 120:1273-85. [DOI: 10.1213/ane.0000000000000672] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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187
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Vale JMD, Silva E, Pereira IG, Marques C, Sanchez-Serrano A, Torres AS. Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation. J Bras Pneumol 2015; 40:574-8. [PMID: 25410846 PMCID: PMC4263339 DOI: 10.1590/s1806-37132014000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/20/2013] [Indexed: 12/03/2022] Open
Abstract
The Chiari malformation type I (CM-I) has been associated with sleep-disordered
breathing, especially central sleep apnea syndrome. We report the case of a
44-year-old female with CM-I who was referred to our sleep laboratory for suspected
sleep apnea. The patient had undergone decompressive surgery 3 years prior. An
arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory
disturbance index of 108 events/h, and all were central apnea events. Treatment with
adaptive servo-ventilation was initiated, and central apnea was resolved. This report
demonstrates the efficacy of servo-ventilation in the treatment of central sleep
apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a
history of decompressive surgery.
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188
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Correia S, Martins V, Sousa L, Moita J, Teixeira F, Dos Santos JM. Clinical impact of adaptive servoventilation compared to other ventilatory modes in patients with treatment-emergent sleep apnea, central sleep apnea and Cheyne-Stokes respiration. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:132-137. [PMID: 25926251 DOI: 10.1016/j.rppnen.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/15/2014] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Adaptive servoventilation is a recent ventilatory mode initially designed to treat Cheyne-Stokes respiration (CSR). Recently, the efficacy of ASV has been discussed for the treatment of central sleep apnea (CSA) and treatment-emergent central sleep apnea (treatment-emergent CSA) where other forms of traditional positive airway pressure (PAP) may be insufficient. OBJECTIVES To compare the clinical impact of ASV with other forms of PAP in treating patients with treatment-emergent CSA, CSA and CSR. METHODS Medical data of all the patients who underwent polysomnography (PSG) with ASV titration were evaluated. The patients were divided into two groups according to the mode of ventilation reimbursed: ASV and PAP (AutoCPAP/CPAP/BIPAP). All patients had a minimal follow-up of 6 months. Both groups were compared in terms of symptoms, apnea hypopnea index, compliance, cardiac function and cardiovascular events. RESULTS ASV titration was performed in 33 patients (30M/3F) with a mean age of 69±8 years. The majority (58%) present a treatment-emergent SA and 42% a CSA and or CSR. The median initial diagnostic AHI was 46±22events/h. After the initial diagnosis, 28 patients were treated with PAP and 5 with servoventilation. All of the patients treated with PAP were posteriorly submitted to PSG and ASV titration because of suboptimal response to PAP. Despite a clear indication for ASV, due to differences in reimbursement, 15 patients continued treatment with PAP (12 with AutoCPAP, 1 with BIPAP and 2 with CPAP) and 16 changed to ASV. Two patients were lost in follow-up. In both groups, most of patients present a treatment-emergent SA (53% in ASV group vs. 67% in PAP group) or a CSA/CSR (29.4% in ASV group vs. 20% in PAP). After ASV titration, the mean follow-up was 25±14 months. Both groups (ASV vs. PAP) were similar in terms of compliance (77±23% vs.88±14%) and in terms of Epworth sleepiness scale score (6±5 vs. 7±5). There was a statistical difference in terms of residual AHI: mean AHI was 4±3 in ASV group and 9±3 in PAP group (P=0.005). We found no differences in terms of left ventricular fractional shortening (ASV 33±10% vs. PAP 32±10%). Although no difference was observed between the 2 groups in terms of non-fatal cardiovascular events (3 events in each group), 2 fatal cardiovascular events occurred in the PAP group (sudden death). CONCLUSIONS These data confirm that ASV is an efficient treatment in patients with treatment-emergent CSA, CSA/CSR significantly decreasing residual AHI. In both groups, compliance rate was high and sleepiness improved. It is relevant that the 2 patients who died of sudden death were treated with PAP.
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Affiliation(s)
- Sílvia Correia
- Pneumology Department, ULS-Guarda, Sousa Martins Hospital, Guarda, Portugal.
| | - Vitória Martins
- Pneumology Department, HG-CHUC, Sleep Medicine Center, Coimbra, Portugal
| | - Liliana Sousa
- Neurophysiology Department, HG-CHUC, Sleep Medicine Center, Coimbra, Portugal
| | - Joaquim Moita
- Pneumology Department, HG-CHUC, Sleep Medicine Center, Coimbra, Portugal
| | - Fátima Teixeira
- Pneumology Department, HG-CHUC, Sleep Medicine Center, Coimbra, Portugal
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189
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Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Böhm M, Oldenburg O. The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 2015; 104:705-18. [DOI: 10.1007/s00392-015-0859-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 01/22/2023]
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190
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Contal O, P�pin JL, Borel JC, Espa F, Perrig S, L�cker LM, Adler D, Janssens JP, Lador F. Underlying Mechanisms for Coexisting Central and Obstructive Sleep Apnea: Nocturnal PaCO 2 and Poor Sleep Quality Are Key Issues. Respiration 2015; 89:416-9. [DOI: 10.1159/000375315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/30/2014] [Indexed: 11/19/2022] Open
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191
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Tovar-Torres MP, Bodkin C, Sigua NL. A 44-year-old woman with excessive sleepiness. Opioid-induced central sleep apnea. Chest 2015; 146:e204-e207. [PMID: 25451363 DOI: 10.1378/chest.14-0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Cynthia Bodkin
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN
| | - Ninotchka L Sigua
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, IN.
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192
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Ramasubban S, Goswami L, Banerjee N. Central sleep apnea in a patient with dengue encephalitis. APOLLO MEDICINE 2015. [DOI: 10.1016/j.apme.2015.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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193
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Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m. Sleep Med 2015; 16:343-6. [DOI: 10.1016/j.sleep.2014.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 12/28/2022]
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194
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Baertsch NA, Baker-Herman TL. Intermittent reductions in respiratory neural activity elicit spinal TNF-α-independent, atypical PKC-dependent inactivity-induced phrenic motor facilitation. Am J Physiol Regul Integr Comp Physiol 2015; 308:R700-7. [PMID: 25673781 DOI: 10.1152/ajpregu.00359.2014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/07/2015] [Indexed: 12/19/2022]
Abstract
In many neural networks, mechanisms of compensatory plasticity respond to prolonged reductions in neural activity by increasing cellular excitability or synaptic strength. In the respiratory control system, a prolonged reduction in synaptic inputs to the phrenic motor pool elicits a TNF-α- and atypical PKC-dependent form of spinal plasticity known as inactivity-induced phrenic motor facilitation (iPMF). Although iPMF may be elicited by a prolonged reduction in respiratory neural activity, iPMF is more efficiently induced when reduced respiratory neural activity (neural apnea) occurs intermittently. Mechanisms giving rise to iPMF following intermittent neural apnea are unknown. The purpose of this study was to test the hypothesis that iPMF following intermittent reductions in respiratory neural activity requires spinal TNF-α and aPKC. Phrenic motor output was recorded in anesthetized and ventilated rats exposed to brief intermittent (5, ∼1.25 min), brief sustained (∼6.25 min), or prolonged sustained (30 min) neural apnea. iPMF was elicited following brief intermittent and prolonged sustained neural apnea, but not following brief sustained neural apnea. Unlike iPMF following prolonged neural apnea, spinal TNF-α was not required to initiate iPMF during intermittent neural apnea; however, aPKC was still required for its stabilization. These results suggest that different patterns of respiratory neural activity induce iPMF through distinct cellular mechanisms but ultimately converge on a similar downstream pathway. Understanding the diverse cellular mechanisms that give rise to inactivity-induced respiratory plasticity may lead to development of novel therapeutic strategies to treat devastating respiratory control disorders when endogenous compensatory mechanisms fail.
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Affiliation(s)
- Nathan A Baertsch
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tracy L Baker-Herman
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
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195
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Jin J, Sánchez-Sinencio E. A home sleep apnea screening device with time-domain signal processing and autonomous scoring capability. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2015; 9:96-104. [PMID: 25486649 DOI: 10.1109/tbcas.2014.2314301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Current solutions of sleep apnea diagnosis require the patient to undergo overnight studies at a specialized sleep laboratory. Due to such inconvenience and high cost, millions of sleep apnea patients remain undiagnosed and thus untreated. Based on a micro-electro-mechanical systems (MEMS) sensor and an effective apnea detection algorithm, we propose a low-cost single-channel apnea screening solution applicable in the comfort of patients' homes. A prototype device was designed and assembled including a MEMS sensor for measuring the patient's nasal air flows, and a time-domain signal processing IC for apnea detection and autonomous scoring. The IC chip was fabricated in standard 0.5- μm CMOS technology. The proposed device was tested for both respiratory rhythm detection and sleep apnea screening under clinical environment. Apnea-hypopnea indices (AHI) were scored to indicate severity of sleep apnea conditions. Test results suggest that the proposed device can be a valuable screening solution for the broader public with undiagnosed apnea conditions.
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196
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Sawatari H, Chishaki A, Nishizaka M, Matsuoka F, Yoshimura C, Kuroda H, Rahmawati A, Hashiguchi N, Miyazono M, Ono J, Ohkusa T, Ando SI. A nationwide cross-sectional study on congenital heart diseases and symptoms of sleep-disordered breathing among Japanese Down's syndrome people. Intern Med 2015; 54:1003-8. [PMID: 25948338 DOI: 10.2169/internalmedicine.54.3989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE It is well known that people with Down's syndrome (DS) frequently complicate with congenital heart diseases (CHDs). Patients with heart diseases often have sleep-disordered breathing as a co-morbidity (SDB) which worsens the heart diseases. However, the relationship between SDB and CHDs in DS people has not yet been fully elucidated. The aim of this study was to establish the association between SDB and CHDs in DS people using data from a large nationwide questionnaire survey in Japan. METHODS We conducted a cross-sectional questionnaire survey of a randomly selected sample of 2,000 DS people and their caregivers throughout Japan to examine the associations between observed signs of SDB and CHDs in DS people. The questionnaire included the presence of SDB symptoms (snoring, apnea, arousal, nocturia, and napping) and CHDs (the presence and types of CHDs). RESULTS Of the 1,222 replies received from the caregivers, 650 reported complications of some type of CHDs. The observed apnea tended to be higher among DS people with CHDs than those without CHDs (OR=1.28, 95% CI=0.97-1.70, p=0.09). DS people with tetralogy of Fallot reported significantly more frequent apnea than those without CHDs (OR=3.10, 95% CI=1.36-7.05, p<0.01). CONCLUSION SDB prevailed among DS people with severe CHDs, such as tetralogy of Fallot. Careful attention to the signs of SDB in such patients may lead to earlier clinical intervention removing the vicious cycle between SDB and CHDs.
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Affiliation(s)
- Hiroyuki Sawatari
- Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, 2) Research Fellow of the Japan Society for the Promotion of Science, Japan
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197
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Impact of rapid ascent to high altitude on sleep. Sleep Breath 2014; 19:819-26. [PMID: 25491080 DOI: 10.1007/s11325-014-1093-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/24/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Sleep disturbance at high altitude is common in climbers. In this study, we intended to evaluate the effect of rapid ascent on sleep architecture using polysomnography (PSG) and to compare the differences between subjects with and without acute mountain sickness (AMS). METHODS The study included 40 non-acclimatized healthy subjects completing PSG at four time points, 3 days before the ascent (T0), two successive nights at 3150 m (T1 and T2), and 2 days after the descent (T3). All subjects were transported by bus from 555 to 3150 m within 3 h. AMS was diagnosed using self-reported questionnaire of Lake Louise score. RESULTS Twenty of 40 (50%) subjects developed AMS. At high altitude, awakening percentages increased in AMS group but changed insignificantly in non-AMS group. Arousal index and apnea/hypopnea index (AHI) increased irrespective of AMS. The increases of AHI were more evident in non-AMS group than in AMS group. Compared to subjects without AMS, those with AMS had significantly lower sleep efficiency, lower central apnea index, and longer latencies to sleep and rapid eye movement (REM) sleep at T1 and lower REM sleep percentages at T1 and T2. Subjects with older age and lower minimum arterial oxygen saturation during sleep at sea level were prone to develop AMS. CONCLUSIONS Higher AHI did not cause more frequent awakenings and arousals at high altitude. Central sleep apneas were observed in non-AMS but not in AMS group. Subjects unacclimatized to acute hypobaric hypoxia might have delayed and less REM sleep.
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198
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Lim DC, Brady DC, Po P, Chuang LP, Marcondes L, Kim EY, Keenan BT, Guo X, Maislin G, Galante RJ, Pack AI. Simulating obstructive sleep apnea patients' oxygenation characteristics into a mouse model of cyclical intermittent hypoxia. J Appl Physiol (1985) 2014; 118:544-57. [PMID: 25429097 DOI: 10.1152/japplphysiol.00629.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mouse models of cyclical intermittent hypoxia (CIH) are used to study the consequences of both hypoxia and oxidative stress in obstructive sleep apnea (OSA). Whether or not a mouse model of CIH that simulates OSA patients' oxygenation characteristics would translate into improved patient care remains unanswered. First we identified oxygenation characteristics using the desaturation and resaturation time in 47 OSA subjects from the Molecular Signatures of Obstructive Sleep Apnea Cohort (MSOSA). We observe that a cycle of intermittent hypoxia is not sinusoidal; specifically, desaturation time increases in an almost linear relationship to the degree of hypoxia (nadir), whereas resaturation time is somewhat constant (∼15 s), irrespective of the nadir. Second, we modified the Hycon mouse model of CIH to accommodate a 15-s resaturation time. Using this modified CIH model, we explored whether a short resaturation schedule (15 s), which includes the characteristics of OSA patients, had a different effect on levels of oxidative stress (i.e., urinary 8,12-iso-iPF2α-VI levels) compared with sham and a long resaturation schedule (90 s), a schedule that is not uncommon in rodent models of CIH. Results suggest that shorter resaturation time may result in a higher level of 8,12-iso-iPF2α-VI compared with long resaturation or sham conditions. Therefore, simulating the rodent model of CIH to reflect this and other OSA patients' oxygenation characteristics may be worthy of consideration to better understand the effects of hypoxia, oxidative stress, and their interactions.
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Affiliation(s)
- Diane C Lim
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Daniel C Brady
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pengse Po
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Li Pang Chuang
- Department of Thoracic Medicine and Department of Sleep Center, Chang Gung Memorial Hospital, Taipei, Taiwan and Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tauyan, Taiwan; and
| | | | - Emily Y Kim
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xiaofeng Guo
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Greg Maislin
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond J Galante
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
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200
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Diogo LN, Monteiro EC. The efficacy of antihypertensive drugs in chronic intermittent hypoxia conditions. Front Physiol 2014; 5:361. [PMID: 25295010 PMCID: PMC4170135 DOI: 10.3389/fphys.2014.00361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/03/2014] [Indexed: 12/22/2022] Open
Abstract
Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CPAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.
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Affiliation(s)
- Lucilia N Diogo
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisboa, Portugal
| | - Emília C Monteiro
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisboa, Portugal
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