Sleep-related breathing disorders

Two-dimensional facial photography for assessment of craniofacial morphology in sleep breathing disorders: a systematic review

PURPOSE

Craniofacial morphology is integral to Sleep Breathing Disorders (SBD), particularly Obstructive Sleep Apnea (OSA), informing treatment strategies. This review assesses the utility of two-dimensional (2D) photogrammetry in evaluating these metrics among OSA patients.

METHODS

Following PRISMA guidelines, a systematic review was conducted. PubMed, Embase, and Lilacs databases were systematically searched for studies utilizing 2D photography in SBD. Findings were narratively synthesized.

RESULTS

Thirteen studies involving 2,328 patients were included. Significant correlations were found between craniofacial measurements-specifically neck parameters and facial width-and OSA severity, even after BMI adjustment. Ethnic disparities in craniofacial morphology were observed, with photogrammetry effective in predicting OSA in Caucasians and Asians, though data for other ethnicities were limited. Pediatric studies suggest the potential of craniofacial measurements as predictors of childhood OSA, with certain caveats.

CONCLUSION

2D photogrammetry emerges as a practical and non-invasive tool correlating with OSA severity across diverse populations. However, further validation in various ethnic cohorts is essential to enhance the generalizability of these findings.

Proportion of rapid eye movement sleep related obstructive sleep apnea (REM related OSA) in patients with sleep disordered breathing: A cross sectional study

Background and Objectives:

Obstructive sleep apnea (OSA) during rapid eye movement (REM) stage of sleep is gaining importance in recent years. This study was done to determine the proportion of REM-related OSA and its associated polysomnographic features.

Methods:

One hundred forty-two patients were included in the study. REM-related OSA was defined based on previously established broad and strict criteria (REM apnea–hypopnea index [AHI]/non-REM [NREM] AHI ratio ≥2 and REM AHI >5 with NREM AHI <5, respectively), and its association with polysomnographic features was studied using appropriate statistical tools.

Results:

The proportion of REM-related OSA in the study was 56.3% and 25.3% as per broad and strict criterion, respectively. The REM-related OSA group had a mean younger age (47.4 ± 13.2 years) as compared to NREM-related OSA group (52.6 ± 15.8 years). Females (34 out of 45; 75.6%) were more likely to have REM-related OSA as compared to males (46 out of 107; 47.4%). Supine AHI, arousal index, oxygen desaturation index, length of the longest event, and the lowest oxygen saturation recorded during sleep had a significant association with REM-related OSA. 74% of patients with overall AHI <5 and 87% patients with overall AHI 5 to 15 satisfied the criteria for REM-related OSA as per broad criterion.

Conclusion:

REM-related OSA was quite prevalent in the study population (56.3%) and was more common in the mild and moderate severity subgroups of OSA.

Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children

OBJECTIVES

Different pathophysiological mechanisms and the distribution of respiratory events among rapid eye movement (REM) and non-rapid eye movement (NREM) sleep modulate the effect of obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for REM-related OSA in children.

STUDY DESIGN

Retrospective, cross-sectional study.

METHODS

We recruited 366 children with OSA confirmed by polysomnography (PSG) over a 5-year period. REM-related OSA is defined by an obstructive apnea-hypopnea index (OAHI) in the REM sleep ≥2× than during NREM sleep.

RESULTS

The prevalence of REM-related OSA in children was 50.3%. Children with REM-related OSA were more likely to be female (P = 0.042), and had lower prevalence of adenotonsillar hypertrophy (P = 0.043) compared with children with other OSA subtypes. Children with REM-related OSA slept longer in the supine position (P = 0.003), had shorter duration of NREM1 sleep (P = 0.018), lower nadir SpO₂ (P = 0.005), and a higher oxygen desaturation index 3% (ODI3%) (P = 0.014), and lower arousal index (P = 0.034) compared with other OSA subtypes. Female gender and supine sleep was the independent risk factors for REM-related OSA.

CONCLUSION

The prevalence of REM-related OSA was 50.3%. OAHI_REM should be considered as an important parameter in future clinical research studies done in children with OSA.

Prevalence of obstructive sleep apnea in Alzheimer's disease patients

OBJECTIVE

To assess the prevalence of obstructive sleep apnea (OSA) in patients with mild-moderate Alzheimer's Disease (AD) and to evaluate cognitive characteristics according to the severity of OSA.

METHODS

Patients with mild-moderate AD, recruited prospectively from a cognitive impairment unit, underwent overnight polysomnography. OSA was defined as an apnea-hypopnea index > 5/h. AD severity was assessed using the Mini-Mental State Examination and extensive neuropsychological battery. Epworth Sleepiness Scale and APOE status were analyzed.

RESULTS

The cohort included 128 patients with a median [IQR] age of 75.0 [72.0;79.2] years and 57.8% were women. OSA was diagnosed in 116 subjects (90.6%). The distribution of mild, moderate and severe severity of OSA was 29 (22.7%), 37 (28.9%) and 50 (39.1%), respectively. Regarding sleep symptoms, the cohort showed normal values of daytime sleepiness (median EES score 5 [3, 8]), while nycturia (89.1%) and snoring (71.1%) were the most common symptoms. Participants with severe OSA included a higher proportion of older men, were associated with snoring and sedentariness. No significant differences in cognitive assessment were found between patients with and without severe OSA in any of the domains. The prevalence of APOE ε4 was not significantly different between patients with and without severe OSA.

CONCLUSION

There was a high prevalence of OSA in patients with mild-moderate AD. OSA was not associated with sleepiness or worse cognitive function. APOE ε4 was not related to the presence or severity of OSA. Further longitudinal studies will be required to evaluate whether OSA impairs cognitive evolution in AD patients.

A review of fluid-structure interaction simulation for patients with sleep related breathing disorders with obstructive sleep

Obstructive sleep apnea is one of the most common breathing disorders. Undiagnosed sleep apnea is a hidden health crisis to the patient and it could raise the risk of heart diseases, high blood pressure, depression and diabetes. The throat muscle (i.e., tongue and soft palate) relax narrows the airway and causes the blockage of the airway in breathing. To understand this phenomenon computational fluid dynamics method has emerged as a handy tool to conduct the modeling and analysis of airflow characteristics. The comprehensive fluid-structure interaction method provides the realistic visualization of the airflow and interaction with the throat muscle. Thus, this paper reviews the scientific work related to the fluid-structure interaction (FSI) for the evaluation of obstructive sleep apnea, using computational techniques. In total 102 articles were analyzed, each article was evaluated based on the elements related with fluid-structure interaction of sleep apnea via computational techniques. In this review, the significance of FSI for the evaluation of obstructive sleep apnea has been critically examined. Then the flow properties, boundary conditions and validation of the model are given due consideration to present a broad perspective of CFD being applied to study sleep apnea. Finally, the challenges of FSI simulation methods are also highlighted in this article.

Symptoms and Cognitive Functions in Adolescents in Relation to Mobile Phone Use during Night

Many adolescents tend to leave their mobile phones turned on during night, accepting that they may be awakened by an incoming text message or call. Using self-reported and objective operator recorded mobile phone use data, we thus aimed to analyze how being awakened during night by mobile phone affects adolescents' perceived health and cognitive functions. In this cross-sectional study, 439 adolescents completed questionnaires about their mobile phone use during night, health related quality of life and possible confounding factors. Standardized computerized cognitive tests were performed to assess memory and concentration capacity. Objective operator recorded mobile phone use data was further collected for 233 study participants. Data were analyzed by multivariable regression models adjusted for relevant confounders including amount of mobile phone use. For adolescents reporting to be awakened by a mobile phone during night at least once a month the odds ratio for daytime tiredness and rapid exhaustibility were 1.86 (95% CI: 1.02-3.39) and 2.28 (95% CI: 0.97-5.34), respectively. Similar results were found when analyzing objective operator recorded mobile phone use data (tiredness: 1.63, 95% CI: 0.94-2.82 and rapid exhaustibility: 2.32, 95% CI: 1.01-5.36). The cognitive tests on memory and concentration capacity were not related to mobile phone use during night. Overall, being awakened during night by mobile phone was associated with an increase in health symptom reports such as tiredness, rapid exhaustibility, headache and physical ill-being, but not with memory and concentration capacity. Prevention strategies should focus on helping adolescents set limits for their accessibility by mobile phone, especially during night.

A review of signals used in sleep analysis

This article presents a review of signals used for measuring physiology and activity during sleep and techniques for extracting information from these signals. We examine both clinical needs and biomedical signal processing approaches across a range of sensor types. Issues with recording and analysing the signals are discussed, together with their applicability to various clinical disorders. Both univariate and data fusion (exploiting the diverse characteristics of the primary recorded signals) approaches are discussed, together with a comparison of automated methods for analysing sleep.

Sleep-disordered breathing in children with congenital muscular dystrophies

OBJECTIVE

Most types of neuromuscular diseases are known to be associated with a high risk of sleep-disordered breathing. We performed a prospective study in a well individualized group of muscular disorders, congenital muscular dystrophies (CMD), to characterize the frequency of sleep-disordered breathing and thereby to determine the potential usefulness of sleep studies in such patients.

METHODS

Twenty CMD children (12 F, 8 M, aged 4-17 years) were included. Using overnight polysomnography, we determined the following parameters: sleep stages, sleep latency, sleep efficiency index, wake time duration, total sleep time (TST), apnea/hypopnea index (AHI), arterial blood oxygen saturation, and nocturnal paroxysmal EEG activity.

RESULTS

As compared to healthy controls, we detected in our study group frequent awakenings, a decreased TST (mean 448 ± 44.4 min) and a decreased REM duration (mean 11.5 ± 3.5% of TST). Significant increase in wake time duration (28-90 min) and decrease in REM duration were observed in 12 patients. An apnea/hypopnea syndrome was detected in 13 patients (65%) with central apneas in 8, obstructive apneas in 2 and 3 mixed apneas in 3 patients. AHI was >10 in 3 cases, <10> 5 in 4 cases and were concomitant with blood oxygen de-saturation in four cases. NPA were detected in 10 patients ranging from 10 to 40% of TST.

INTERPRETATION

Our results confirm the high incidence of sleep disordered breathing in children with CMD, and thereby, the usefulness of overnight polysomnography recordings in such patients.

Age-dependent association between sleep duration and hypertension in the adult Korean population

BACKGROUND

In Western countries, sleep deprivation has been reported to elevate blood pressure. Here, we examined whether this association is true also for an Asian population.

METHODS

The study sample comprised 5,393 Korean adults aged 19-99 years who had participated in the 2005 Korean National Health and Nutrition Examination Survey. Hypertension was defined as a systolic blood pressure (SBP) ≥140 mm Hg or a diastolic blood pressure (DBP) ≥90 mm Hg, or regular use of antihypertensive medication.

RESULTS

Among the participants, 1,345 subjects (24.9%) displayed hypertension. The median sleep duration was 7 h/day. In the young and middle-aged adults aged <65 years, the unadjusted odds ratio (OR) for hypertension was 1.5-fold greater in those with a sleep duration of ≤5 h (OR 1.52; 95% confidence interval (CI) 1.19, 1.94) as compared to those who slept 7 h. This trend did not significantly change after adjustments for putative risk factors for hypertension such as gender, obesity, smoking status, alcohol consumption, physical activity, depressive symptom, diabetes mellitus, and stroke (OR 1.31; 95% CI 1.01, 1.71). However, in the older adults aged ≥65 years, no association was found between sleep duration and the risk of hypertension. Long sleep duration (≥8 h) was not associated with hypertension in either the younger or older adults in this study.

CONCLUSION

Short sleep duration (≤5 h) is independently associated with hypertension in young and middle-aged Korean adults.

Apneic disorders associated with heart failure: pathophysiology and clinical management

Cardiovascular diseases remain the most common cause of both morbidity and mortality in the industrialized world. The frequency of sleep-related breathing disorders (SRBD) is significantly increased in individuals with cardiovascular diseases such as heart failure. Given the co-morbidities associated with SRBD coexisting with HF, prompt recognition and early management of SRBD is critical to improving the overall prognosis and quality of life in heart failure patients with concomitant SRBD.

Correlates of short and long sleep duration: a cross-cultural comparison between the United Kingdom and the United States: the Whitehall II Study and the Western New York Health Study

The authors examined sociodemographic, lifestyle, and comorbidity factors that could confound or mediate U-shaped associations between sleep duration and health in 6,472 United Kingdom adults from the Whitehall II Study (1997-1999) and 3,027 US adults from the Western New York Health Study (1996-2001). Cross-sectional associations between short (<6 hours) and long (>8 hours) durations of sleep across several correlates were calculated as multivariable odds ratios. For short sleep duration, there were significant, consistent associations in both samples for unmarried status (United Kingdom: adjusted odds ratio (AOR) = 1.49, 95% confidence interval (CI): 1.15, 1.94; United States: AOR = 1.49, 95% CI: 1.10, 2.02), body mass index (AORs were 1.04 (95% CI: 1.01, 1.07) and 1.02 (95% CI: 1.00, 1.05)), and Short Form-36 physical (AORs were 0.96 (95% CI: 0.95, 0.98) and 0.97 (95% CI: 0.96, 0.98)) and mental (AORs were 0.95 (95% CI: 0.94, 0.96) and 0.98 (95% CI: 0.96, 0.99)) scores. For long sleep duration, there were fewer significant associations: age among men (AORs were 1.08 (95% CI: 1.01, 1.14) and 1.05 (95% CI: 1.02, 1.08)), low physical activity (AORs were 1.75 (95% CI: 0.97, 3.14) and 1.60 (95% CI: 1.09, 2.34)), and Short Form-36 physical score (AORs were 0.96 (95% CI: 0.93, 0.99) and 0.97 (95% CI: 0.95, 0.99)). Being unmarried, being overweight, and having poor general health are associated with short sleep and may contribute to observed disease associations. Long sleep may represent an epiphenomenon of comorbidity.

Cross-sectional versus prospective associations of sleep duration with changes in relative weight and body fat distribution: the Whitehall II Study

A cross-sectional relation between short sleep and obesity has not been confirmed prospectively. The authors examined the relation between sleep duration and changes in body mass index and waist circumference using the Whitehall II Study, a prospective cohort of 10,308 white-collar British civil servants aged 35-55 years in 1985-1988. Data were gathered in 1997-1999 and 2003-2004. Sleep duration and other covariates were assessed. Changes in body mass index and waist circumference were assessed between the two phases. The incidence of obesity (body mass index: > or =30 kg/m(2)) was assessed among nonobese participants at baseline. In cross-sectional analyses (n = 5,021), there were significant, inverse associations (p < 0.001) between duration of sleep and both body mass index and waist circumference. Compared with 7 hours of sleep, a short duration of sleep (< or =5 hours) was associated with higher body mass index (beta = 0.82 units, 95% confidence interval (CI): 0.38, 1.26) and waist circumference (beta = 1.88 cm, 95% CI: 0.64, 3.12), as well as an increased risk of obesity (odds ratio(adjusted) = 1.65, 95% CI: 1.22, 2.24). In prospective analyses, a short duration of sleep was not associated with significant changes in body mass index (beta = -0.06, 95% CI: -0.26, 0.14) or waist circumference (beta = 0.44, 95% CI: -0.23, 1.12), nor with the incidence of obesity (odds ratio(adjusted) = 1.05, 95% CI: 0.60, 1.82). There is no temporal relation between short duration of sleep and future changes in measures of body weight and central adiposity.