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Magnusdottir S, Magnusdottir I, Gunnlaugsdottir AK, Hilmisson H, Hrolfsdottir L, Paed AEEM. Sleep duration and social jetlag in healthy adolescents. Association with anxiety, depression, and chronotype: a pilot study. Sleep Breath 2024; 28:1541-1551. [PMID: 38546939 DOI: 10.1007/s11325-024-03026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/23/2024] [Accepted: 03/20/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Misalignment between sleep opportunity and chronotype preference during adolescence may affect sleep and mental health. The aim of this study was to objectively evaluate sleep duration and social jetlag (SJL) to observe if there is a relationship with anxiety, depression, or chronotype. METHODS Community based cohort study (n = 65) was conducted in Northern Europe. Participants recorded their sleep during the regular school schedule for 3 school nights and 2 free nights with FDA-cleared/EU Medical Device Directive (CE-02862) compliant home sleep test. They also completed validated questionnaires to assess (Morningness Eveningness Questionnaire; MEQ), sleepiness (Epworth Sleepiness Scale; ESS), and insomnia (Insomnia Severity Index; ISI), anxiety (General Anxiety Disorder-7; GAD-7), and depression symptoms (Beck's Depression Inventory-II; BDI-II). Data were collected during the last week of February and the first 2 weeks of March, 2023. RESULTS Average sleep duration on school nights was 7 h, 15 min, with 18% of participants on average sleeping ≥ 8 h. Average sleep onset was significantly later on free nights (1 hour, 47 minutes; p < 0.0001) causing a high prevalence of moderate-severe SJL, in 71% of participants. Evening chronotypes (prevalence 15.4%) fell asleep later on free nights, causing them to have significantly more SJL (2 hours, 58 minutes) than morning chronotypes (1 hour, 32 minutes) and intermediary chronotypes (1 hour, 36 minutes). Evening chronotypes also had more severe insomnia (ISI + 4.4, p = 0.006; + 4.0, p = 0.001) and greater depressive symptoms (BDI-II + 21.6, p < 0.0001; + 17.1, p < 0.0001). A significant negative correlation was observed between MEQ scores and ESS (r = - 0.287; p = 0.001), ISI (r = - 0.343, p < 0.0001), GAD-7 (r = - 0.185, p < 0.0001), BDI-II (r = - 0.501, p = 0.0001), and suicidal thoughts (r = - 0.294, p = 0.017). CONCLUSION Adolescents are sleep-deprived and have a high prevalence of SJL that is positively correlated with depressive symptoms and evening chronotype. That evening chronotypes have shorter sleep duration, more severe SJL, and significantly more sleepiness and insomnia, anxiety, and depressive symptoms may indicate possible benefits in identifying this group with the aim to assist them in improving their sleep habits with potentially positive effects on mental health.
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Affiliation(s)
| | | | - Audur Karen Gunnlaugsdottir
- Akureyri Junior College, Akureyri, Iceland
- University of Akureyri, Akureyri, Iceland
- The Healthcare Institution of North Iceland, Husavik, Iceland
| | - Hugi Hilmisson
- MyCardio LLC, 3200 East Cherry Creek South Drive, Denver, CO, 80209, USA
| | - Laufey Hrolfsdottir
- Institution of Health Science Research, University of Akureyri and Akureyri Hospital, Akureyri, Iceland
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Kajisa T, Kuroi T, Hara H, Sakai T. Correlation analysis of heart rate variations and glucose fluctuations during sleep. Sleep Med 2024; 113:180-187. [PMID: 38042028 DOI: 10.1016/j.sleep.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE The body's glucose concentration is influenced by carbohydrate intake, insulin-induced carbohydrate reduction, and hepatic glycogen breakdown induced by stress hormones. This study investigated the potential of employing glucose fluctuations as a measure of stress by examining the relationship between heart rate variability (HRV) data and glucose levels during sleep in healthy subjects. METHODS In this cross-sectional study, a chest-worn electrocardiogram (ECG) and continuous glucose monitoring device (CGM) were respectively used to monitor the heart rate intervals and glucose fluctuations of five subjects (two males, three females) during sleep. A time-series correlation analysis was performed on the HRV data extracted from heart rate intervals and the corresponding glucose fluctuation data. RESULTS The time-series analysis of ECG and CGM data collected from subjects during sleep (n = 25 nights) revealed a moderate negative correlation between glucose levels and HRV, with a cross-correlation coefficient of r = -0.453. CONCLUSION Similar to HRV, changes in stress levels can be detected by observing glucose fluctuations, particularly during sleep when the impact of food intake can be eliminated. Our findings highlight a significant correlation between glucose levels and HRV, indicating that glucose fluctuations can be used as an indicator of autonomic nervous system activity in an exploratory study.
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Affiliation(s)
- Taira Kajisa
- Course of Bio-Nano Science Fusion, Graduate School of Interdisciplinary New Science, Toyo University, 2100 Kujirai, Kawagoe, Saitama, 350-8585, Japan.
| | - Toshiya Kuroi
- Hakuju Institute for Health Science Co., Ltd, 1-37-5 Tomigaya, Shibuya, Tokyo, Japan
| | - Hiroyuki Hara
- Hakuju Institute for Health Science Co., Ltd, 1-37-5 Tomigaya, Shibuya, Tokyo, Japan
| | - Toshiyuki Sakai
- Department of Student, Student Support Division, Toyo University, 2100 Kujirai, Kawagoe, Saitama, 350-8585, Japan
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Magnusdottir S, Witmans M, Hilmisson H. Sleep quality, sleep apnea, and metabolic health in children treated with adenotonsillectomy. Sleep Breath 2023; 27:1527-1540. [PMID: 36434376 DOI: 10.1007/s11325-022-02747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may predict changes in metabolic health in children treated with early adenotonsillectomy (eAT) for obstructive sleep apnea (OSA). METHODS Secondary analysis of the Childhood Adenotonsillectomy Trial (CHAT) was performed including children 5.0-9.9 years with OSA assigned to eAT. The cohort was stratified based on SQI and AHI to evaluate (1) response to eAT in children with high sleep quality (SQI ≥ 75) and mild-OSA, AHI < 5.0 (group1) and children with moderate-OSA AHI ≥ 5.0 or SQI < 75 (group2) at baseline and (2) effect of eAT therapy on metabolic health, GroupRemission (AHI < 1.0, SQI ≥ 75) compared to GroupResidual. RESULTS At baseline group2 (n=124) had higher average heart rate during sleep (AHRSleep), 87 vs. 81 beats/minute (p < 0.001) compared to group1 (n=72). After surgery, group2 on average had less increase in BMI z-score 0.13 vs. 0.27, (p = 0.025), improved their SQI + 2.06 compared to decline - 3.75 in group1, (p = 0.015), decreased AHRSleep-- 2.90 vs. - 0.34 (p = 0.025) and AHI - 5.00 vs. - 0.36 (p = 0.002). GroupRemission was younger 6.59 vs. 7.41; p < 0.001; with lower BMI z-score 0.90 vs. 1.34; p = 0.021; AHRSleep 80.60 vs. 83.50; p = 0.032; fasting insulin (µIU/ml) 7.54 vs. 12.58; p = 0.017 and glucose (mmol/L) 4.45 vs. 4.60; p = 0.049, with better lipid metabolism though not statistically significantly, low-density-lipoprotein 90.26 mg/dL vs. 97.94; p = 0.081 and cholesterol 154.66 mg/dL vs. 164.36; p = 0.076. CONCLUSION The results may indicate that children with mild-OSA and high-SQI may be less likely to benefit from eAT than children with moderate-OSA. To improve metabolic health, successfully treating both AHI and SQI is likely needed. CPC-calculated SQI may have a role to identify children less likely to benefit from eAT and to evaluate success of therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00560859.
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Affiliation(s)
| | | | - Hugi Hilmisson
- MyCardio LLC, SleepImage®, 3003 E 3rd Avenue, Denver, CO, 80206, USA
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4
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ma N, Ning Q, Li M, Hao C. The First-Night Effect on the Instability of Stage N2: Evidence from the Activity of the Central and Autonomic Nervous Systems. Brain Sci 2023; 13:brainsci13040667. [PMID: 37190632 DOI: 10.3390/brainsci13040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
A series of studies have suggested that stage N2 is vulnerable and strongly affected by the first-night effect (FNE). However, the neurophysiological mechanism underlying the vulnerability of stage N2 of the FNE has not been well examined. A total of 17 healthy adults (11 women and 6 men, mean age: 21.59 ± 2.12) underwent two nights of polysomnogram recordings in the sleep laboratory. We analyzed sleep structure and central and autonomic nervous system activity during stage N2 and applied the electroencephalographic (EEG) activation index (beta/delta power ratio) and heart rate variability to reflect changes in central and autonomic nervous system activity caused by the FNE. Correlation analyses were performed between EEG activation and heart rate variability. The results showed that EEG activation and high-frequency heart rate variability increased on the adaptation night (Night 1). Importantly, EEG activation was significantly associated with the percentage of stage N1, and the correlation between EEG activation and high-frequency heart rate variability decreased due to the FNE. These findings indicate that the FNE affects the instability of stage N2 by increasing central nervous system activity and uncoupling the activity between the central and autonomic nervous systems.
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Affiliation(s)
- Ning Ma
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Qian Ning
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Mingzhu Li
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Chao Hao
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou 510631, China
- Center for Sleep Research, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health & Cognitive Science, School of Psychology, South China Normal University, Guangzhou 510631, China
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Chen PC, Zhang J, Thayer JF, Mednick SC. Understanding the roles of central and autonomic activity during sleep in the improvement of working memory and episodic memory. Proc Natl Acad Sci U S A 2022; 119:e2123417119. [PMID: 36279428 PMCID: PMC9636982 DOI: 10.1073/pnas.2123417119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The last decade has seen significant progress in identifying sleep mechanisms that support cognition. Most of these studies focus on the link between electrophysiological events of the central nervous system during sleep and improvements in different cognitive domains, while the dynamic shifts of the autonomic nervous system across sleep have been largely overlooked. Recent studies, however, have identified significant contributions of autonomic inputs during sleep to cognition. Yet, there remain considerable gaps in understanding how central and autonomic systems work together during sleep to facilitate cognitive improvement. In this article we examine the evidence for the independent and interactive roles of central and autonomic activities during sleep and wake in cognitive processing. We specifically focus on the prefrontal-subcortical structures supporting working memory and mechanisms underlying the formation of hippocampal-dependent episodic memory. Our Slow Oscillation Switch Model identifies separate and competing underlying mechanisms supporting the two memory domains at the synaptic, systems, and behavioral levels. We propose that sleep is a competitive arena in which both memory domains vie for limited resources, experimentally demonstrated when boosting one system leads to a functional trade-off in electrophysiological and behavioral outcomes. As these findings inevitably lead to further questions, we suggest areas of future research to better understand how the brain and body interact to support a wide range of cognitive domains during a single sleep episode.
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Affiliation(s)
- Pin-Chun Chen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104
| | - Jing Zhang
- Department of Cognitive Sciences, University of California, Irvine, CA 92697
| | - Julian F. Thayer
- Department of Psychological Sciences, University of California, Irvine, CA 92697
| | - Sara C. Mednick
- Department of Cognitive Sciences, University of California, Irvine, CA 92697
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Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, Pizzarotti S, Zilioli A, Misirocchi F, Mutti C. Sleep medicine: Practice, challenges and new frontiers. Front Neurol 2022; 13:966659. [PMID: 36313516 PMCID: PMC9616008 DOI: 10.3389/fneur.2022.966659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.
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Affiliation(s)
- Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- *Correspondence: Liborio Parrino
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szucs
- Department of Behavioral Sciences, National Institute of Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Nicoletta Azzi
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Francesco Rausa
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Silvia Pizzarotti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Alessandro Zilioli
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Francesco Misirocchi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
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Seol J, Lee J, Park I, Tokuyama K, Fukusumi S, Kokubo T, Yanagisawa M, Okura T. Bidirectional associations between physical activity and sleep in older adults: a multilevel analysis using polysomnography. Sci Rep 2022; 12:15399. [PMID: 36100642 PMCID: PMC9470065 DOI: 10.1038/s41598-022-19841-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractAlthough recent studies have examined the bidirectional associations between physical activity and sleep parameters, few have focused on older adults utilizing objective assessments, such as polysomnography. This micro-longitudinal observational study included 92 Japanese older adults (aged 65–86 years) who underwent objective evaluations of sleep quality using polysomnography and completed subjective sleep-related questionnaires. Activity levels were assessed using an accelerometer. Polysomnography, subjective sleep-related questionnaires, and accelerometer were administered for 7 consecutive days. Multilevel models (participant-, day-level) were used to examine the temporal associations of objective and subjective sleep parameters with sedentary behavior and physical activity. In the day-level analysis, higher levels of sedentary behavior during daytime were associated with longer rapid eye movement (REM) sleep, shorter REM latency, lower levels of non-REM sleep (stage N3), and reduced delta power during daytime. Higher levels of low-intensity physical activity during daytime were associated with lower levels of REM sleep, longer REM latency, and increased stage N3 sleep in the day-level analysis. Higher levels of moderate-to-vigorous physical activity were associated with increased REM latency. Longer subjective sleep time was associated with increased next-day moderate-to-vigorous physical activity. Thus, low-intensity physical activity may provide objective benefits related to deep sleep parameters in older adults.
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Ura M, Fujimoto K, Kanai M. Association between sleep quality, hypertensive disorders of pregnancy, and sleep-disordered breathing in pregnant women with and without obesity: An observational cross-sectional study. J Obstet Gynaecol Res 2022; 48:2774-2789. [PMID: 35920333 DOI: 10.1111/jog.15376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
AIM To elucidate whether pregnancy and obesity are associated with poor sleep quality, and to investigate if sleep quality is associated with hypertensive disorders of pregnancy in pregnant women with obesity. METHODS This observational cross-sectional study examined 15 obese pregnant women (body mass index ≥30 kg/m2 ) (p-Ob group), 15 nonobese pregnant women (p-nOb group), and 30 nonobese nonpregnant women (n-Pr group), using home recording devices to monitor sleep-disordered breathing (SDB): respiratory disturbance index, oxygen saturation, and sleep stage and quality. These variables were compared among the groups. Moreover, obese women with and without hypertensive disorders of pregnancy were compared. RESULTS Significant differences in respiratory disturbance index (median: 10.3 [p-Ob], 7.1 [p-nOb], 3.5 [n-Pr]) and oxygen saturation (95.1%, 96.5%, and 96.6%) were observed among the groups. Seven participants in the p-Ob group experienced hypertensive disorders of pregnancy with SDB before or after sleep examination. Particularly, those who developed hypertensive disorders of pregnancy before sleep examination showed a lower delta power throughout the night than those without this condition. CONCLUSION Pregnant women had poor sleep quality; those with obesity had higher frequency of SDB with worsened respiratory conditions that might cause complications. Our findings suggest that the development of hypertensive disorders of pregnancy in some obese pregnant women might be associated with insufficient delta power. Focusing on delta power may reflect subtle changes in sleep quality that occur in pregnant women. Future longitudinal studies with larger sample sizes are required to confirm these findings and investigate causality.
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Affiliation(s)
- Midori Ura
- Department of Medical Laboratory Science, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Nagano, Japan
| | - Makoto Kanai
- Department of Family and Child Nursing, and Midwifery, Shinshu University School of Health Sciences, Nagano, Japan
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10
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Autonomic Central Coupling during Daytime Sleep Differs between Older and Younger People. Neurobiol Learn Mem 2022; 193:107646. [PMID: 35671980 DOI: 10.1016/j.nlm.2022.107646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 04/12/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022]
Abstract
Decreased functioning in the elderly is mirrored by independent changes in central and autonomic nervous systems. Additionally, recent work suggests that the coupling of these systems may also serve an important role. In young adults, Autonomic and Central Events (ACEs), measured in the temporal coincidence of heart rate bursts (HRBs) and increased slow-wave-activity (SWA, 0.5-1Hz) and sigma activity (12-15Hz), followed by parasympathetic surge (RRHF) during non-rapid eye movement (NREM) sleep, predicted cognitive improvements. However, ACEs have not been examined in the elderly. Thus, the current study compared ACEs during wake and daytime sleep in older and younger adults and examined associations with working memory improvement before and after a nap. Compared to youngers, older adults showed lower amplitude of ACEs during NREM sleep, but not during wake. Furthermore, while younger adults demonstrated a parasympathetic surge after HRBs, older adults showed an earlier rise and longer maintenance of the RRHF. Taken together, our results demonstrate that autonomic-central coupling declines with age. Pathological aging implicates independent roles for decreased autonomic and central nervous system functioning, the current findings suggest that the coupling of these systems may also deserve attention.
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11
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Tsai HJ, Yang AC, Tsai SJ, Ma Y, Kuo TBJ, Yang CCH, Peng CK. Associations of Reduced Sympathetic Neural Activity and Elevated Baroreflex Sensitivity With Non-Rapid Eye Movement Sleep: Evidence From Electroencephalogram- and Electrocardiogram-Based Sleep Staging. Psychosom Med 2022; 84:621-631. [PMID: 35420584 DOI: 10.1097/psy.0000000000001079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Autonomic neural controls in sleep regulation have been previously demonstrated; however, whether these alternations can be observed by different sleep staging approaches remains unclear. Two established methods for sleep staging-the standardized visual scoring and the cardiopulmonary coupling (CPC) analysis based on electrocardiogram-were used to explore the cardiovascular profiles of sleep. METHODS Overnight polysomnography was recorded together with continuous beat-to-beat blood pressure. Cortical activity, heart rate variability, blood pressure variability, and baroreflex sensitivity during sleep stages from 24 nights of sleep were obtained from 15 normotensive participants and analyzed. RESULTS Non-rapid eye movement sleep (NREM) from visual scoring and restful sleep (RS) of CPC both showed the highest delta power of electroencephalogram (EEG) and lowest beta activity of EEG in comparison with other sleep stages (p < .001); likewise, the lowest total power of heart rate variability and suppressed vascular-sympathetic activity, reflected by low-frequency power of blood pressure variability, as well as a trend in elevated baroreflex sensitivity, were observed in the NREM or RS. This suppressed vascular-sympathetic activity during stable sleep further exhibited a significant correlation with increased slow-wave activity (NREM: r = -0.292 ± 0.34, p = .002; RS: r = -0.209 ± 0.30, p = .010). CONCLUSIONS Autonomic nervous system is evidently associated with stable sleep, as indicated by the similar findings obtained from sleep stages categorized by standardized visual scoring or CPC analysis. Such association between cardiovascular neural activity and sleep EEGs can be observed regardless of the sleep staging approach followed.
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Affiliation(s)
- Hsin-Jung Tsai
- From the Department of Psychiatry (H.-J. Tsai, S.-J. Tsai), Taipei Veterans General Hospital; Institute of Brain Science (H.-J. Tsai, A.C. Yang, S.-J. Tsai, Kuo, C.C.H. Yang), National Yang Ming Chiao Tung University, Digital Medicine Center (A.C. Yang), National Yang Ming Chiao Tung University; Department of Medical Research (A.C. Yang), Taipei Veterans General Hospital, Taipei, Taiwan; Osher Center for Integrative Medicine (Ma), Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School; Center for Dynamical Biomarkers (Ma, Peng), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts; Clinical Research Center (Kuo), Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan; and Sleep Research Center (H.-J. Tsai, Kuo, C.C.H. Yang), National Yang Ming Chiao Tung University, Taipei, Taiwan
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Abstract
Spontaneous synchronization over large networks is ubiquitous in nature, ranging from inanimate to biological systems. In the human brain, neuronal synchronization and de-synchronization occur during sleep, with the greatest degree of neuronal synchronization during slow wave sleep (SWS). The current sleep classification schema is based on electroencephalography and provides common criteria for clinicians and researchers to describe stages of non-rapid eye movement (NREM) sleep as well as rapid eye movement (REM) sleep. These sleep stage classifications have been based on convenient heuristic criteria, with little consideration of the accompanying normal physiological changes across those same sleep stages. To begin to resolve those inconsistencies, first focusing only on NREM sleep, we propose a simple cluster synchronization model to explain the emergence of SWS in healthy people without sleep disorders. We apply the empirical mode decomposition (EMD) analysis to quantify slow wave activity in electroencephalograms, and provide quantitative evidence to support our model. Based on this synchronization model, NREM sleep can be classified as SWS and non-SWS, such that NREM sleep can be considered as an intrinsically bistable process. Finally, we develop an automated algorithm for SWS classification. We show that this new approach can unify brain wave dynamics and their corresponding physiologic changes.
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ECG and Heart Rate Variability in Sleep-Related Breathing Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:159-183. [PMID: 36217084 DOI: 10.1007/978-3-031-06413-5_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Here we discuss the current perspectives of comprehensive heart rate variability (HRV) analysis in electrocardiogram (ECG) signals as a non-invasive and reliable measure to assess autonomic function in sleep-related breathing disorders (SDB). It is a tool of increasing interest as different facets of HRV can be implemented to screen and diagnose SDB, monitor treatment efficacy, and prognose adverse cardiovascular outcomes in patients with sleep apnea. In this context, the technical aspects, pathophysiological features, and clinical applications of HRV are discussed to explore its usefulness in better understanding SDB.
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Al Ashry HS, Ni Y, Thomas RJ. Cardiopulmonary Sleep Spectrograms Open a Novel Window Into Sleep Biology-Implications for Health and Disease. Front Neurosci 2021; 15:755464. [PMID: 34867165 PMCID: PMC8633537 DOI: 10.3389/fnins.2021.755464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
The interactions of heart rate variability and respiratory rate and tidal volume fluctuations provide key information about normal and abnormal sleep. A set of metrics can be computed by analysis of coupling and coherence of these signals, cardiopulmonary coupling (CPC). There are several forms of CPC, which may provide information about normal sleep physiology, and pathological sleep states ranging from insomnia to sleep apnea and hypertension. As CPC may be computed from reduced or limited signals such as the electrocardiogram or photoplethysmogram (PPG) vs. full polysomnography, wide application including in wearable and non-contact devices is possible. When computed from PPG, which may be acquired from oximetry alone, an automated apnea hypopnea index derived from CPC-oximetry can be calculated. Sleep profiling using CPC demonstrates the impact of stable and unstable sleep on insomnia (exaggerated variability), hypertension (unstable sleep as risk factor), improved glucose handling (associated with stable sleep), drug effects (benzodiazepines increase sleep stability), sleep apnea phenotypes (obstructive vs. central sleep apnea), sleep fragmentations due to psychiatric disorders (increased unstable sleep in depression).
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Affiliation(s)
- Haitham S Al Ashry
- Division of Pulmonary and Sleep Medicine, Elliot Health System, Manchester, NH, United States
| | - Yuenan Ni
- Division of Pulmonary, Critical Care and Sleep Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Robert J Thomas
- Division of Pulmonary and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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15
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Magnusdottir S, Hilmisson H, Raymann RJEM, Witmans M. Characteristics of Children Likely to Have Spontaneous Resolution of Obstructive Sleep Apnea: Results from the Childhood Adenotonsillectomy Trial (CHAT). CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110980. [PMID: 34828693 PMCID: PMC8620731 DOI: 10.3390/children8110980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may have a role in identifying children that may benefit from other intervention than early adenotonsillectomy (eAT) in management of obstructive sleep apnea (OSA). METHODS A secondary analysis of electrocardiogram-signals (ECG) and oxygen saturation-data (SpO2) collected during polysomnography-studies in the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to calculate CPC-SQI and apnea hypopnea index (AHI) was executed. In the CHAT, children 5-9 years with OSA without prolonged oxyhemoglobin desaturations were randomly assigned to adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcomes were to document change in attention and executive function evaluated with the Developmental Neuropsychological Assessment (NEPSY). In our analysis, children in the WWSC-group with spontaneous resolution of OSA (AHIObstructive < 1.0) and high-sleep quality (SQI ≥ 75) after 7-months were compared with children that showed residual OSA. RESULTS Of the 227 children randomized to WWSC, 203 children had available data at both baseline and 7-month follow-up. The group that showed resolution of OSA at month 7 (n = 43, 21%) were significantly more likely to have high baseline SQI 79.96 [CI95% 75.05, 84.86] vs. 72.44 [CI95% 69.50, 75.39], p = 0.005, mild OSA AHIObstructive 4.01 [CI95% 2.34, 5.68] vs. 6.52 [CI95% 5.47, 7.57], p= 0.005, higher NEPSY-attention-executive function score 106.22 [CI95% 101.67, 110.77] vs. 101.14 [CI95% 98.58, 103.72], p = 0.038 and better quality of life according to parents 83.74 [CI95% 78.95, 88.54] vs. 77.51 [74.49, 80.53], p = 0.015. The groups did not differ when clinically evaluated by Mallampati score, Friedman palate position or sleep related questionnaires. CONCLUSIONS Children that showed resolution of OSA were more likely to have high-SQI and mild OSA, be healthy-weight and have better attention and executive function and quality of life at baseline. As this simple method to evaluate sleep quality and OSA is based on analyzing signals that are simple to collect, the method is practical for sleep-testing, over multiple nights and on multiple occasions. This method may assist physicians and parents to determine the most appropriate therapy for their child as some children may benefit from WWSC rather than interventions. If the parameters can be used to plan care a priori, this would provide a fundamental shift in how childhood OSA is diagnosed and managed.
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Affiliation(s)
- Solveig Magnusdottir
- MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA; (H.H.); (R.J.E.M.R.)
| | - Hugi Hilmisson
- MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA; (H.H.); (R.J.E.M.R.)
| | - Roy J. E. M. Raymann
- MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA; (H.H.); (R.J.E.M.R.)
| | - Manisha Witmans
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Ayas NT, Jen R, Baumann B. Revisiting level II sleep studies in the era of COVID-19: a theoretical economic decision model in patients with suspected obstructive sleep apnea. SLEEP SCIENCE AND PRACTICE 2021; 5:11. [PMID: 34307895 PMCID: PMC8279805 DOI: 10.1186/s41606-021-00063-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background The recent pandemic has made it more challenging to assess patients with suspected obstructive sleep apnea (OSA) with in laboratory polysomnography (PSG) due to concerns of patient and staff safety. The purpose of this study was to assess how Level II sleep studies (LII, full PSG in the home) might be utilized in diagnostic algorithms of suspected OSA using a theoretical decision model. Methods We examined four diagnostic algorithms for suspected OSA: an initial PSG approach, an initial LII approach, an initial Level III approach (LIII, limited channel home sleep study) followed by PSG if needed, and an initial LIII approach followed by LII if needed. Costs per patient assessed was calculated as a function of pretest OSA probability and a variety of other variables (e.g. costs of tests, failure rate of LIII/LII, sensitivity/specificity of LIII). The situation in British Columbia was used as a case study. Results The variation in cost per test was calculated for each algorithm as a function of the above variables. For British Columbia, initial LII was the least costly across a broad range of pretest OSA probabilities (< 0.80) while initial LIII followed by LII as needed was least costly at very high pretest probability (> 0.8). In patients with a pretest OSA probability of 0.5, costs per patient for initial PSG, initial LII, initial LIII followed by PSG, and initial LIII followed by LII were: $588, $417, $607, and $481 respectively. Conclusions Using a theoretical decision model, we developed a preliminary cost framework to assess the potential role of LII studies in OSA assessment. Across a broad range of patient pretest probabilities, initial LII studies may provide substantial cost advantages. LII studies might be especially useful during pandemics as they combine the extensive physiologic information characteristic of PSG with the ability to avoid in-laboratory stays. More empiric studies need to be done to test these different algorithms. Supplementary Information The online version contains supplementary material available at 10.1186/s41606-021-00063-5.
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Affiliation(s)
- Najib T Ayas
- Sleep Disorders Program, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, 7th Floor, Diamond Centre, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Rachel Jen
- Sleep Disorders Program, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, 7th Floor, Diamond Centre, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Brett Baumann
- Department of Medicine, University of British Columbia, 7th Floor, Diamond Centre, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
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Thomas RJ, Kim H, Maillard P, DeCarli CS, Heckman EJ, Karjadi C, Ang TFA, Au R. Digital sleep measures and white matter health in the Framingham Heart Study. EXPLORATION OF MEDICINE 2021; 2:253-267. [PMID: 34927164 PMCID: PMC8682916 DOI: 10.37349/emed.2021.00045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/18/2021] [Indexed: 01/23/2023] Open
Abstract
AIM Impaired sleep quality and sleep oxygenation are common sleep pathologies. This study assessed the impact of these abnormalities on white matter (WM) integrity in an epidemiological cohort. METHODS The target population was the Framingham Heart Study Generation-2/Omni-1 Cohorts. Magnetic resonance imaging (diffusion tensor imaging) was used to assess WM integrity. Wearable digital devices were used to assess sleep quality: the (M1-SleepImage™ system) and the Nonin WristOx for nocturnal oxygenation. The M1 device collects trunk actigraphy and the electrocardiogram (ECG); sleep stability indices were computed using cardiopulmonary coupling using the ECG. Two nights of recording were averaged. RESULTS Stable sleep was positively associated with WM health. Actigraphic periods of wake during the sleep period were associated with increased mean diffusivity. One marker of sleep fragmentation which covaries with respiratory chemoreflex activation was associated with reduced fractional anisotropy and increased mean diffusivity. Both oxygen desaturation index and oxygen saturation time under 90% were associated with pathological directions of diffusion tensor imaging signals. Gender differences were noted across most variables, with female sex showing the larger and significant impact. CONCLUSIONS Sleep quality assessed by a novel digital analysis and sleep hypoxia was associated with WM injury, especially in women.
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Affiliation(s)
- Robert Joseph Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Hyun Kim
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Pauline Maillard
- Department of Neurology, University of California Davis Health, Sacramento, CA 95817, USA
| | - Charles S. DeCarli
- Department of Neurology, University of California Davis Health, Sacramento, CA 95817, USA
| | - Eric James Heckman
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Cody Karjadi
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Rhoda Au
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Neurology and Epidemiology, Boston University School of Medicine and Public Health, Boston, MA 02118, USA
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18
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Cardiopulmonary coupling-derived sleep quality is associated with improvements in blood pressure in patients with obstructive sleep apnea at high-cardiovascular risk. J Hypertens 2021; 38:2287-2294. [PMID: 32649638 DOI: 10.1097/hjh.0000000000002553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Investigate if changes in objective sleep quality index (SQI) assessed through cardiopulmonary-coupling analysis impacts blood pressure (BP) in patients with obstructive sleep apnea at high-cardiovascular risk. METHODS Secondary analysis of ECG and pulse-oximetry-[oxygen saturation (SpO2)] data from the Heart Biomarker Evaluation in Apnea Treatment study, multicenter, controlled trial in patients with cardiovascular disease and moderate-severe obstructive sleep apnea, randomly assigned to intervention of healthy lifestyle and sleep hygiene education (HLSE; control group), continuous positive airway pressure (CPAP) or nocturnal supplemental oxygen (NSO). Participants with good-quality ECG-signal and SpO2-signal (n = 241) were included. RESULTS CPAP-therapy significantly improved BP, with net average improvement in mean arterial blood pressure during sleep (MAP) when compared with nocturnal supplemental oxygen-therapy or healthy lifestyle and sleep education-therapy, -3.92 (P = 0.012) and -3.83 (P = 0.016), respectively. When stratified on the basis of baseline-SQI, CPAP-therapy improves 24-h MAP -3.02 (P = 0.030) and MAP -5.00 (P = 0.001), in patients with compromised baseline-SQI (SQI < 55). Stratifying the cohort based on changes in SQI during the study period (SQI-SQI), controlling for sex, age over 60, apnea-hypopnea index, SpO2 less than 80%, baseline BP and cardiovascular disease, significant differences are observed comparing the groups that Improved-SQI (SQI < 55, SQI ≥ 55) and Declined-SQI (SQI ≥ 55, SQI < 55) in MAP -4.87 (P = 0.046) and mean diastolic blood pressure (MDP) -4.42 (P = 0.026) as well as MAP -6.36 (P = 0.015), mean systolic blood pressure wake (MSP) -7.80 (P = 0.048) and MDP -5.64 (P = 0.009), respectively. Improved SQI reflects the magnitude of positive effect on BP which is reached mostly through initiation of CPAP-therapy. CONCLUSION Cardiopulmonary coupling-derived sleep quality impacted 24-h MAP and MDP, as well as BP during wake, in patients participating in the Heart Biomarker Evaluation in Apnea Treatment-study.
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Zhang X, Song B, Liu Y, Wan Y, Zhou K, Xue R. Cognitive deficit is correlated with sleep stability in insomnia: A cardiopulmonary coupling study. Brain Behav 2021; 11:e02068. [PMID: 33960731 PMCID: PMC8213939 DOI: 10.1002/brb3.2068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To assess the correlation of cognitive function with sleep stability and depressive-anxious symptoms in insomnia patients. METHODS Twenty-two insomnia patients with cognitive impairment (insomnia-CI), 21 insomnia patients with normal cognition (insomnia-CN), and 15 matched healthy control subjects (HCs) were enrolled and completed neuropsychological tests, the Hamilton Depression and Anxiety Scales (HAMD and HAMA), the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index (PSQI),the Insomnia Severity Index (ISI), and the cardiopulmonary coupling (CPC) examination. Ratios of high-frequency coupling (HFC), low-frequency coupling (LFC), and very low-frequency coupling (VLFC) measured by CPC analysis represent stable sleep, unstable sleep, and wake/rapid eye movement (REM) sleep, respectively. RESULTS The HAMD, HAMA, PSQI, and ISI scores were higher in the insomnia-CN patients than in the HCs (all p < .01). However, no differences were found in the HFC, LFC, and VLFC ratio between the HCs and insomnia-CN groups. Compared with the insomnia-CN patients, insomnia-CI patients exhibited higher scores on the HAMD, HAMA (all p < .01), and PSQI (p < .05), performed worse on the Auditory Verbal Learning Test, Trial Making Test B, and Stroop Test B (all p < .01), had a lower HFC ratio, and had a higher LFC ratio in the CPC analysis (all p < .01). Furthermore, in the insomnia patients, poorer cognition was correlated with a decreased HFC ratio and an increased VLFC ratio (r = .356, p = .019; r = -.339, p =.026, respectively) and increased HAMD and HAMA scores (r = -.507, p < .001; r = -.561, p < .001, respectively); a higher VLFC ratio was correlated with an increased ISI score (r = .346, p = .023). CONCLUSIONS Cognitive deterioration in insomnia patients was associated with a decreased stable sleep ratio, an increased wake/REM sleep ratio and more severe symptoms of depression and anxiety. CPC analysis can reflect the severity of insomnia.
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Affiliation(s)
- Xuan Zhang
- Department of Neurology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Bingxin Song
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanyan Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yahui Wan
- Department of Neurology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Kaili Zhou
- Department of Neurology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Rong Xue
- Department of Neurology, Tianjin Medical University General Hospital Airport Site, Tianjin, China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
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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.
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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.
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Sun H, Ganglberger W, Panneerselvam E, Leone MJ, Quadri SA, Goparaju B, Tesh RA, Akeju O, Thomas RJ, Westover MB. Sleep staging from electrocardiography and respiration with deep learning. Sleep 2021; 43:5682785. [PMID: 31863111 DOI: 10.1093/sleep/zsz306] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/13/2019] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES Sleep is reflected not only in the electroencephalogram but also in heart rhythms and breathing patterns. We hypothesized that it is possible to accurately stage sleep based on the electrocardiogram (ECG) and respiratory signals. METHODS Using a dataset including 8682 polysomnograms, we develop deep neural networks to stage sleep from ECG and respiratory signals. Five deep neural networks consisting of convolutional networks and long- and short-term memory networks are trained to stage sleep using heart and breathing, including the timing of R peaks from ECG, abdominal and chest respiratory effort, and the combinations of these signals. RESULTS ECG in combination with the abdominal respiratory effort achieved the best performance for staging all five sleep stages with a Cohen's kappa of 0.585 (95% confidence interval ±0.017); and 0.760 (±0.019) for discriminating awake vs. rapid eye movement vs. nonrapid eye movement sleep. Performance is better for younger ages, whereas it is robust for body mass index, apnea severity, and commonly used outpatient medications. CONCLUSIONS Our results validate that ECG and respiratory effort provide substantial information about sleep stages in a large heterogeneous population. This opens new possibilities in sleep research and applications where electroencephalography is not readily available or may be infeasible.
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Affiliation(s)
- Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | | | | | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Syed A Quadri
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Balaji Goparaju
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert J Thomas
- Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Shirota A, Kamimura M, Kishi A, Adachi H, Taniike M, Kato T. Discrepancies in the Time Course of Sleep Stage Dynamics, Electroencephalographic Activity and Heart Rate Variability Over Sleep Cycles in the Adaptation Night in Healthy Young Adults. Front Physiol 2021; 12:623401. [PMID: 33867997 PMCID: PMC8044772 DOI: 10.3389/fphys.2021.623401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the present study was to characterize the cyclic sleep processes of sleep-stage dynamics, cortical activity, and heart rate variability during sleep in the adaptation night in healthy young adults. METHODS Seventy-four healthy adults participated in polysomnographic recordings on two consecutive nights. Conventional sleep variables were assessed according to standard criteria. Sleep-stage continuity and dynamics were evaluated by sleep runs and transitions, respectively. These variables were compared between the two nights. Electroencephalographic and cardiac activities were subjected to frequency domain analyses. Cycle-by-cycle analysis was performed for the above variables in 34 subjects with four sleep cycles and compared between the two nights. RESULTS Conventional sleep variables reflected lower sleep quality in the adaptation night than in the experimental night. Bouts of stage N1 and stage N2 were shorter, and bouts of stage Wake were longer in the adaptation night than in the experimental night, but there was no difference in stage N3 or stage REM. The normalized transition probability from stage N2 to stage N1 was higher and that from stage N2 to N3 was lower in the adaptation night, whereas that from stage N3 to other stages did not differ between the nights. Cycle-by-cycle analysis revealed that sleep-stage distribution and cortical beta EEG power differed between the two nights in the first sleep cycle. However, the HF amplitude of the heart rate variability was lower over the four sleep cycles in the adaptation night than in the experimental night. CONCLUSION The results suggest the distinct vulnerability of the autonomic adaptation processes within the central nervous system in young healthy subjects while sleeping in a sleep laboratory for the first time.
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Affiliation(s)
- Ai Shirota
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Mayo Kamimura
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Akifumi Kishi
- Graduate School of Education, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroyoshi Adachi
- Osaka University Hospital, Sleep Medicine Center, Suita, Japan
- Osaka University Health and Counseling Center, Toyonaka, Japan
| | - Masako Taniike
- Osaka University Hospital, Sleep Medicine Center, Suita, Japan
- Department of Child Development, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
- Osaka University Hospital, Sleep Medicine Center, Suita, Japan
- Department of Child Development, Osaka University United Graduate School of Child Development, Suita, Japan
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Cerebral cortical autonomic connectivity in low-risk term newborns. Clin Auton Res 2021; 31:415-424. [PMID: 33718981 DOI: 10.1007/s10286-021-00793-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/24/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The mature central autonomic network includes connectivity between autonomic nervous system brainstem centers and the cerebral cortex. The study objective was to evaluate the regional connectivity between the cerebral cortex and brainstem autonomic centers in term newborns by measuring coherence between high-density electroencephalography and heart rate variability as measured by electrocardiography. METHODS Low-risk term newborns with birth gestational age of 39-40 weeks were prospectively enrolled and studied using time-synced electroencephalography and electrocardiography for up to 60 min before discharge from the birth hospital. The ccortical autonomicc nervous system association was analyzed using coherence between electroencephalography-delta power and heart rate variability. Heart rate variability measured the parasympathetic tone (root mean square of successive differences of heart rate) and sympathetic tone (standard deviation of heart rate). RESULTS One hundred and twenty-nine low-risk term infants were included. High coherence delta-root mean square of successive differences was found in central, bitemporal, and occipital brain regions, with less robust coherence delta-standard deviation in the central region and bitemporal areas. CONCLUSIONS Our findings describe a topography of ccortical autonomicc connectivity present at term in low-risk newborns, which was more robust to parasympathetic than sympathetic brainstem centers and was independent of newborn state.
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Wood C, Bianchi MT, Yun CH, Shin C, Thomas RJ. Multicomponent Analysis of Sleep Using Electrocortical, Respiratory, Autonomic and Hemodynamic Signals Reveals Distinct Features of Stable and Unstable NREM and REM Sleep. Front Physiol 2020; 11:592978. [PMID: 33343390 PMCID: PMC7744633 DOI: 10.3389/fphys.2020.592978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/13/2020] [Indexed: 12/05/2022] Open
Abstract
A new concept of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep is proposed, that of multi-component integrative states that define stable and unstable sleep, respectively, NREMS, NREMUS REMS, and REMUS. Three complementary data sets are used: obstructive sleep apnea (20), healthy subjects (11), and high loop gain sleep apnea (50). We use polysomnography (PSG) with beat-to-beat blood pressure monitoring, and electrocardiogram (ECG)-derived cardiopulmonary coupling (CPC) analysis to demonstrate a bimodal, rather than graded, characteristic of NREM sleep. Stable NREM (NREMS) is characterized by high probability of occurrence of the <1 Hz slow oscillation, high delta power, stable breathing, blood pressure dipping, strong sinus arrhythmia and vagal dominance, and high frequency CPC. Conversely, unstable NREM (NREMUS) has the opposite features: a fragmented and discontinuous <1 Hz slow oscillation, non-dipping of blood pressure, unstable respiration, cyclic variation in heart rate, and low frequency CPC. The dimension of NREM stability raises the possibility of a comprehensive integrated multicomponent network model of NREM sleep which captures sleep onset (e.g., ventrolateral preoptic area-based sleep switch) processes, synaptic homeostatic delta power kinetics, and the interaction of global and local sleep processes as reflected in the spatiotemporal evolution of cortical “UP” and “DOWN” states, while incorporating the complex dynamics of autonomic-respiratory-hemodynamic systems during sleep. Bimodality of REM sleep is harder to discern in health. However, individuals with combined obstructive and central sleep apnea allows ready recognition of REMS and REMUS (stable and unstable REM sleep, respectively), especially when there is a discordance of respiratory patterns in relation to conventional stage of sleep.
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Affiliation(s)
- Christopher Wood
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Matt Travis Bianchi
- Division of Sleep Medicine, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Chang-Ho Yun
- Department of Neurology, Bundang Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Robert Joseph Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Seo MY, Yoo J, Hwang SJ, Lee SH. Diagnosis of Obstructive Sleep Apnea in Adults Using the Cardiopulmonary Coupling-Derived Software-Generated Apnea-Hypopnea Index. Clin Exp Otorhinolaryngol 2020; 14:424-426. [PMID: 33092318 PMCID: PMC8606287 DOI: 10.21053/ceo.2020.01984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Min Young Seo
- Division of Rhinology and Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jun Yoo
- Division of Rhinology and Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sun Jin Hwang
- Division of Rhinology and Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Hoon Lee
- Division of Rhinology and Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Yang J, Pan Y, Wang T, Zhang X, Wen J, Luo Y. Sleep-Dependent Directional Interactions of the Central Nervous System-Cardiorespiratory Network. IEEE Trans Biomed Eng 2020; 68:639-649. [PMID: 32746063 DOI: 10.1109/tbme.2020.3009950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We investigated the nature of interactions between the central nervous system (CNS) and the cardiorespiratory system during sleep. METHODS Overnight polysomnography recordings were obtained from 33 healthy individuals. The relative spectral powers of five frequency bands, three ECG morphological features and respiratory rate were obtained from six EEG channels, ECG, and oronasal airflow, respectively. The synchronous feature series were interpolated to 1 Hz to retain the high time-resolution required to detect rapid physiological variations. CNS-cardiorespiratory interaction networks were built for each EEG channel and a directionality analysis was conducted using multivariate transfer entropy. Finally, the difference in interaction between Deep, Light, and REM sleep (DS, LS, and REM) was studied. RESULTS Bidirectional interactions existed in central-cardiorespiratory networks, and the dominant direction was from the cardiorespiratory system to the brain during all sleep stages. Sleep stages had evident influence on these interactions, with the strength of information transfer from heart rate and respiration rate to the brain gradually increasing with the sequence of REM, LS, and DS. Furthermore, the occipital lobe appeared to receive the most input from the cardiorespiratory system during LS. Finally, different ECG morphological features were found to be involved with various central-cardiac and cardiac-respiratory interactions. CONCLUSION These findings reveal detailed information regarding CNS-cardiorespiratory interactions during sleep and provide new insights into understanding of sleep control mechanisms. SIGNIFICANCE Our approach may facilitate the investigation of the pathological cardiorespiratory complications of sleep disorders.
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Chen PC, Whitehurst LN, Naji M, Mednick SC. Autonomic/central coupling benefits working memory in healthy young adults. Neurobiol Learn Mem 2020; 173:107267. [PMID: 32535198 DOI: 10.1016/j.nlm.2020.107267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
Working memory (WM) is an executive function that can improve with training. However, the precise mechanism for this improvement is not known. Studies have shown greater WM gains after a period of sleep than a similar period of wake, and correlations between WM improvement and slow wave activity (SWA; 0.5-1 Hz) during slow wave sleep (SWS). A different body of literature has suggested an important role for autonomic activity during wake for WM. A recent study from our group reported that the temporal coupling of Autonomic/CentralEvents (ACEs) during sleep was associated with memory consolidation. We found that heart rate bursts (HR bursts) during non-rapid eye movement (NREM) sleep are accompanied by increases in SWA and sigma (12-15 Hz) power, as well as increases in the high-frequency (HF) component of the RR interval, reflecting vagal rebound. In addition, ACEs predict long-term, episodic memory improvement. Building on these previous results, we examined whether ACEs also contribute to gains in WM. We tested 104 young adults in an operation span task (OSPAN) in the morning and evening, with either a nap (n = 53; with electroencephalography (EEG) and electrocardiography (ECG)) or wake (n = 51) between testing sessions. We identified HR bursts in the ECG and replicated the increases in SWA and sigma prior to peak of the HR burst, as well as vagal rebound after the peak. Furthermore, we showed sleep-dependent WM improvement, which was predicted by ACE activity. Using regression analyses, we discovered that significantly more variance in WM improvement could be explained with ACE variables than with overall sleep activity not time-locked with ECG. These results provide the first evidence that coordinated autonomic and central events play a significant role in sleep-related WM improvement and implicate the potential of autonomic interventions during sleep for cognitive enhancement.
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Affiliation(s)
- Pin-Chun Chen
- Department of Cognitive Science, University of California, Irvine USA
| | | | - Mohsen Naji
- Department of Medicine, University of California, San Diego, CA, USA
| | - Sara C Mednick
- Department of Cognitive Science, University of California, Irvine USA.
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Zhu T, Zhou J, Zhou J, Feng L, Yang J, Wang G. High-frequency cardiopulmonary coupling during sleep correlates with memory in depressed patients: A pilot study. J Affect Disord 2020; 270:118-123. [PMID: 32339101 DOI: 10.1016/j.jad.2020.03.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 01/03/2020] [Accepted: 03/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND It has been demonstrated that a reduction in the amount of high-frequency cardiopulmonary coupling (CPC) is indicative of unstable sleep in unmedicated patients with major depressive disorder (MDD). Considering the close relationship between sleep quality and memory consolidation, this study sought to investigate the potential of high-frequency CPC as a novel biomarker for objective evaluation of memory impairment in MDD. METHODS A total of 64 depressed patients and 35 healthy controls were included in this cross-sectional study. High-frequency coupling (HFC) was assessed by electrocardiogram-based CPC analysis using a portable sleep-respiration monitor during sleep for one night. The next day, subjects completed the cognition assessment with the Assessment of Neuropsychological Status (RBANS). The 17-Item Hamilton Depression Rating Scale (HAMD17) and the Hamilton Rating Scales for Anxiety (HAMA) were used to evaluate the severity of depression and anxiety in each patient, respectively. RESULTS There was no significant difference in the proportion of HFC between depressed patients and healthy controls. In patients with low HFC proportion (<35%), severe anxiety could significantly decrease HFC proportion. The HFC proportion positively correlated with immediate and delayed memory in depressed patients. Further analysis showed that patients with low HFC proportion may have worse delayed memory. LIMITATIONS The lack of prior exposure to the monitoring equipment and procedure could have generated artefacts that would have disappeared after habituation. CONCLUSIONS These results support a positive correlation between the HFC proportion and memory in depressed patients. Further research is required to explore the clinical implications of these findings.
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Affiliation(s)
- Tong Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian Yang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Seo MY, Han MS, Jeong YJ, Lee MK, Park S, Hwang SJ, Lee SH. Variation in Sleep Stability with Differences in Severity of Sleep-Disordered Breathing in Children. Laryngoscope 2020; 131:435-439. [PMID: 32473062 DOI: 10.1002/lary.28769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/06/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the association between obstructive sleep apnea (OSA) severity and various cardiopulmonary coupling (CPC) parameters in children with OSA. STUDY DESIGN Retrospective cross-sectional study. METHODS A cross-sectional study was conducted among 117 children (aged 7.96 ± 3.54 years, 86 male) who underwent both full-night polysomnography (PSG) and CPC for suspicion of sleep-disordered breathing (SDB). We analyzed the association between various CPC and PSG findings. RESULTS The apnea-hypopnea index (AHI) was negatively correlated with high frequency coupling (HFC, r = -0.374, P < .001) and very low frequency coupling (VLFC, r = -0.192, P = .038) and positively correlated with low frequency coupling (LFC, r = 0.503, P < .001), elevated low frequency coupling (e-LFC, r = 0.475, P < .001), and narrow and broad band e-LFC (e-LFCNB and e-LFCBB ; r = 0.221, P = .016 and r = 0.468, P < .001, respectively). The arousal index was negatively correlated with HFC (r = - 0.466, P < .001) and positively correlated with LFC, e-LFC, e-LFCNB , and e-LFCBB (r = 0.543, r = 0.460, r = 0.239, and r = 0.445, respectively; all P < .001). In addition, we also found a significant difference in various CPC values according to OSA severity. CONCLUSION CPC parameters accurately reflect sleep fragmentation and OSA severity in children. Thus, we can verify objective sleep quality using CPC analysis, which is a simple method of analyzing sleep stability in children with SDB. LEVEL OF EVIDENCE 4 Laryngoscope, 131:435-439, 2021.
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Affiliation(s)
- Min Young Seo
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Mun Soo Han
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Yong Jun Jeong
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Min Kyu Lee
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Seongbin Park
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Sun Jin Hwang
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Seung Hoon Lee
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
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Sleep apnea diagnosis in children using software-generated apnea-hypopnea index (AHI) derived from data recorded with a single photoplethysmogram sensor (PPG). Sleep Breath 2020; 24:1739-1749. [DOI: 10.1007/s11325-020-02049-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
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Ma Y, Sun S, Zhang M, Guo D, Liu AR, Wei Y, Peng CK. Electrocardiogram-based sleep analysis for sleep apnea screening and diagnosis. Sleep Breath 2020; 24:231-240. [PMID: 31222591 PMCID: PMC6925360 DOI: 10.1007/s11325-019-01874-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Despite the increasing number of research studies of cardiopulmonary coupling (CPC) analysis, an electrocardiogram-based technique, the use of CPC in underserved population remains underexplored. This study aimed to first evaluate the reliability of CPC analysis for the detection of obstructive sleep apnea (OSA) by comparing with polysomnography (PSG)-derived sleep outcomes. METHODS Two hundred five PSG data (149 males, age 46.8 ± 12.8 years) were used for the evaluation of CPC regarding the detection of OSA. Automated CPC analyses were based on ECG signals only. Respiratory event index (REI) derived from CPC and apnea-hypopnea index (AHI) derived from PSG were compared for agreement tests. RESULTS CPC-REI positively correlated with PSG-AHI (r = 0.851, p < 0.001). After adjusting for age and gender, CPC-REI and PSG-AHI were still significantly correlated (r = 0.840, p < 0.001). The overall results of sensitivity and specificity of CPC-REI were good. CONCLUSION Compared with the gold standard PSG, CPC approach yielded acceptable results among OSA patients. ECG recording can be used for the screening or diagnosis of OSA in the general population.
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Affiliation(s)
- Yan Ma
- Center for Dynamical Biomarkers, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Shuchen Sun
- Department of Otolaryngology and South Campus Sleep Center, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Ming Zhang
- Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210000, China
| | - Dan Guo
- Center for Dynamical Biomarkers, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Arron Runzhou Liu
- Center for Dynamical Biomarkers, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Yulin Wei
- China-Japan Friendship Hospital, Beijing, 100029, China
| | - Chung-Kang Peng
- Center for Dynamical Biomarkers, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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Seo MY, Hwang SJ, Nam KJ, Lee SH. Significance of sleep stability using cardiopulmonary coupling in sleep disordered breathing. Laryngoscope 2019; 130:2069-2075. [PMID: 31750962 DOI: 10.1002/lary.28379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/17/2019] [Accepted: 10/03/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess the sleep quality and sleep stability according to the severity of obstructive sleep apnea (OSA) by using questionnaires and cardiopulmonary coupling (CPC) analysis. METHODS Two hundred and twenty-one adults were evaluated using subjective sleep questionnaires, CPC parameters, and respiratory parameters measured during full-night polysomnography. We measured the differences in the CPC parameters of each OSA group and the correlation between the apnea-hypopnea index (AHI) and CPC parameters. RESULTS AHI and CPC parameters were not associated with sleep questionnaires. AHI is negatively correlated with high frequency coupling (HFC, r = -0.725, P < 0.001) and very low frequency coupling (VLFC, r = -0.475, P < 0.001), but it is positively correlated with low frequency coupling (LFC, r = 0.786, P < 0.001) and narrow- and broadband-elevated low frequency coupling (e-LFCNB and e-LFCBB ; r = 0.522, P < 0.001 and r = 0.668, P < 0.001, respectively). We also found similar results regarding the correlation between the arousal index and CPC parameters. In addition, there were significant differences in HFC, LFC, VLFC, e-LFCNB , and e-LFCBB (all P < 0.001) between the severe OSA group and all other groups. CONCLUSION We found that CPC parameters significantly correlated with AHI. In addition, sleep stability-related parameters differ significantly based on OSA severity, and apneic parameters in the severe OSA group are significantly different from those in the other groups. LEVEL OF EVIDENCE 4 Laryngoscope, 130: 2069-2075, 2020.
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Affiliation(s)
- Min Young Seo
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea University College of Medicine, Ansan-city, Gyeonggi-do, Republic of Korea
| | - Sun Jin Hwang
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea University College of Medicine, Ansan-city, Gyeonggi-do, Republic of Korea
| | - Kuk Jin Nam
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea University College of Medicine, Ansan-city, Gyeonggi-do, Republic of Korea
| | - Seung Hoon Lee
- Division of Rhinology & Sleep Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Ansan, Korea University College of Medicine, Ansan-city, Gyeonggi-do, Republic of Korea
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Tsai HJ, Kuo TBJ, Kuo KL, Yang CCH. Failure to de-arouse during sleep-onset transitions in the heart rates of individuals with sleep-onset insomnia. J Psychosom Res 2019; 126:109809. [PMID: 31622837 DOI: 10.1016/j.jpsychores.2019.109809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/11/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Increased cardiovascular risk associated with sleep-onset insomnia has been reported, but the patterns of heart rate (HR) transitions during sleep onset in individuals with sleep-onset insomnia remain uncertain. This study explored the HR dynamics during objective and subjective sleep onset transitions among sleep-onset insomnia. METHODS Seventeen good sleepers and 17 individuals with sleep-onset insomnia had their night-time HR measured. HR and heart rate variability (HRV) were analyzed within 8-min periods of pre- and post-transition of stage N1, stage N2 and subjective sleep onset. RESULTS A significantly higher low-frequency percentage of HRV was observed in pre-N1 period among insomnia group, compared with good sleepers. Decline in HR begins in 160 s prior to N1 onset among good sleepers, whereas the HRs of insomnia group were reduced only after N1 onset in comparison to their HRs at the time of N1 onset. The good sleepers and insomnia group both had their HRs dropped to a level comparable to their HRs at respective stage N2 onset at 220 s and 80 s prior to N2 onset. No differences in HR was found during subjective sleep onset transition in both groups. CONCLUSION During the wake-to-sleep transition, a low and stable HR was observed before cortical alternations in good sleepers; however, a consistently high HR until N1 onset was shown among sleep-onset insomnia. This finding suggests a state-dependent and failure to de-arouse from the high arousal level of wakefulness into light sleep is associated with sleep initiation difficulty.
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Affiliation(s)
- Hsin-Jung Tsai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Center for Dynamical Biomarkers, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Terry B J Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Liang Kuo
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Sleep Research Center, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
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Wu JG, Wang D, Rowsell L, Wong KK, Yee BJ, Nguyen CD, Han F, Hilmisson H, Thomas RJ, Grunstein RR. The effect of acute exposure to morphine on breathing variability and cardiopulmonary coupling in men with obstructive sleep apnea: A randomized controlled trial. J Sleep Res 2019; 29:e12930. [DOI: 10.1111/jsr.12930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Justin G.‐A. Wu
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
| | - David Wang
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital Sydney NSW Australia
| | - Luke Rowsell
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
| | - Keith K. Wong
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital Sydney NSW Australia
| | - Brendon J. Yee
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital Sydney NSW Australia
| | - Chinh D. Nguyen
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
| | - Fang Han
- Department of Respiratory Medicine Peking University People's Hospital Beijing China
| | | | - Robert J. Thomas
- Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Ronald R. Grunstein
- Centre for Integrated Research and Understanding of Sleep (CIRUS) Woolcock Institute of Medical Research Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital Sydney NSW Australia
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Abstract
Obstructive sleep apnea (OSA) is a heterogeneous disorder. Cluster analysis has identified different physiologic subtypes with respect to symptoms. A difference exists in cardiovascular risk from OSA between the 7 subtypes identified. There are 3 basic subtypes replicated in multiple studies: (a) a group where insomnia is the main symptom; (b) an asymptomatic group; (c) a group with marked excessive sleepiness. The symptomatic benefit from treatment with nasal CPAP varies between these 3 subtypes. Data from the Sleep Heart Health Study reveal that the increased risk of cardiovascular disease from OSA occurs only in the excessively sleepy group.
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Affiliation(s)
- Allan I Pack
- Translational Research Laboratories, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Suite 2100, 125 South 31st Street, Philadelphia, PA 19104-3403, USA.
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Walter LM, Tamanyan K, Weichard AJ, Biggs SN, Davey MJ, Nixon GM, Horne RSC. Age and autonomic control, but not cerebral oxygenation, are significant determinants of EEG spectral power in children. Sleep 2019; 42:5513436. [DOI: 10.1093/sleep/zsz118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/05/2019] [Indexed: 01/28/2023] Open
Abstract
AbstractStudy ObjectivesSleep disordered breathing (SDB) in children has significant effects on daytime functioning and cardiovascular control; attributed to sleep fragmentation and repetitive hypoxia. Associations between electroencephalograph (EEG) spectral power, autonomic cardiovascular control and cerebral oxygenation have been identified in adults with SDB. To date, there have been no studies in children. We aimed to assess associations between EEG spectral power and heart rate variability as a measure of autonomic control, with cerebral oxygenation in children with SDB.MethodsOne hundred sixteen children (3–12 years) with SDB and 42 controls underwent overnight polysomnography including measurement of cerebral oxygenation. Power spectral analysis of the EEG derived from C4-M1 and F4-M1, quantified delta, theta, alpha, and beta waveforms during sleep. Multiple regression tested whether age, SDB severity, heart rate (HR), HR variability (HRV), and cerebral oxygenation were determinants of EEG spectral power.ResultsThere were no differences in EEG spectral power derived from either central or frontal regions for any frequency between children with different severities of SDB so these were combined. Age, HR, and HRV low frequency power were significant determinants of EEG spectral power depending on brain region and sleep stage.ConclusionThe significant findings of this study were that age and autonomic control, rather than cerebral oxygenation and SDB severity, were predictive of EEG spectral power in children. Further research is needed to elucidate how the physiology that underlies the relationship between autonomic control and EEG impacts on the cardiovascular sequelae in children with SDB.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Aidan J Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sarah N Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
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Hilmisson H, Sveinsdottir E, Lange N, Magnusdottir S. Insomnia symptoms in primary care: A prospective study focusing on prevalence of undiagnosed co-morbid sleep disordered breathing. Eur J Intern Med 2019; 63:19-26. [PMID: 30686663 DOI: 10.1016/j.ejim.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/12/2019] [Accepted: 01/21/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine prevalence of comorbid undiagnosed sleep disordered breathing (SDB) in chronic insomnia patients, using two complementary methods, one standard and one novel. METHODS Using prospective design, adult patients diagnosed with chronic insomnia, treated with prescription pharmacological agents for >3 months without prior objective sleep evaluation or diagnosis of SDB were invited to participate. All patients recorded their sleep for two consecutive nights using level 3 home-sleep-apnea-test (HSAT) device to derive Respiratory Event Index (REI) for OSA diagnosis. The electrocardiogram-signal (ECG) recorded by the same device was analyzed using FDA cleared medical software, Cardiopulmonary Coupling (CPC) to quantify sleep time and identify sleep-quality and pathology. RESULTS Of 110 chronic insomnia patients who volunteered between May 2017 and June 2018, 88% were women. Prevalence of moderate-severe SDB (REI > 15) was 25% based on REI-scoring. Surrogate markers of moderate-severe SDB detected by the novel method identified prevalence of 33%, with negative predictive value 96%, reclassifying 10 individuals that HSAT diagnosed with mild SDB with more advanced disease state. Agreement between the methods is 88%. CONCLUSION High prevalence and overlap in symptoms between insomnia and SDB warrants objective testing when evaluating sleep complaints before therapy is initiated. Diagnostic caution is even more importantly warranted for female patients presenting insomnia sleep complaints, as SDB may not be initially considered as a biological symptom driver. CPC-analysis can complement standard HSAT or serve as a standalone option to evaluate sleep complaints in individuals presenting insomnia symptoms before therapy is initiated. CLINICAL TRIAL REGISTRY NAME AND NUMBER Pilot study: Co-occurrence of Insomnia and Sleep Disordered Breathing (SDB) symptoms: Prospective study focusing on chronic insomnia patients treated with pharmacological agents. Approved by the Bioethics Committee on March 7th, 2017. VSNb: 17- 047- S1/ ST - GRA - 17029 - PDX - SH http://vsn.is/is/content/17-047.
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Affiliation(s)
- Hugi Hilmisson
- SleepImage, 3513 Brighton Blvd, Suite 530, Denver, CO 80216, USA.
| | | | - Neale Lange
- University of Colorado Health, Denver-Anschutz Medical Campus, Division of Pulmonary Sciences and Critical Care Medicine, Denver, CO 80045, USA
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de Chazal P, Sutherland K, Cistulli PA. Advanced polysomnographic analysis for OSA: A pathway to personalized management? Respirology 2019; 25:251-258. [PMID: 31038827 DOI: 10.1111/resp.13564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly heterogeneous disorder, with diverse pathways to disease, expression of disease, susceptibility to co-morbidities and response to therapy, and is ideally suited to precision medicine approaches. Clinically, the content of the information-rich polysomnogram (PSG) is not currently fully utilized in determining patient management. Novel PSG parameters such as hypoxic burden, pulse transit time, cardiopulmonary coupling and the frequency representations of PSG sensor signals could predict a variety of cardiovascular disease, cancer and neurodegeneration co-morbidities. The PSG can also be used to identify key pathophysiological parameters such as loop gain, arousal threshold and muscle compensation which can enhance understanding of the causes of OSA in an individual, and thereby guide choices on therapy. Machine learning methods performing their own parameter extraction coupled with large PSG data sets offer an exciting opportunity for discovering new links between the PSG variables and disease outcomes. By exploiting existing and emerging analytical methods, the PSG may offer a pathway to personalized management for OSA.
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Affiliation(s)
- Philip de Chazal
- Charles Perkins Centre, Faculty of Engineering and I.T., University of Sydney, Sydney, NSW, Australia
| | - Kate Sutherland
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Objective sleep quality and metabolic risk in healthy weight children results from the randomized Childhood Adenotonsillectomy Trial (CHAT). Sleep Breath 2019; 23:1197-1208. [PMID: 30798410 DOI: 10.1007/s11325-019-01802-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesized that cardiopulmonary coupling (CPC) sleep quality reflects cardiovascular and cardiometabolic health, in healthy weight children. METHODS Retrospective signal analysis of existing ECG data utilizing CPC, FDA cleared, software as medical device (SaMD). ECG signals were extracted from baseline polysomnography studies in the prospective Childhood Adenotonsillectomy Trial database, multicenter, single-blind, randomized controlled trial of 5.0-9.9-year-old children identified with obstructive sleep apnea syndrome without severe hypoxemia. Healthy weight was defined as age- and gender-specific BMI in the 5th-85th percentile range and overweight above the 85th percentile. The cohort was stratified based on CPC sleep quality Index (SQI) defined as high sleep quality (SQI ≥ 80) or low sleep quality (SQI < 60). Cardiovascular, cardiometabolic, quality of life, and cognition were compared between the sleep quality groups. RESULTS Healthy weight children with low sleep quality had more fragmented sleep with significantly higher arousal index (10.0 ± 4.3 vs.7.2 ± 3.1; p = 0.00) and eLFCBB (12.4 ± 4.9 vs. 0.9 ± 1.0; p < 0.001) CPC indicator of sleep fragmentation, higher average heart rate during sleep (84.5 ± 10.6 vs. 79.4 ± 7.1; p = 0.03) and worse insulin/glucose ratio (1.7 ± 1.6 vs. 1.1 ± 1.1; p = 0.03) and fasting insulin levels (7.9 ± 7.2 vs.5.3 ± 5.5; p = 0.05) when compared to healthy weight children with high sleep quality. SQI significantly correlates with average heart rate during sleep, insulin and triglyceride levels; for a unit increase in SQI, there is 0.154 unit decrease in average heart rate during sleep, 0.109 unit in insulin levels and 0.332 unit in triglyceride levels, respectively. CONCLUSION CPC sleep quality offers insights into pediatric sleep and how it affects cardiovascular and cardiometabolic health. ECG is simple signal to collect, which makes this method practical for testing sleep, over multiple nights, and on multiple occasions providing information on sleep dynamics not possible before. TRIAL REGISTRATION NCT00560859.
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de Zambotti M, Rosas L, Colrain IM, Baker FC. The Sleep of the Ring: Comparison of the ŌURA Sleep Tracker Against Polysomnography. Behav Sleep Med 2019; 17:124-136. [PMID: 28323455 PMCID: PMC6095823 DOI: 10.1080/15402002.2017.1300587] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective/Background: To evaluate the performance of a multisensor sleep-tracker (ŌURA ring) against polysomnography (PSG) in measuring sleep and sleep stages. Participants: Forty-one healthy adolescents and young adults (13 females; Age: 17.2 ± 2.4 years). Methods: Sleep data were recorded using the ŌURA ring and standard PSG on a single laboratory overnight. Metrics were compared using Bland-Altman plots and epoch-by-epoch (EBE) analysis. Results: Summary variables for sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO) were not different between ŌURA ring and PSG. PSG-ŌURA discrepancies for WASO were greater in participants with more PSG-defined WASO (p < .001). Compared with PSG, ŌURA ring underestimated PSG N3 (~20 min) and overestimated PSG REM (~17 min; p < .05). PSG-ŌURA differences for TST and WASO lay within the ≤ 30 min a-priori-set clinically satisfactory ranges for 87.8% and 85.4% of the sample, respectively. From EBE analysis, ŌURA ring had a 96% sensitivity to detect sleep, and agreement of 65%, 51%, and 61%, in detecting "light sleep" (N1), "deep sleep" (N2 + N3), and REM sleep, respectively. Specificity in detecting wake was 48%. Similarly to PSG-N3 (p < .001), "deep sleep" detected with the ŌURA ring was negatively correlated with advancing age (p = .001). ŌURA ring correctly categorized 90.9%, 81.3%, and 92.9% into PSG-defined TST ranges of < 6 hr, 6-7 hr, > 7 hr, respectively. Conclusions: Multisensor sleep trackers, such as the ŌURA ring have the potential for detecting outcomes beyond binary sleep-wake using sources of information in addition to motion. While these first results could be viewed as promising, future development and validation are needed.
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Affiliation(s)
- Massimiliano de Zambotti
- 1. Center for Health Sciences, SRI International, Menlo Park, CA, USA,Corresponding author: Massimiliano de Zambotti, PhD, SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025.
| | - Leonardo Rosas
- 1. Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Ian M. Colrain
- 1. Center for Health Sciences, SRI International, Menlo Park, CA, USA,2. Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona C. Baker
- 1. Center for Health Sciences, SRI International, Menlo Park, CA, USA,3. Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Niizeki K, Saitoh T. Association Between Phase Coupling of Respiratory Sinus Arrhythmia and Slow Wave Brain Activity During Sleep. Front Physiol 2018; 9:1338. [PMID: 30319446 PMCID: PMC6167474 DOI: 10.3389/fphys.2018.01338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022] Open
Abstract
Phase coupling of respiratory sinus arrhythmia (RSA) has been proposed to be an alternative measure for evaluating autonomic nervous system (ANS) activity. The aim of this study was to analyze how phase coupling of RSA is altered during sleep, in order to explore whether this measure is a predictor of slow wave sleep (SWS). Overnight electroencephalograms (EEG), electrocardiograms (ECG), and breathing using inductance plethysmography were recorded from 30 healthy volunteers (six females, age range 21–64, 31.6 ± 14.7 years). Slow wave activity was evaluated by the envelope of the amplitude of the EEG δ-wave (0.5–4 Hz). The RSA was extracted from the change in the R-R interval (RRI) by band-pass filter, where pass band frequencies were determined from the profile of the power spectral density for respiration. The analytic signals of RSA and respiration were obtained by Hilbert transform, after which the amplitude of RSA (ARSA) and the degree of phase coupling (λ) were quantified. Additionally, the normalized high-frequency component (HFn) of the frequency-domain heart rate variability (HRV) was calculated. Using auto- and cross-correlation analyses, we found that overnight profiles of λ and δ-wave were correlated, with significant cross-correlation coefficients (0.461 ± 0.107). The δ-wave and HFn were also correlated (0.426 ± 0.115). These correlations were higher than that for the relationship between δ-wave and ARSA (0.212 ± 0.161). The variation of λ precedes the onset of the δ-wave by ~3 min, suggesting a vagal enhancement prior to the onset of SWS. Auto correlation analysis revealed that the periodicity of λ was quite similar to that of the δ-wave (88.3 ± 15.7 min vs. 88.6 ± 16.3 min, λ-cycle = 0.938 × δ-cycle + 5.77 min, r = 0.902). These results suggest that phase coupling analysis of RSA appears to be a marker for predicting SWS intervals, thereby complementing other noninvasive tools and diagnostic efforts.
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Affiliation(s)
- Kyuichi Niizeki
- Department of Biosystems Engineering, Graduate School of Science and Engineering, Yamagata University, Yamagata, Japan
| | - Tadashi Saitoh
- Department of Biosystems Engineering, Graduate School of Science and Engineering, Yamagata University, Yamagata, Japan
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Mazzotti DR, Lim DC, Sutherland K, Bittencourt L, Mindel JW, Magalang U, Pack AI, de Chazal P, Penzel T. Opportunities for utilizing polysomnography signals to characterize obstructive sleep apnea subtypes and severity. Physiol Meas 2018; 39:09TR01. [PMID: 30047487 DOI: 10.1088/1361-6579/aad5fe] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder with many pathophysiological pathways to disease. Currently, the diagnosis and classification of OSA is based on the apnea-hypopnea index, which poorly correlates to underlying pathology and clinical consequences. A large number of in-laboratory sleep studies are performed around the world every year, already collecting an enormous amount of physiological data within an individual. Clinically, we have not yet fully taken advantage of this data, but combined with existing analytical approaches, we have the potential to transform the way OSA is managed within an individual patient. Currently, respiratory signals are used to count apneas and hypopneas, but patterns such as inspiratory flow signals can be used to predict optimal OSA treatment. Electrocardiographic data can reveal arrhythmias, but patterns such as heart rate variability can also be used to detect and classify OSA. Electroencephalography is used to score sleep stages and arousals, but specific patterns such as the odds-ratio product can be used to classify how OSA patients responds differently to arousals. OBJECTIVE In this review, we examine these and many other existing computer-aided polysomnography signal processing algorithms and how they can reflect an individual's manifestation of OSA. SIGNIFICANCE Together with current technological advance, it is only a matter of time before advanced automatic signal processing and analysis is widely applied to precision medicine of OSA in the clinical setting.
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Affiliation(s)
- Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, United States of America
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de Zambotti M, Trinder J, Silvani A, Colrain IM, Baker FC. Dynamic coupling between the central and autonomic nervous systems during sleep: A review. Neurosci Biobehav Rev 2018; 90:84-103. [PMID: 29608990 PMCID: PMC5993613 DOI: 10.1016/j.neubiorev.2018.03.027] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/16/2018] [Accepted: 03/24/2018] [Indexed: 12/19/2022]
Abstract
Sleep is characterized by coordinated cortical and cardiac oscillations reflecting communication between the central (CNS) and autonomic (ANS) nervous systems. Here, we review fluctuations in ANS activity in association with CNS-defined sleep stages and cycles, and with phasic cortical events during sleep (e.g., arousals, K-complexes). Recent novel analytic methods reveal a dynamic organization of integrated physiological networks during sleep and indicate how multiple factors (e.g., sleep structure, age, sleep disorders) affect "CNS-ANS coupling". However, these data are mostly correlational and there is a lack of clarity of the underlying physiology, making it challenging to interpret causality and direction of coupling. Experimental manipulations (e.g., evoking K-complexes or arousals) provide information on the precise temporal sequence of cortical-cardiac activity, and are useful for investigating physiological pathways underlying CNS-ANS coupling. With the emergence of new analytical approaches and a renewed interest in ANS and CNS communication during sleep, future work may reveal novel insights into sleep and cardiovascular interactions during health and disease, in which coupling could be adversely impacted.
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Affiliation(s)
| | - John Trinder
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia.
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia.
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
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Hilmisson H, Lange N, Duntley SP. Sleep apnea detection: accuracy of using automated ECG analysis compared to manually scored polysomnography (apnea hypopnea index). Sleep Breath 2018; 23:125-133. [DOI: 10.1007/s11325-018-1672-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
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Cysarz D, Linhard M, Seifert G, Edelhäuser F. Sleep Instabilities Assessed by Cardiopulmonary Coupling Analysis Increase During Childhood and Adolescence. Front Physiol 2018; 9:468. [PMID: 29867529 PMCID: PMC5951979 DOI: 10.3389/fphys.2018.00468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/13/2018] [Indexed: 11/24/2022] Open
Abstract
The electrocardiogram-based cardiopulmonary coupling (CPC) technique may be used to track sleep instabilities. With progressing age, maturational changes during childhood and adolescence affect sleep. The objective was to assess developmental changes in sleep instabilities in a natural setting. ECGs during nighttime sleep on regular school days were recorded from 363 subjects aged 4 to 22 years (204 females). The estimated total sleep time (ETST) decreased from 598 to 445 min during childhood and adolescence. Stable sleep linearly decreased with progressing age (high frequency coupling (HFC): 70–48% ETST). Unstable sleep [low frequency coupling (LFC): 9–19% ETST], sleep fragmentation or disordered breathing (elevated LFC: 4–12% ETST), and wake/REM states [very low frequency coupling (VLFC): 20–32% ETST] linearly increased with age. Hence, with progressing age the sleep of children and adolescents shortens, becomes more unstable and is more often affected by fragmentation or sleep disordered breathing, especially in the age group >13 years. It remains to be clarified whether some of the changes are caused by a social jetlag, i.e., the misalignment of body clock and social time especially in adolescents.
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Affiliation(s)
- Dirk Cysarz
- Integrated Curriculum for Anthroposophic Medicine, Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Maijana Linhard
- Department of Pediatric Oncology/Hematology, Otto-Heubner-Center for Pediatric and Adolescent Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Georg Seifert
- Department of Pediatric Oncology/Hematology, Otto-Heubner-Center for Pediatric and Adolescent Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine, Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
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Huang Z, Goparaju B, Chen H, Bianchi MT. Heart rate phenotypes and clinical correlates in a large cohort of adults without sleep apnea. Nat Sci Sleep 2018; 10:111-125. [PMID: 29719424 PMCID: PMC5914741 DOI: 10.2147/nss.s155733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Normal sleep is associated with typical physiological changes in both the central and autonomic nervous systems. In particular, nocturnal blood pressure dipping has emerged as a strong marker of normal sleep physiology, whereas the absence of dipping or reverse dipping has been associated with cardiovascular risk. However, nocturnal blood pressure is not measured commonly in clinical practice. Heart rate (HR) dipping in sleep may be a similar important marker and is measured routinely in at-home and in-laboratory sleep testing. METHODS We performed a retrospective cross-sectional analysis of diagnostic polysomnography in a clinically heterogeneous cohort of n=1047 adults without sleep apnea. RESULTS We found that almost half of the cohort showed an increased HR in stable nonrapid eye movement sleep (NREM) compared to wake, while only 13.5% showed a reduced NREM HR of at least 10% relative to wake. The strongest correlates of HR dipping were younger age and male sex, whereas the periodic limb movement index (PLMI), sleep quality, and Epworth Sleepiness Scale (ESS) scores were not correlated with HR dipping. PLMI was however significantly correlated with metrics of impaired HR variability (HRV): increased low-frequency power and reduced high-frequency power. HRV metrics were unrelated to sleep quality or the ESS value. Following the work of Vgontzas et al, we also analyzed the sub-cohort with insomnia symptoms and short objective sleep duration. Interestingly, the sleep-wake stage-specific HR values depended upon insomnia symptoms more than sleep duration. CONCLUSION While our work demonstrates heterogeneity in cardiac metrics (HR and HRV), the population analysis suggests that pathological signatures of HR (nondipping and elevation) are common even in this cohort selected for the absence of sleep apnea. Future prospective work in clinical populations will further inform risk stratification and set the stage for testing interventions.
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Affiliation(s)
- Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Balaji Goparaju
- Department of Neurology, Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - He Chen
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People's Republic of China
| | - Matt T Bianchi
- Department of Neurology, Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA, USA
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Jortberg E, Silva I, Bhatkar V, McGinnis RS, Sen-Gupta E, Morey B, Wright JA, Pindado J, Bianchi MT. A novel adhesive biosensor system for detecting respiration, cardiac, and limb movement signals during sleep: validation with polysomnography. Nat Sci Sleep 2018; 10:397-408. [PMID: 30538592 PMCID: PMC6263294 DOI: 10.2147/nss.s179588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although in-lab polysomnography (PSG) remains the gold standard for objective sleep monitoring, the use of at-home sensor systems has gained popularity in recent years. Two categories of monitoring, autonomic and limb movement physiology, are increasingly recognized as critical for sleep disorder phenotyping, yet at-home options remain limited outside of research protocols. The purpose of this study was to validate the BiostampRC® sensor system for respiration, electrocardiography (ECG), and leg electromyography (EMG) against gold standard PSG recordings. METHODS We report analysis of cardiac and respiratory data from 15 patients and anterior tibialis (AT) data from 19 patients undergoing clinical PSG for any indication who simultaneously wore BiostampRC® sensors on the chest and the bilateral AT muscles. BiostampRC® is a flexible, adhesive, wireless sensor capable of capturing accelerometry, ECG, and EMG. We compared BiostampRC® data and feature extractions with those obtained from PSG. RESULTS The heart rate extracted from BiostampRC® ECG showed strong agreement with the PSG (cohort root mean square error of 5 beats per minute). We found the thoracic BiostampRC® respiratory waveform, derived from its accelerometer, accurately calculated the respiratory rate (mean average error of 0.26 and root mean square error of 1.84 breaths per minute). The AT EMG signal supported periodic limb movement detection, with area under the curve of the receiver operating characteristic curve equaling 0.88. Upon completion, 88% of subjects indicated willingness to wear BiostampRC® at home on an exit survey. CONCLUSION The results demonstrate that BiostampRC® is a tolerable and accurate method for capturing respiration, ECG, and AT EMG time series signals during overnight sleep when compared with simultaneous PSG recordings. The signal quality sufficiently supports analytics of clinical relevance. Larger longitudinal in-home studies are required to support the role of BiostampRC® in clinical management of sleep disorders involving the autonomic nervous system and limb movements.
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Affiliation(s)
| | | | | | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT 05405, USA
| | | | | | | | | | - Matt T Bianchi
- Neurology Department, Massachusetts General Hospital, Boston, MA 02114, USA
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Ambulatory screening tool for sleep apnea: analyzing a single-lead electrocardiogram signal (ECG). Sleep Breath 2017; 22:421-429. [DOI: 10.1007/s11325-017-1566-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022]
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Thomas RJ, Shin C, Bianchi MT, Kushida C, Yun CH. Distinct polysomnographic and ECG-spectrographic phenotypes embedded within obstructive sleep apnea. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0012-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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50
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Kuhnhold A, Schumann AY, Bartsch RP, Ubrich R, Barthel P, Schmidt G, Kantelhardt JW. Quantifying cardio-respiratory phase synchronization-a comparison of five methods using ECGs of post-infarction patients. Physiol Meas 2017; 38:925-939. [PMID: 28151433 DOI: 10.1088/1361-6579/aa5dd3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Phase synchronization between two weakly coupled oscillators occurs in many natural systems. Since it is difficult to unambiguously detect such synchronization in experimental data, several methods have been proposed for this purpose. Five popular approaches are systematically optimized and compared here. APPROACH We study and apply the automated synchrogram method, the reduced synchrogram method, two variants of a gradient method, and the Fourier mode method, analyzing 24h data records from 1455 post-infarction patients, the same data with artificial inaccuracies, and corresponding surrogate data generated by Fourier phase randomization. MAIN RESULTS We find that the automated synchrogram method is the most robust of all studied approaches when applied to records with missing data or artifacts, whereas the gradient methods should be preferred for noisy data and low-accuracy R-peak positions. We also show that a strong circadian rhythm occurs with much more frequent phase synchronization episodes observed during night time than during day time by all five methods. SIGNIFICANCE In specific applications, the identified characteristic differences as well as strengths and weaknesses of each method in detecting episodes of cardio-respiratory phase synchronization will be useful for selecting an appropriate method with respect to the type of systematic and dynamical noise in the data.
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Affiliation(s)
- Anja Kuhnhold
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany. Physique et Matériaux, Faculté des Sciences, de la Technologie et de la Communication, Université du Luxembourg, Luxembourg
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