1
|
Shahbazi M, Heidari R, Tafakhori A, Samadi S, Nikeghbalian Z, Amirifard H, Najafi A. The effects of atomoxetine and trazodone combination on obstructive sleep apnea and sleep microstructure: A double-blind randomized clinical trial study. Sleep Med 2024; 113:13-18. [PMID: 37979502 DOI: 10.1016/j.sleep.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
STUDY OBJECTIVES we aimed to compare the effects of atomoxetine and trazodone (A-T) in combination with placebo in patients with obstructive sleep apnea (OSA). METHODS This randomized, placebo-controlled, double-blind, crossover trial study was conducted in adults with OSA referred to a Sleep Clinic. Participants with eligibility criteria were recruited. Patients were studied on two separate nights with one-week intervals, once treated with trazodone (50 mg) and atomoxetine (80 mg) combination and then with a placebo and the following polysomnography tests. RESULTS A total of 18 patients with OSA completed the study protocol, 9(50%) were male, the mean age was 47.5 years (SD = 9.8) and the mean Body mass index of participants was 28.4 kg/m2 (SD = 3.4). Compared with the placebo, the A-T combination resulted in significant differences in AHI (28.3(A-T) vs. 42.7 (placebo), p = 0.025), duration of the REM stage (1.3%TST (A-T) vs. 13.1%TST (placebo), p = 0.001), and the number of REM cycles (0.8 (A-T) vs. 4.7 (placebo), p = 0.001), number of apneas (38.3 (A-T) vs. 79.3 (placebo), p = 0.011), number of obstructive apneas (37.2 (A-T) vs. 75.2 (placebo), p = 0.011), oxygen desaturation index (29.5 (A-T) vs. 42.3 (placebo), p = 0.022) and number of respiratory arousals (43.2 (A-T) vs. 68.5 (placebo), p = 0.048). This decrement effect did not change among those with a low-arousal phenotype of OSA. CONCLUSIONS The A-T combination significantly improved respiratory events' indices compared with placebo in patients with OSA. This combination is recommended to be assessed in a large trial. It could be an alternative for those who do not adhere to the standard available treatments for OSA.
Collapse
Affiliation(s)
- Mojtaba Shahbazi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Heidari
- Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Samadi
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Nikeghbalian
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Amirifard
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arezu Najafi
- Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran; Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Yankova A, Georgiev K, Dimitrova D, Dimitrova-Kirilova V, Nestorova V. A patient with insomnia due to restless leg and periodic limb movement syndrome after stroke–A clinical case. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Restless legs syndrome (or Willis-Ekbom) presents with an overwhelming need for movement of the lower limbs in order to eliminate the unpleasant sensations in them, which appear during rest and sleep. The unpleasant sensations are described as “tingling, pulling or pain” in the knees, ankles, or through the entire lower limbs. Periodic limb movement syndrome presents with involuntary movements of the lower limbs or the body during sleep, for which the patient has no recollection, unlike in those in restless leg syndrome. In most cases they present with four or more successive movements of dorsal flection of the toes and ancles with partial flection of the knees and hips divided into five to 90 second intervals.<br />
A 44-year-old man, a taxi driver, is admitted in a neurological clinic with complaints of a headache, dizziness, exhaustion, which he associates with difficulty falling asleep and maintaining a sleeping state after an ischemic stroke in the right middle cerebral artery four months earlier. The conducted polysomnography reveals an increased sleep latency, periodic limb movement syndrome and multiple arousals before entering REM sleep.
Collapse
Affiliation(s)
- Aleksandra Yankova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University “Prof Paraskev Stoyanov”–Varna, Varna, BULGARIA
| | - Kristiyan Georgiev
- Department of Neurological Diseases and Neuroscience, Faculty of Medicine, Medical University “Prof Paraskev Stoyanov”–Varna, Varna, BULGARIA
| | - Dimitrinka Dimitrova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University “Prof Paraskev Stoyanov”–Varna, Varna, BULGARIA
| | - Vladina Dimitrova-Kirilova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University “Prof Paraskev Stoyanov”–Varna, Varna, BULGARIA
| | - Veselinka Nestorova
- Department of Optometry and Occupational Diseases, Faculty of Public Health, Medical University “Prof Paraskev Stoyanov”–Varna, Varna, BULGARIA
| |
Collapse
|
3
|
Zhang M, Yu H, Wang F, Tang J, Liu N, Xue Y, Ren X, Shi L, Fu J. Electrical Activity During Slow-Wave Sleep and the Relationship With Enlarged Perivascular Spaces in Arteriosclerotic Cerebral Small Vessel Disease. J Clin Neurophysiol 2023; 40:79-85. [PMID: 34009853 DOI: 10.1097/wnp.0000000000000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE We sought to analyze EEG spectral power during slow-wave sleep among patients with arteriosclerotic cerebral small vessel disease (CSVD) compared with community-dwelling individuals. We also sought to determine the relationship between EEG activity and the severity of enlarged perivascular spaces (EPVSs). METHODS Consecutive subjects with arteriosclerotic CSVD ( n = 36) and community-dwelling individuals ( n = 26) between 50 and 80 years of age were included. Nocturnal polysomnography was performed, and EEG spectral analysis was conducted during slow-wave sleep using the F4/M1 and C4/M1 channel. Regionalized EPVSs in the basal ganglia and centrum semiovale were assessed on a validated 4-point visual rating scale (0 = none, 1 = 1-10, 2 = 11-20, 3 = 21-40, and 4 = >40) using MRI. RESULTS CSVD group showed lower delta:beta ratios in the frontal ( P = 0.017) and central ( P = 0.038) regions after adjusting for age, sex, mini-mental state examination score, and arousal index. The significance still remained in the frontal region when including age, sex, mini-mental state examination, and apnea-hypopnea index as covariates ( P = 0.037). Among patients with arteriosclerotic CSVD, decreased delta power ( P = 0.031) and theta power ( P = 0.034) in the frontal region were associated with a higher degree of EPVSs in the centrum semiovale rather than in the basal ganglia. Delta power in the central region showed an extremely weak association with EPVSs in the centrum semiovale ( P = 0.047). CONCLUSIONS Among patients with arteriosclerotic CSVD, the intrusion of high-frequency EEG activity into slow-wave sleep was identified, and slow-wave activity during slow-wave sleep might be negatively associated with the severity of EPVSs in the centrum semiovale. Further studies are required to corroborate the conclusions.
Collapse
Affiliation(s)
- Miaoyi Zhang
- Department of Neurology, North Huashan Hospital, Fudan University, Shanghai, China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Huan Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Fei Wang
- Department of Neurology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang Province, China
| | - Jie Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Na Liu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Yang Xue
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Xue Ren
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Langfeng Shi
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Jianhui Fu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| |
Collapse
|
4
|
Gurges P, Murray BJ, Boulos MI. Relationship between gastroesophageal reflux disease and objective sleep quality. J Clin Sleep Med 2022; 18:2731-2738. [PMID: 35934919 PMCID: PMC9713921 DOI: 10.5664/jcsm.10198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES To objectively characterize (1) the relationship between gastroesophageal reflux disease (GERD) and sleep quality, and (2) the influence of sleep position on this relationship, using in-laboratory polysomnography. METHODS We retrospectively analyzed first-night diagnostic in-laboratory polysomnography data for 3411 patients (median age 55 years; 48% male). Medication use and medical condition data were obtained through self-reported questionnaires. Associations between sleep quality and the presence of GERD, and the influence of sleep position on these associations, were analyzed using multivariable linear regression models. RESULTS After adjusting for age, sex, body mass index, and relevant comorbidities, GERD was associated with a 3.0% decrease in sleep efficiency, 8.8-minute increase in wake after sleep onset, 24.4-minute increase in rapid eye movement (REM) latency, 13.4-minute decrease in total sleep time, 1.4% decrease in %REM sleep, and 1.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the right side was associated with an 8.6% decrease in sleep efficiency, 27.5-minute increase in wake after sleep onset, 35.6-minute decrease in total sleep time, 2.1% decrease in %REM sleep, and 3.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the left side was associated with an 8.7-minute increase in sleep onset latency. CONCLUSIONS GERD is associated with an impairment in objective sleep quality. These associations were more pronounced in right-sided sleep and mostly ameliorated in left-sided sleep. Physicians should recognize the potential for poor sleep quality in patients with GERD and the effect of body position on this relationship. CITATION Gurges P, Murray BJ, Boulos MI. Relationship between gastroesophageal reflux disease and objective sleep quality. J Clin Sleep Med. 2022;18(12):2731-2738.
Collapse
Affiliation(s)
- Patrick Gurges
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian J. Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I. Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Bansal K, Garcia J, Feltch C, Earley C, Robucci R, Banerjee N, Brooks J. A pilot study to understand the relationship between cortical arousals and leg movements during sleep. Sci Rep 2022; 12:12685. [PMID: 35879382 PMCID: PMC9314423 DOI: 10.1038/s41598-022-16697-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Leg movements during sleep occur in patients with sleep pathology and healthy individuals. Some (but not all) leg movements during sleep are related to cortical arousals which occur without conscious awareness but have a significant effect of sleep fragmentation. Detecting leg movements during sleep that are associated with cortical arousals can provide unique insight into the nature and quality of sleep. In this study, a novel leg movement monitor that uses a unique capacitive displacement sensor and 6-axis inertial measurement unit, is used in conjunction with polysomnography to understand the relationship between leg movement and electroencephalogram (EEG) defined cortical arousals. In an approach that we call neuro-extremity analysis, directed connectivity metrics are used to interrogate causal linkages between EEG and leg movements measured by the leg movement sensors. The capacitive displacement measures were more closely related to EEG-defined cortical arousals than inertial measurements. Second, the neuro-extremity analysis reveals a temporally evolving connectivity pattern that is consistent with a model of cortical arousals in which brainstem dysfunction leads to near-instantaneous leg movements and a delayed, filtered signal to the cortex leading to the cortical arousal during sleep.
Collapse
Affiliation(s)
- Kanika Bansal
- US CCDC Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA.,Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Javier Garcia
- US CCDC Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, USA
| | | | - Christopher Earley
- Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan Robucci
- Tanzen Medical Inc., Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Nilanjan Banerjee
- Tanzen Medical Inc., Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Justin Brooks
- Tanzen Medical Inc., Baltimore, MD, USA. .,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Catonsville, MD, USA. .,Tanzen Medical Inc, 5926 Lebanon Lane, Elkridge, MD, 21075, USA.
| |
Collapse
|
6
|
Ahmed RI, Hendy RM, Ahmed MI, Ali SA, AboOmira MH, Shaban MM. Periodic limb movement index and severity of obstructive sleep apnea. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two frequent coincident sleep disorders. The association of PLMS with OSAS severity and predictors of PLMS in OSAS patients were investigated.
Material and method
This is a retrospective study that enrolled adult patients ≥ 16 years old who visited the sleep unit at Mouwasat Hospital, Saudi Arabia, between January 2021 and October 2021. All were subjected to full medical history, clinical examination, Epworth Sleepiness (ESS), STOP-Bang questionnaires, and standard overnight polysomnography. Subjects were subdivided into two groups based on PSG findings: group I, OSA patients (153). Patients were classified into mild n = 57 (AHI ≥ 5 and < 15), moderate n = 35 (AHI ≥ 15 and < 30), and severe n = 61 (AHI ≥ 30). Group II, control group included 100 subjects.
Result
There was a higher frequency of PLMS in OSA patients vs control group (with a statistically significant value). The study showed a statistically significantly positive correlation between PLMI and each of AHI, hypopnea index, desaturation index, and PLMs with arousal index, in contrast; it had a statistically significantly negative correlation with BMI among the OSA group. By performing multivariate logistic regression to predict the possible factors associated with the existence of PLMS among the OSA group, it was showed that the apnea index and desaturation index were statistically significant predictors.
Conclusion
The present study showed that OSA patients with PLM were older; had greater AHI, hypopnea index, desaturation index, and PLMs with arousal index; and had lower BMI. Further studies are needed for better understanding this complex relationship.
Collapse
|
7
|
Drakatos P, Olaithe M, Verma D, Ilic K, Cash D, Fatima Y, Higgins S, Young AH, Chaudhuri KR, Steier J, Skinner T, Bucks R, Rosenzweig I. Periodic limb movements during sleep: a narrative review. J Thorac Dis 2022; 13:6476-6494. [PMID: 34992826 PMCID: PMC8662505 DOI: 10.21037/jtd-21-1353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/20/2021] [Indexed: 01/02/2023]
Abstract
Objective Using narrative review techniques, this paper evaluates the evidence for separable underlying patho-mechanisms of periodic limb movements (PLMs) to separable PLM motor patterns and phenotypes, in order to elucidate potential new treatment modalities. Background Periodic limb movement disorder (PLMD) is estimated to occur in 5–8% of the paediatric population and 4–11% of the general adult population. Due to significant sleep fragmentation, PLMD can lead to functional impairment, including hyperactivity and delayed language development in children, and poor concentration and work performance in adults. Longitudinal data demonstrate that those with PLMD are at greater risk of depression and anxiety, and a 4-fold greater risk of developing dementia. PLMD has been extensively studied over the past two decades, and several key insights into the genetic, pathophysiological, and neural correlates have been proposed. Amongst these proposals is the concept of separable PLM phenotypes, proposed on the basis of nocturnal features such as the ratio of limb movements and distribution throughout the night. PLM phenotype and presentation, however, varies significantly depending on the scoring utilized and the nocturnal features examined, across age, and co-morbid clinical conditions. Furthermore, associations between these phenotypes with major neurologic and psychiatric disorders remain controversial. Methods In order to elucidate potential divergent biological pathways that may help clarify important new treatment modalities, this paper utilizes narrative review and evaluates the evidence linking PLM motor patterns and phenotypes with hypothesised underlying patho-mechanisms. Distinctive, underlying patho-mechanisms include: a pure motor mechanism originating in the spinal cord, iron deficiency, dopamine system dysfunction, thalamic glutamatergic hyperactivity, and a more cortical-subcortical interplay. In support of the latter hypothesis, PLM rhythmicity appears tightly linked to the microarchitecture of sleep, not dissimilarly to the apnoeic/hypopneic events seen in obstructive sleep apnea (OSA). Conclusions This review closes with a proposal for greater investigation into the identification of potential, divergent biological pathways. To do so would require prospective, multimodal imaging clinical studies which may delineate differential responses to treatment in restless legs syndrome (RLS) without PLMS and PLMS without RLS. This could pave the way toward important new treatment modalities.
Collapse
Affiliation(s)
- Panagis Drakatos
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK.,Faculty of Life and Sciences Medicine, King's College London, London, UK
| | - Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Dhun Verma
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK
| | - Katarina Ilic
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,BRAIN, Imaging Centre, CNS, King's College London, London, UK
| | - Diana Cash
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,BRAIN, Imaging Centre, CNS, King's College London, London, UK
| | - Yaqoot Fatima
- Institute for Social Science Research, University of Queensland, Brisbane, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK
| | - Allan H Young
- School of Academic Psychiatry, King's College London, London, UK
| | - K Ray Chaudhuri
- King's College London and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Joerg Steier
- Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK.,Faculty of Life and Sciences Medicine, King's College London, London, UK
| | - Timothy Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark.,La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Romola Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.,The Raine Study, University of Western Australia, Perth, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK
| |
Collapse
|
8
|
Imayama I, Gupta A, Yen PS, Chen YF, Keenan B, Townsend RR, Chirinos JA, Weaver FM, Carley DW, Kuna ST, Prasad B. Socioeconomic status impacts blood pressure response to positive airway pressure treatment. J Clin Sleep Med 2021; 18:1287-1295. [PMID: 34931603 PMCID: PMC9059597 DOI: 10.5664/jcsm.9844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) reduces blood pressure (BP). Retrospective data suggest that African Americans (AA), a group at high-risk for hypertensive organ dysfunction, may have a greater BP response to PAP therapy than European Americans (EA). We examined the difference in 24-hour BP response to three months of PAP treatment between AA and EA. METHODS Participants (N=259, 161 AA and 98 EA) with apnea-hypopnea index (AHI) ≥15/hour from two prospective cohorts were included. T-tests and multiple linear regression were used to examine BP outcomes in AA vs. EA, adjusting for PAP adherence, socioeconomic status (SES), and baseline characteristics. RESULTS Participants were middle-aged (mean ± standard deviation, 53.8±9.3 years), 86% (227) men, AHI 35.6±19.2/hour, and PAP adherence of 3.36±2.24 hours/day. The reductions in 24-hour systolic and diastolic BP (mm Hg) were not different in AA vs. EA (systolic=-1.13±12.1 vs. -0.61±12.8, p=0.80 and diastolic=-0.74±7.9 vs. -0.80±7.4, p=0.96), and race was not a predictor of 24-hour systolic or diastolic BP reduction (p=0.75 and 0.54). SES and PAP adherence demonstrated a significant interaction; low SES was associated with an increase in 24-hour systolic BP (β=19.3, p=0.03) in the absence of PAP use but a greater reduction in 24-hour systolic BP with higher PAP adherence (β=-3.96, p=0.03). CONCLUSIONS 24-hour BP response to PAP treatment is similar in AA and EA. Adherence to PAP treatment is more effective in improving 24-hour systolic BP in those with low SES. The study was a clinical trial. Clinical Trial Registration: NCT01960465 and NCT01578031.
Collapse
Affiliation(s)
- Ikuyo Imayama
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Ahana Gupta
- GPPA Medical Scholars Program, University of Illinois at Chicago, Chicago, IL
| | - Pei-Shan Yen
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Yi-Fan Chen
- Biostatistics Core, Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL
| | - Brendan Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Raymond R Townsend
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Julio A Chirinos
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Health Care (CINCCH), Hines VA, Hines, IL and Parkinson School of Health Sciences and Public Health, Loyola University, Chicago, IL
| | - David W Carley
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL
| | - Samuel T Kuna
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Bharati Prasad
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL
| |
Collapse
|
9
|
Kholghi M, Szollosi I, Hollamby M, Bradford D, Zhang Q. A validation study of a ballistocardiograph sleep tracker EMFIT QS against polysomnography. J Clin Sleep Med 2021; 18:1203-1210. [PMID: 34705630 DOI: 10.5664/jcsm.9754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Consumer home sleep trackers provide a great opportunity for longitudinal objective sleep monitoring. Non-wearable sleep devices cause little to no disruption in the daily life routine and need little maintenance. However, their validity needs further investigation. This study aims to evaluate the accuracy of sleep outcomes of EMFIT Quantified Sleep (QS), an unobtrusive non-wearable sleep tracker based on ballistocardiography, against polysomnography (PSG). METHODS 62 sleep-lab patients underwent a single clinical PSG with measures simultaneously collected through PSG and EMFIT QS. Resting heart rate (HR), Total Sleep Time (TST), Wake After Sleep Onset (WASO), Sleep Onset Latency (SOL) and duration in sleep stages, collected from the two devices, compared using paired t-tests and their agreement analyzed using Bland-Altman plots. Additionally, continuous HR and sleep stages in 30-seconds epochs were evaluated. RESULTS EMFIT QS data loss occurred in 47% of participants. In the remaining 33 participants (15 females, with mean age of 53.7±16.5), EMFIT QS overestimated TST by 177.5±119.4 minutes (p<0.001) and underestimated WASO by 44.74±68.81 minutes (p<0.001). It accurately measured average resting HR and was able to distinguish SOL with some accuracy. However, the agreement between EMFIT QS and PSG on sleep-wake detection was very low (kappa=0.13, p<0.001), EMFIT QS failed to distinguish sleep stages. CONCLUSIONS A consensus between PSG and EMFIT QS was found in SOL and average HR. There was significant discrepancy and lack of consensus in other sleep outcomes. These findings indicated that further development is necessary before using EMFIT QS in clinical and research settings. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: Sleep parameter validation of a consumer home sleep monitoring device, EMFIT Quantified Sleep (QS), against Polysomnography; Identifier: ACTRN12621000600842; URL: https://www.anzctr.org.au/ACTRN12621000600842.aspx.
Collapse
Affiliation(s)
| | - Irene Szollosi
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Mitchell Hollamby
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | | | - Qing Zhang
- Health & Biosecurity, CSIRO, Brisbane, QLD, Australia
| |
Collapse
|
10
|
Spektor E, Fietze I, Poluektov MG. Periodic Limb Movements Syndrome in Patients With Cerebral Small Vessel Disease: Protocol for a Prospective Observational Study. Front Neurol 2021; 12:700151. [PMID: 34646228 PMCID: PMC8503532 DOI: 10.3389/fneur.2021.700151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Cerebrovascular diseases are the leading cause of cognitive decline and dementia. Therefore, the investigation of the potential ways to slow down the disease progression is an important research field. Periodic limb movements in sleep (PLMS) are known to be associated with transient changes in heart rate and blood pressure. These changes might influence the course of cerebral small vessel disease (cSVD). Nevertheless, the clinical significance of PLMS, particularly its influence on cardiovascular diseases course, is still controversial and underinvestigated. Methods/design: Patients from 60 to 75 years old diagnosed with cSVD will undergo nocturnal polysomnography. Subjects with apnea/hypopnea index under 5 will be enrolled. Sleep quality and daytime functioning will be assessed at baseline with self-reported questionnaires. Brain MRI and cognitive assessment will be performed at baseline and in the 2-year follow-up. Progression of cSVD markers and cognitive dysfunction will be compared between patients with PLMS index (PLMI) equal to or more than 15 movements per hour of sleep and controls (PLMI <15/h). Discussion: The negative role of PLMS in cSVD progression and related cognitive decline is expected. We suppose that patients with PLMS tend to worsen in cognitive performance more rapidly than age-, gender-, and comorbidity-matched controls. We also expect them to have more rapid white matter hyperintensities and other cSVD marker progression. The limitations of the study protocol are the short follow-up period, the absence of a treatment group, and inability to make a conclusion about causality.
Collapse
Affiliation(s)
- Ekaterina Spektor
- Department of Sleep Medicine, Chair of Neurology and Neurosurgery, University Clinical Hospital No. 3, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ingo Fietze
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,The Fourth People's hospital of Guangyuan, Guangyuan City, China.,The Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Mikhail G Poluektov
- Department of Sleep Medicine, Chair of Neurology and Neurosurgery, University Clinical Hospital No. 3, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
11
|
Bowles NP, Shea SA. Is the bedtime ingestion of hypertensive medications effective and safe? Sleep Med Rev 2021; 59:101511. [PMID: 34175781 DOI: 10.1016/j.smrv.2021.101511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Nicole P Bowles
- Institute of Occupational Health Sciences, Oregon Health and Sciences University, Portland, OR 97239, USA.
| | - Steven A Shea
- Institute of Occupational Health Sciences, Oregon Health and Sciences University, Portland, OR 97239, USA
| |
Collapse
|
12
|
Ramos AR, Alperin N, Lee S, Gonzalez KA, Tarraf W, Hernandez-Cardenache R. Cognitive and Neuroimaging Correlates of the Insomnia Severity Index in Obstructive Sleep Apnea: A Pilot-Study. APPLIED SCIENCES-BASEL 2021; 11. [PMID: 34221490 PMCID: PMC8253601 DOI: 10.3390/app11125314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We aim to determine the sleep correlates of age-related brain loss in a sample of middle-aged to older males with obstructive sleep apnea (OSA). We recruited consecutive treatment naïve male patients with moderate to severe OSA from January to November of 2019. We excluded participants if they had dementia, stroke or heart disease. We collected demographic variables and vascular risk factors. We also obtained the insomnia severity index, the Epworth sleepiness scale and the Pittsburgh sleep quality index. We also obtained computerized neurocognitive testing with the go-no-go response inhibition test, Stroop interference test, catch game test, staged information processing speed test, verbal memory test and non-verbal memory test. We derived age and education adjusted domain-specific Z-scores for global cognition, memory, attention, processing speed and executive function. We used brain MRI T1-weighted images to derive total hippocampal and gray matter volumes. Partial correlations evaluated associations between variables from sleep questionnaires (e.g., insomnia severity index score), and polysomnographic variables (the apnea-hypopnea index, average oxygen levels during sleep) with cognitive domains and brain volumes. We examined 16 participants with an age range of 40–76 years, 73% Hispanic/Latino. The mean apnea-hypopnea index was 48.9 ± 25.5 and average oxygen saturation during sleep was 91.4% ± 6.9%. Hypertension was seen in 66% and diabetes mellitus in 27%. We found that the insomnia severity index score and average oxygen levels during sleep had the strongest correlations with brain volumes and cognition. These preliminary findings may aid in developing future strategies to improve age-related brain loss in patients with OSA.
Collapse
Affiliation(s)
- Alberto R. Ramos
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
| | - Noam Alperin
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Sang Lee
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Kevin A. Gonzalez
- Department of Neuroscience, University of California, San Diego, CA 92093, USA
| | - Wassim Tarraf
- Department of Health Care Sciences, Institute of Gerontology, Wayne State University, Detroit, MI 48202, USA
| | | |
Collapse
|
13
|
Magnusdottir S, Thomas RJ, Hilmisson H. Can improvements in sleep quality positively affect serum adiponectin-levels in patients with obstructive sleep apnea? Sleep Med 2021; 84:324-333. [PMID: 34225174 DOI: 10.1016/j.sleep.2021.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Assess if changes in sleep quality (Sleep Quality Index, SQI) based on cardiopulmonary coupling-analysis (CPC) impacts serum adiponectin-levels in patients with cardiovascular disease (CVD). METHODS Secondary analysis of electrocardiogram (ECG) data from the Heart Biomarker Evaluation in Apnea Treatment study (HeartBEAT), a multicenter, controlled trial in patients with CVD and moderate-severe sleep apnea, randomly assigned to intervention of Continuous Positive Airway Pressure (CPAP), Nocturnal Supplemental Oxygen (NSO) or Healthy Lifestyle and Sleep Hygiene Education (HLSE; control group). Participants with good-quality ECG-signal (n = 241) were included. RESULTS Improving CPC-sleep quality was associated with net average improvements in serum adiponectin-levels 2.69 μg/ml (p = 0.005) irrespective of therapy initiated. After controlling for confounders, a unit increase in SQI was associated with increase in serum adiponectin-levels 0.071 μg/ml (p = 0.012) and decrease in insulin-levels 0.197 μIU/ml (p = 0.0018). Similarly, a percentage point increase in sleep apnea indicator (SAI) was associated with decrease in serum adiponectin-levels of 0.071 μg/ml (p = 0.017) and increase in insulin-levels of 0.218 μIU/ml (p = 0.020). A percentage point increase in CPC-sleep fragmentation (eLFCBB) had a predicted increase in glucose-levels 0.371 mg/dl (p = 0.009) and insulin-levels 0.284 μIU/ml (p = 0.010). In patients receiving CPAP-therapy, a difference in serum adiponictin levels of 3.82 μg/ml (p = 0.025) is observed comparing patients in which SQI-improved to patients that SQI-declined during the study period. The difference is mostly due to a decrease in serum adiponectin levels in patients that decline in SQI (-3.20 μg/ml). CONCLUSION Improvements in sleep quality were associated with higher serum adiponectin-levels, and improved measures of glycemic metabolism which may have beneficial effects on metabolic syndrome and cardiovascular health. CLINICAL TRIAL REGISTRATION NAME AND NUMBER The Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study is registered at https://clinicaltrials.gov/ct2/show/NCT01086800.
Collapse
Affiliation(s)
| | - Robert Joseph Thomas
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
| | - Hugi Hilmisson
- MyCardio LLC, SleepImage®, 3003 E 3rd Avenue, Denver, CO 80206, USA.
| |
Collapse
|
14
|
Tăuţan AM, Ionescu B, Santarnecchi E. Artificial intelligence in neurodegenerative diseases: A review of available tools with a focus on machine learning techniques. Artif Intell Med 2021; 117:102081. [PMID: 34127244 DOI: 10.1016/j.artmed.2021.102081] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Neurodegenerative diseases have shown an increasing incidence in the older population in recent years. A significant amount of research has been conducted to characterize these diseases. Computational methods, and particularly machine learning techniques, are now very useful tools in helping and improving the diagnosis as well as the disease monitoring process. In this paper, we provide an in-depth review on existing computational approaches used in the whole neurodegenerative spectrum, namely for Alzheimer's, Parkinson's, and Huntington's Diseases, Amyotrophic Lateral Sclerosis, and Multiple System Atrophy. We propose a taxonomy of the specific clinical features, and of the existing computational methods. We provide a detailed analysis of the various modalities and decision systems employed for each disease. We identify and present the sleep disorders which are present in various diseases and which represent an important asset for onset detection. We overview the existing data set resources and evaluation metrics. Finally, we identify current remaining open challenges and discuss future perspectives.
Collapse
Affiliation(s)
- Alexandra-Maria Tăuţan
- University "Politehnica" of Bucharest, Splaiul Independenţei 313, 060042 Bucharest, Romania.
| | - Bogdan Ionescu
- University "Politehnica" of Bucharest, Splaiul Independenţei 313, 060042 Bucharest, Romania.
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School, 330 Brookline Avenue, Boston, United States.
| |
Collapse
|
15
|
Najar LL, de Castro Araújo Pastor RA, Foldvary-Schaefer N, da Mota Gomes M. Prevalence of periodic limb movement in sleep in people with epilepsy: A semi-structured literature review. Epilepsy Behav 2021; 116:107721. [PMID: 33493804 DOI: 10.1016/j.yebeh.2020.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Epilepsy is a prevalent health problem worldwide in all ages, and it is essential to identify disease markers for diagnosis and treatment. Periodic limb movements in sleep (PLMS) are a common finding in polysomnography (PSG). Still, its clinical relevance in people with epilepsy (PWE) is unknown. The aim of this review was to compare PLMS frequency in PWE and controls. METHODS A semi-structured literature review was conducted using PubMed in search of relevant studies in English on August 23, 2019, with the search terms "sleep," "epilepsy," or "seizure," and "polysomnography" in the title and/or abstract. The research was complemented with citation analysis and manual search using Google Scholar. Studies involved PWE and comparative controls using PSG with reported PLMS index (PLMI). RESULTS Seven studies were identified. Only two showed a statistically significant difference in PLMI between cases and controls, and in another study, cases had uncontrolled seizures. In general, studies did not adjust for potential confounders including demographics, apnea-hypopnea index, or medication use. CONCLUSIONS We found few studies exploring the prevalence of PLMS in PWE. In the majority, PLMI did not differ from controls. Further studies are warranted given the prevalence of sleep disturbances in epilepsy.
Collapse
Affiliation(s)
- Lucas Lima Najar
- Graduate Program in Psychiatry and Mental Health of the Institute of Psychiatry - PROPSAM-IPUB: Federal University of Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, Brazil.
| | | | - Nancy Foldvary-Schaefer
- Sleep Disorders and Epilepsy Centers, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH, United States of America.
| | - Marleide da Mota Gomes
- Institute of Neurology, Federal University of Rio de Janeiro, Av. Venceslau Brás, 95 - Botafogo, Rio de Janeiro, Brazil.
| |
Collapse
|
16
|
Chalacheva P, Ji Y, Rosen CL, DeBaun MR, Khoo MCK, Coates TD. Nocturnal peripheral vasoconstriction predicts the frequency of severe acute pain episodes in children with sickle cell disease. Am J Hematol 2021; 96:60-68. [PMID: 33027545 DOI: 10.1002/ajh.26014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 01/27/2023]
Abstract
The basic model of SCD physiology states that vaso-occlusion occurs when hemoglobin S-containing red blood cells (RBC) undergo sickling before they escape the capillary into a larger vessel. We have shown that mental stress, pain and cold, and events reported by patients to trigger SCD vaso-occlusive crisis (VOC), cause rapid and significant decrease in blood flow, reducing the likelihood that RBC could transit the microvasculature before sickling occurs. However, the critical link between decrease in microvascular blood flow and the incidence of future sickle VOC has never been established experimentally in humans. Using data from centrally adjudicated, overnight polysomnograms (PSG), previously collected in a prospective multi-center cohort sleep study, we analyzed the beat-to-beat amplitudes of vasoconstriction reported by the fingertip photoplethysmogram in 212 children and adolescents with SCD and developed an algorithm that detects vasoconstriction events and quantifies the magnitude (Mvasoc ), duration, and frequency of vasoconstriction that reflect the individual's inherent peripheral vasoreactivity. The propensity to vasoconstrict, quantified by median Mvasoc , predicted the incidence rate of post-PSG severe acute vaso-occlusive pain events (P = .006) after accounting for age and hemoglobin. Indices of sleep-disordered breathing contributed to median Mvasoc but did not predict future pain rate. Median Mvasoc was not associated with vaso-occlusive pain events that occurred prior to each PSG. These results show that SCD individuals with high inherent propensity to vasoconstrict have more frequent severe acute pain events. Our empirical findings are consistent with the fundamental SCD hypothesis that decreased microvascular flow promotes microvascular occlusion.
Collapse
Affiliation(s)
| | - Yunhua Ji
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Carol L. Rosen
- Department of Pediatrics, Division of Pediatric Pulmonary Allergy/Immunology and Sleep, University Hospitals‐Cleveland Medical Center, Rainbow Babies and Children's Hospitals Cleveland Ohio
| | - Michael R. DeBaun
- Division of Hematology‐Oncology, Department of Pediatrics Vanderbilt University School of Medicine Nashville Tennessee
| | - Michael C. K. Khoo
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Thomas D. Coates
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Department of Pediatrics University of Southern California Keck School of Medicine Los Angeles California
| |
Collapse
|
17
|
Wang Q, Li Y, Li J, Wang J, Shen J, Wu H, Guo K, Chen R. Low Arousal Threshold: A Potential Bridge Between OSA and Periodic Limb Movements of Sleep. Nat Sci Sleep 2021; 13:229-238. [PMID: 33658878 PMCID: PMC7917361 DOI: 10.2147/nss.s292617] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Periodic Limb Movements of Sleep (PLMS) is a poorly understood comorbidity with close association to Obstructive Sleep Apnea (OSA). The mechanistic link between the two is unclear. Recent studies on the latter have uncovered low respiratory arousal threshold as an important non-anatomical cause of the disorder. This study sought to investigate whether periodic limb movements are associated with the low respiratory arousal threshold (ArTH) in OSA. METHODS Retrospective data on 720 OSA patients (mean age = 47.0) who underwent Polysomnography (PSG) were collected. Using PLMS diagnostic criteria of PLMS index ≥ 15, patients were divided into the OSA-PLMS group (n=95) and the OSA-only group (n=625). Binary logistic regression analysis was used to examine the correlation between PLMS and the presence of low ArTH, classified using a predicted tool (developed by Edward et al) requiring meeting at least two of the three criteria: apnea-hypopnea index (AHI) < 30/h, nadir oxygen saturation (SaO2) > 82.5%, and fraction of hypopneas > 58.3%. The resulting model was validated in the external MrOS database. RESULTS The patients in the OSA-PLMS group tend to be older, with a higher prevalence of hypertension, diabetes, and stroke. PLMS was associated with age, diabetes, oxygen desaturation index, and low respiratory arousal threshold (OR=8.78 (4.73-16.30), p<0.001). When validated against the MrOS database, low ArTH remained a significant predictor of PLMS with an odds ratio of 1.33 (1.08-1.64, p = 0.009). CONCLUSION This is the first study that demonstrated a strong correlation between PLMS and low respiratory arousal threshold. This suggests a possible mechanistic link between the physical manifestation of PLMS and the non-anatomical low arousal threshold phenotype in OSA.
Collapse
Affiliation(s)
- Qiaojun Wang
- Sleep Center, Respiratory Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China.,Sleep Center, Neurology Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| | - Yezhou Li
- School of Medicine, The University of Manchester, Manchester, UK
| | - Jie Li
- Sleep Center, Neurology Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| | - Jing Wang
- Sleep Center, Respiratory Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| | - Jiucheng Shen
- Sleep Center, Respiratory Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| | - Huaman Wu
- Sleep Center, Respiratory Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| | - Kaida Guo
- Sleep Center, Respiratory Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| | - Rui Chen
- Sleep Center, Respiratory Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China.,Sleep Center, Neurology Department, The Second Affiliated Hospital of the Soochow University, Suzhou, People's Republic of China
| |
Collapse
|
18
|
Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea. Sci Rep 2020; 10:13207. [PMID: 32764677 PMCID: PMC7411028 DOI: 10.1038/s41598-020-70039-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Conventionally, apnea–hypopnea index (AHI) is used to define and categorize the severity of obstructive sleep apnea. However, routine polysomnography (PSG) includes multiple parameters for assessing the severity of obstructive sleep apnea. The goal of this study is to identify and categorize obstructive sleep apnea phenotypes using unsupervised learning methods from routine PSG data. We identified four clusters from 4,603 patients by using 29 PSG variable and arranged according to their mean AHI. Cluster 1, spontaneous arousal (mean AHI = 8.52/h); cluster 2, poor sleep and periodic limb movements (mean AHI = 12.16/h); cluster 3, hypopnea (mean AHI = 38.60/h); and cluster 4, hypoxia (mean AHI = 69.66/h). Conventional obstructive sleep apnea classification based on apnea–hypopnea index severity showed no significant difference in cardiovascular or cerebrovascular mortality (Log rank P = 0.331), while 4 clusters showed an overall significant difference (Log rank P = 0.009). The risk of cardiovascular or cerebrovascular mortality was significantly increased in cluster 2 (hazard ratio = 6.460, 95% confidence interval 1.734–24.073) and cluster 4 (hazard ratio = 4.844, 95% confidence interval 1.300–18.047) compared to cluster 1, which demonstrated the lowest mortality. After adjustment for age, sex, body mass index, and underlying medical condition, only cluster 4 showed significantly increased risk of mortality compared to cluster 1 (hazard ratio = 7.580, 95% confidence interval 2.104–34.620). Phenotyping based on numerous PSG parameters gives additional information on patients’ risk evaluation. Physicians should be aware of PSG features for further understanding the pathophysiology and personalized treatment.
Collapse
|
19
|
Howard ME, O'Donoghue FJ. Periodic leg movements: A marker of cardiovascular risk? Respirology 2020; 25:793-794. [PMID: 32147897 DOI: 10.1111/resp.13795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
20
|
André S, Andreozzi F, Van Overstraeten C, Ben Youssef S, Bold I, Carlier S, Gruwez A, Bruyneel AV, Bruyneel M. Cardiometabolic comorbidities in obstructive sleep apnea patients are related to disease severity, nocturnal hypoxemia, and decreased sleep quality. Respir Res 2020; 21:35. [PMID: 31996224 PMCID: PMC6990595 DOI: 10.1186/s12931-020-1284-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSA) is currently recognized as an independent risk factor for hypertension, arrhythmia, coronary heart disease, stroke, and metabolic disorders (e.g. diabetes, dyslipidemia). In clinical practice, apnea-hypopnea index (AHI) is the marker used to classify disease severity and guide treatment. However, AHI alone does not sufficiently identify OSA patients at risk for cardiometabolic comorbidities. With this in mind, the aim of this retrospective study was to determine whether some polysomnographic parameters (e.g. apnea-hypopnea duration, sleep structure, nocturnal hypoxemia) are specifically associated with cardiometabolic comorbidities in OSA. METHODS In this retrospective study, 1717 patients suffering from moderate/severe OSA were included between 2013 and 2017. Data on demographics, comorbidities, and polysomnographic characteristics were collected and analyzed to identify factors associated with cardiometabolic complications. RESULTS The medical files of 1717 patients (68% male) were reviewed. The mean AHI was 43.1 +/- 27.7 with 57.3% of patients suffering from severe OSA, and 52% from at least one cardiovascular comorbidity (CVCo). Diabetes affected 22% of the patients and 27% exhibited dyslipidemia. Patients affected by CVCos were older, and more often women and non-smokers. These patients also had worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. With regard to diabetes, diabetics were older, more often non-smoker, non-drinker women, and were more obese. These patients also exhibited more severe OSA, especially in non-REM (NREM) sleep, worse sleep quality, and a more marked intermittent/global nocturnal hypoxemia. Dyslipidemia was more frequent in the absence of alcohol consumption, and was associated with OSA severity, decreased sleep quality, and longer AH in REM sleep. CONCLUSIONS This study identifies demographic and polysomnographic factors associated with cardiometabolic comorbidities. Patients (especially women) suffering from more severe OSA, longer sleep apneas and hypopneas, worse sleep quality, and marked intermittent/global nocturnal hypoxemia are more likely to develop cardiometabolic comorbidities. This should stimulate clinicians to obtain adequate treatment in this population.
Collapse
Affiliation(s)
- Stephanie André
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium
| | - Fabio Andreozzi
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Chloé Van Overstraeten
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Sidali Ben Youssef
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Ionela Bold
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Carlier
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium
| | - Alexia Gruwez
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium
| | | | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
- Université Libre de Bruxelles, Brussels, Belgium.
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium.
| |
Collapse
|
21
|
Miki H, Minakuchi H, Miyagi M, Hara ES, Shigemoto S, Suzuki Y, Maekawa K, Matsuka Y, Clark GT, Kuboki T. Association of masticatory muscle activity with sleep arousal and other concomitant movements during sleep. J Oral Rehabil 2019; 47:281-288. [DOI: 10.1111/joor.12913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/23/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Haruna Miki
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Hajime Minakuchi
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Mayu Miyagi
- Department of Stomatgnathic Function and Occlusal Reconstruction Institute of Biomedical Sciences Clinical Dentistry Tokushima University Graduate School Tokushima Japan
| | - Emilio Satoshi Hara
- Department of Biomaterials Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Shuji Shigemoto
- Department of Fixed Prosthodontics School of Dental Medicine Tsurumi University Yokohama Japan
| | - Yoshitaka Suzuki
- Department of Stomatgnathic Function and Occlusal Reconstruction Institute of Biomedical Sciences Clinical Dentistry Tokushima University Graduate School Tokushima Japan
| | - Kenji Maekawa
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Yoshizo Matsuka
- Department of Stomatgnathic Function and Occlusal Reconstruction Institute of Biomedical Sciences Clinical Dentistry Tokushima University Graduate School Tokushima Japan
| | - Glenn T. Clark
- Advanced Program in Orofacial Pain and Oral Medicine Ostrow School of DentistryUniversity of Southern California Los Angeles CA USA
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| |
Collapse
|
22
|
Zhong Z, Xu M, Zou X, Ouyang Q, Zhang L, Yu B, Wang K, Yao D. Changes in heart rate related to rhythmic masticatory muscle activities and limb movements in patients with sleep bruxism. J Oral Rehabil 2019; 47:170-179. [PMID: 31697853 DOI: 10.1111/joor.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/05/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
Abstract
Most sleep bruxism (SB) episodes are accompanied by an increase in sympathetic tone and heart rate (HR). To characterise heart rate (HR) changes in relation to rhythmic masticatory muscle activities (RMMAs) in SB patients, polysomnographic recordings were performed on 10 SB patients and 11 normal controls. The duration of movement events, amplitude and duration of HR increases, and time to reach HR peak associated with RMMAs and limb movements (LMs) were determined, and the relationships of the parameters of HR increases with types of movements and RMMAs were analysed. All of the parameters of HR increases associated with three types of movements (RMMAs, RMMAs + LMs and LMs) and masseter activities (phasic, tonic and mixed) were significantly different (two-way ANOVA, P < .001 for all) in both SB patients and controls. The duration of RMMAs/LMs was positively correlated with the parameters (SB patients: R2 = .24-.85, P < .0001; controls: R2 = .23-.68, P < .0001). The amplitude of HR increases was also positively correlated with respiration changes in the SB patients (R2 = .3258, P < .0001) and controls (R2 = .09469, P < .05). The proportions of phasic RMMAs associated with awakenings, microarousals and no cortical arousals were significantly different and so were the proportions of tonic and mixed RMMAs (Friedman's tests, P < .05-.001). The HR increases associated with RMMAs may be intrinsic to the cortical arousal response and autonomic activation, and differences in HR increases associated with different types of movements and RMMAs might be related to the changes in respiration and differences in cortical arousal levels.
Collapse
Affiliation(s)
- Zhijun Zhong
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Miao Xu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, China
| | - Qian Ouyang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Ling Zhang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| | - Bin Yu
- Jiangxi Mental Hospital, Nanchang University, Jiangxi, China
| | - Kelun Wang
- Department of Health Science & Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.,School of Pharmaceutical Sciences, Nanchang University, Jiangxi, China
| |
Collapse
|
23
|
Rassu AL, Chenini S, Barateau L, Lopez R, Evangelista E, Guiraud L, Jaussent I, Dauvilliers Y. Increased blood pressure during the suggested immobilization test in Restless Legs Syndrome. Sleep 2019; 43:5602988. [DOI: 10.1093/sleep/zsz263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/13/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To investigate the relationship between sensory discomfort/motor component and cardiovascular autonomic response by continuous beat-to-beat blood pressure monitoring (CBPM) during the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS).
Methods
Thirty-two drug-free patients with primary RLS (10 men; mean age 60.29 ± 10.81 years) and 17 healthy controls (2 men; mean age 58.82 ± 11.86 years) underwent a 1-hour SIT starting at 8 pm with concomitant CBPM to measure the heart rate (HR) and systolic/diastolic blood pressure (SBP, DBP). In all subjects, the presence of sensory discomfort and motor component during the SIT (S-SIT+ and M-SIT+, respectively) was quantified. Mixed regression models were used to compare the SBP, DBP, and HR profiles during the SIT by taking into account the repeated measures (6 time periods of 10 minutes).
Results
In patients with S-SIT+ (n = 17), SBP (p < 0.0001), DBP (p = 0.0007), and HR (p = 0.03) increased during the SIT compared with other patients and controls. Seventeen patients had M-SIT+ (none among healthy controls). Classifying patients in 4 groups in function of the presence/absence of the SIT sensory and motor components revealed that SDB and DBP increased throughout the SIT in patients with S-SIT+, independently of the motor component (p < 0.0001 and p = 0.0008 for SBD; p < 0.0001 and p = 0.01 for DBP in the S-SIT+/M-SIT− and S-SIT+/M-SIT+ groups, respectively).
Conclusion
During the SIT, BP concomitantly increased only in patients with RLS and sensory discomfort, with or without motor component. This highlights the link between evening sensory RLS symptoms, autonomic activation, and potential long-term cardiovascular consequences.
Collapse
Affiliation(s)
- Anna Laura Rassu
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Sofiène Chenini
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Lucie Barateau
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Regis Lopez
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Elisa Evangelista
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lily Guiraud
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Isabelle Jaussent
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| |
Collapse
|
24
|
Abstract
Hypertension is a major determinant of cardiovascular morbidity and mortality and is highly prevalent in the general population. While the relationship between sleep apnea and increased blood pressure has been well documented, less recognized is emerging evidence linking sleep-related movement disorders such as restless legs syndrome/periodic limb movements of sleep and sleep-related bruxism with blood pressure (BP) dysregulation and hypertension. There is also recent literature linking narcolepsy-cataplexy with elevated BP and altered pressor responses, and there are data suggesting abnormal BP control in rapid eye movement sleep behavior disorder. It is thought that neural circulatory mechanisms, sympathetic activation in particular, comprise the predominant mediator underlying elevated BP in these neurological sleep disorders. There is very limited evidence that treating these sleep disorders may be beneficial in lowering BP primarily because this question has received very little attention. In this review, we discuss the potential pathophysiologic mechanisms underlying elevated BP in restless legs syndrome/periodic limb movements of sleep, sleep-related bruxism, narcolepsy-cataplexy, and rapid eye movement sleep behavior disorder. We also examine the relationship between these sleep disorders and elevated BP and the impact of treatment of these conditions on BP control. Last, we discuss gaps in the literature evaluating the associations between these sleep disorders and elevated BP and identify areas for further research.
Collapse
Affiliation(s)
- Meghna P. Mansukhani
- Center for Sleep Medicine, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| | - Naima Covassin
- Department of Cardiovascular Diseases, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| | - Virend K. Somers
- Department of Cardiovascular Diseases, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| |
Collapse
|
25
|
Byun JI, Kim JS, Shin YY, Hwang KJ, Jung YJ, Shin WC. Difference in Psychological Distress between Patients with Periodic Limb Movement Disorder and Restless Legs Syndrome. SLEEP MEDICINE RESEARCH 2019. [DOI: 10.17241/smr.2019.00339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Kocasarac C, Yigit Y, Trotti LM, Basaran S. Ocular morphological changes in patients with restless legs syndrome analyzed by optical coherence tomography. Sleep Med 2019; 57:1-5. [PMID: 30878898 DOI: 10.1016/j.sleep.2019.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/22/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Two leading hypotheses for restless legs syndrome (RLS) pathophysiology are dopaminergic dysfunction and sympathetic overactivity. Ocular changes occur with both dopaminergic and sympathetic pathologies, and thus may provide unique insights into the pathophysiology of RLS. METHODS Thirty-five patients with RLS and 35 healthy individuals were enrolled in the study. Peripapillary retinal nerve fiber layer (RNFL), macular, and choroidal thicknesses were measured by optical coherence tomography (OCT). RESULTS There were no statistically significant differences between the two groups regarding RNFL and macular thicknesses. The subfoveal, temporal and nasal choroidal thicknesses were significantly thinner in patients with RLS compared with normal subjects (p < 0.05). CONCLUSION Thinning of the choroid is linked to sympathetic overactivity. Our results provide further evidence for sympathetic overactivity in the pathogenesis of RLS.
Collapse
Affiliation(s)
- Can Kocasarac
- Department of Ophthalmology, Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Yavuz Yigit
- Department of Emergency Medicine, Derince Training and Research Hospital, Kocaeli, Turkey
| | | | - Sehnaz Basaran
- Department of Neurology, Derince Training and Research Hospital, Kocaeli, Turkey
| |
Collapse
|
27
|
Lu J, Zhang Y, Han K, Wang C, Zhong Z, Xu M, Zou X, Yu B, Yao D. Heart rate changes associated with rhythmic masticatory muscle activities and limb movements in sleep bruxers: Preliminary findings. Cranio 2019; 39:47-57. [PMID: 30774008 DOI: 10.1080/08869634.2019.1578032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: To investigate the relationship of rhythmic masticatory muscle activities (RMMAs) and limb movements (LMs) with heart rate (HR) acceleration. Methods: The amplitude and duration of HR increases, the time to reach peak HR associated with RMMAs/LMs during sleep, duration of movement events, and their relationships with cortical arousal levels were determined in 9 sleep bruxers and 10 normal controls. Results: A total of 48.15% and 49.44% HR increased before the onset of RMMAs/LMs in the sleep bruxers and controls, respectively. All of the parameters of HR increases were significantly different between the sleep bruxers and the controls (p < 0.05-0.001) and between different cortical arousal levels (p < 0.01), and the duration of RMMAs/LMs was positively correlated with the parameters (Sleep bruxers: r2 = 0.18-0.88, p < 0.0001; Controls: r2 = 0.16-0.78, p < 0.0001). Discussion: These data suggest the HR increases are associated with the movement events and changes in cortical arousal levels in the sleep bruxers and controls. Abbreviations: LMs: Limb movements; HR: Heart rate; RMMAs: Rhythmic masticatory muscle activities; SB: Sleep bruxism; PSG: Polysomnographic; EEG: Electroencephalographic; PLMS: Periodic leg movements; SSRIs: Selective serotonin reuptake inhibitors; ECG: Electrocardiographic; EOG: Electrooculographic; EMG: Electromyographic; SD: Standard deviation; Fig: Figure; SEM: Standard error of mean; N1: Non-rapid eye movement sleep stage 1; N2: Non-rapid eye movement sleep stage 2; N3: Non-rapid eye movement sleep stage 3; REM: Rapid eye movement ; NA: No arousal; mAR: Microarousal; AW: Awakening.
Collapse
Affiliation(s)
- Junlan Lu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital , Nanchang, PR China.,School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Yangping Zhang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital , Nanchang, PR China.,School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Kangning Han
- Queen Mary College, Nanchang University , Nanchang, PR China
| | - Chuanying Wang
- Queen Mary College, Nanchang University , Nanchang, PR China
| | - Zhijun Zhong
- School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Miao Xu
- School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University , Nanchang, PR China
| | - Bin Yu
- Jiangxi Mental Hospital, Nanchang University , Nanchang, PR China
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People's Hospital , Nanchang, PR China.,School of Pharmaceutical Sciences, Nanchang University , Nanchang, PR China
| |
Collapse
|
28
|
Sieminski M. Periodic Limb Movements in Sleep and Blood Pressure. Am J Hypertens 2018; 31:1178-1179. [PMID: 30137195 DOI: 10.1093/ajh/hpy132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mariusz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
29
|
Rosales-Lagarde A, Rodriguez-Torres EE, Itzá-Ortiz BA, Miramontes P, Vázquez-Tagle G, Enciso-Alva JC, García-Muñoz V, Cubero-Rego L, Pineda-Sánchez JE, Martínez-Alcalá CI, Lopez-Noguerola JS. The Color of Noise and Weak Stationarity at the NREM to REM Sleep Transition in Mild Cognitive Impaired Subjects. Front Psychol 2018; 9:1205. [PMID: 30065684 PMCID: PMC6056768 DOI: 10.3389/fpsyg.2018.01205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/22/2018] [Indexed: 11/21/2022] Open
Abstract
In Older Adults (OAs), Electroencephalogram (EEG) slowing in frontal lobes and a diminished muscle atonia during Rapid Eye Movement sleep (REM) have each been effective tracers of Mild Cognitive Impairment (MCI), but this relationship remains to be explored by non-linear analysis. Likewise, data provided by EEG, EMG (Electromyogram) and EOG (Electrooculogram)—the three required sleep indicators—during the transition from REM to Non-REM (NREM) sleep have not been related jointly to MCI. Therefore, the main aim of the study was to explore, with results for Detrended Fluctuation Analysis (DFA) and multichannel DFA (mDFA), the Color of Noise (CN) at the NREM to REM transition in OAs with MCI vs. subjects with good performances. The comparisons for the transition from NREM to REM were made for each group at each cerebral area, taking bilateral derivations to evaluate interhemispheric coupling and anteroposterior and posterior networks. In addition, stationarity analysis was carried out to explore if the three markers distinguished between the groups. Neuropsi and the Mini-Mental State Examination (MMSE) were administered, as well as other geriatric tests. One night polysomnography was applied to 6 OAs with MCI (68.1 ± 3) and to 7 subjects without it (CTRL) (64.5 ± 9), and pre-REM and REM epochs were analyzed for each subject. Lower scores for attention, memory and executive funcions and a greater index of arousals during sleep were found for the MCI group. Results confirmed that EOGs constituted significant markers of MCI, increasing the CN for the MCI group in REM sleep. The CN of the EEG from the pre-REM to REM was higher for the MCI group vs. the opposite for the CTRL group at frontotemporal areas. Frontopolar interhemispheric scaling values also followed this trend as well as right anteroposterior networks. EMG Hurst values for both groups were lower than those for EEG and EOG. Stationarity analyses showed differences between stages in frontal areas and right and left EOGs for both groups. These results may demonstrate the breakdown of fractality of areas especially involved in executive functioning and the way weak stationarity analyses may help to distinguish between sleep stages in OAs.
Collapse
Affiliation(s)
- Alejandra Rosales-Lagarde
- Consejo Nacional de Ciencia y Tecnología, Mexico City, Mexico.,Área Académica de Gerontología, San Agustín Tlaxiaca, Mexico
| | | | | | - Pedro Miramontes
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | | | | | - José E Pineda-Sánchez
- Área Académica de Psicología, Universidad Autónoma del Estado de Hidalgo, San Agustín Tlaxiaca, Mexico
| | - Claudia I Martínez-Alcalá
- Consejo Nacional de Ciencia y Tecnología, Mexico City, Mexico.,Área Académica de Gerontología, San Agustín Tlaxiaca, Mexico
| | - Jose S Lopez-Noguerola
- Área Académica de Gerontología, San Agustín Tlaxiaca, Mexico.,Division of Molecular Psychiatry, Department of Psychiatry and Psychotherapy, University of Medicine, Goettingen, Germany
| |
Collapse
|
30
|
Abstract
INTRODUCTION Stroke is a major cause of disability and death in the United States and across the world, and the incidence and prevalence of stroke are expected to rise significantly due to an aging population. Obstructive sleep apnea, an established independent risk factor for stroke, is a highly prevalent disease that is estimated to double the risk of stroke. It remains uncertain whether non-apnea sleep disorders increase the risk of stroke. Areas covered: This paper reviews the literature describing the association between incident stroke and sleep apnea, rapid eye movement sleep behavior disorder, restless legs syndrome, periodic limb movements of sleep, insomnia, and shift work. Expert commentary: Trials of continuous positive airway pressure for stroke prevention in sleep apnea patients have been largely disappointing, but additional trials that target populations not yet optimally studied are needed. Self-reported short and long sleep duration may be associated with incident stroke. However, abnormal sleep duration may be a marker of chronic disease, which may itself be associated with incident stroke. The relationship between non-apnea sleep disorders and incident stroke deserves further attention. Identification of specific non-apnea sleep disorders or sleep problems that convey an increased risk for stroke may provide novel targets for stroke prevention.
Collapse
Affiliation(s)
- Mollie McDermott
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Devin L. Brown
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
- Michigan Medicine Michael S. Aldrich Sleep Disorders Laboratory, Ann Arbor, Michigan, USA
| | - Ronald D. Chervin
- Michigan Medicine Stroke Program, Cardiovascular Center, Ann Arbor, Michigan, USA
| |
Collapse
|
31
|
|