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Huang Z, Lobbezoo F, de Vries N, Aarab G, Hilgevoord AAJ. Temporal association between leg movements and respiratory events in patients with obstructive sleep apnea: description and differences between the AASM and WASM scoring criteria. Sleep Breath 2023; 27:2295-2304. [PMID: 37148386 PMCID: PMC10163289 DOI: 10.1007/s11325-023-02844-x] [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: 11/07/2022] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To describe the temporal association between leg movements (LMs) and respiratory events in patients with obstructive sleep apnea (OSA), and to quantify the difference in scoring respiratory-related leg movement (RRLM) between the American Academy of Sleep Medicine (AASM) criterion and the criterion recommended by the World Association of Sleep Medicine (WASM). METHODS Patients with OSA who presented with > 10 LMs of any type per hour of sleep were included in this study. For each participant, RRLMs were scored using both the AASM criterion and the recommended WASM criterion. The occurrence of LMs in relation to respiratory events and the difference in scoring RRLM between the AASM criterion and the criterion recommended by the WASM were quantified. RESULTS In 32 patients enrolled, mean age was 48.1 ± 11.0 years and 78% were men. LMs were significantly more frequent after respiratory events, followed by before respiratory events, and were rare during respiratory events (P < 0.01). Compared with the AASM criterion, more LMs were classified as RRLMs based on the recommended WASM criterion (P = 0.01). CONCLUSION LMs are more frequent after respiratory events than before and during respiratory events, and more LMs are scored as RRLMs based on the recommended WASM criterion than based on the AASM criterion.
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Affiliation(s)
- Zhengfei Huang
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands.
- Department of Clinical Neurophysiology, OLVG, Amsterdam, the Netherlands.
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands
- Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands
- Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, the Netherlands
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Brink-Kjaer A, Leary EB, Sun H, Westover MB, Stone KL, Peppard PE, Lane NE, Cawthon PM, Redline S, Jennum P, Sorensen HBD, Mignot E. Age estimation from sleep studies using deep learning predicts life expectancy. NPJ Digit Med 2022; 5:103. [PMID: 35869169 PMCID: PMC9307657 DOI: 10.1038/s41746-022-00630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022] Open
Abstract
Sleep disturbances increase with age and are predictors of mortality. Here, we present deep neural networks that estimate age and mortality risk through polysomnograms (PSGs). Aging was modeled using 2500 PSGs and tested in 10,699 PSGs from men and women in seven different cohorts aged between 20 and 90. Ages were estimated with a mean absolute error of 5.8 ± 1.6 years, while basic sleep scoring measures had an error of 14.9 ± 6.29 years. After controlling for demographics, sleep, and health covariates, each 10-year increment in age estimate error (AEE) was associated with increased all-cause mortality rate of 29% (95% confidence interval: 20-39%). An increase from -10 to +10 years in AEE translates to an estimated decreased life expectancy of 8.7 years (95% confidence interval: 6.1-11.4 years). Greater AEE was mostly reflected in increased sleep fragmentation, suggesting this is an important biomarker of future health independent of sleep apnea.
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Affiliation(s)
- Andreas Brink-Kjaer
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA.
| | - Eileen B Leary
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Paul E Peppard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Nancy E Lane
- Department of Medicine, University of Davis School of Medicine, Sacramento, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark
| | - Helge B D Sorensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA.
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Abstract
Sleep deficiency in patients with obstructive sleep apnea includes abnormal quality, timing, and duration of sleep, and the presence of other comorbid conditions. These include insomnia, circadian misalignment disorders, and periodic limb movements of sleep. The co-occurrence of these conditions with obstructive sleep apnea likely plays a role in the pathogenesis, clinical presentation, and management of obstructive sleep apnea. Considering these conditions and their treatment in evaluating sleep deficiency in obstructive sleep apnea may help to improve patient outcomes. However, future research is needed to understand the intersection between obstructive sleep apnea and these disorders.
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Affiliation(s)
- Olurotimi Adekolu
- Starling Physicians, 533 Cottage Grove Road, Bloomfield, CT 06002, USA
| | - Andrey Zinchuk
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, 300 Cedar Street, The Anlyan Center, 455SE, New Haven, CT 06519, USA.
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The effect of obstructive sleep apnea on peripheral blood amino acid and biogenic amine metabolome at multiple time points overnight. Sci Rep 2021; 11:10811. [PMID: 34031438 PMCID: PMC8144378 DOI: 10.1038/s41598-021-88409-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 12/19/2022] Open
Abstract
There are no clinical studies that have investigated the differences in blood serum metabolome between obstructive sleep apnea (OSA) patients and controls. In a single-center prospective observational study, we compared metabolomic profiles in the serum of OSA patients with apnea–hypopnea index (AHI) ≥ 15/h and control individuals. Peripheral blood was obtained at 3 different time points overnight: 9:00 p.m.; 5:00 a.m. and 7:00 a.m. We used a targeted approach for detecting amino acids and biogenic amines and analyzed the data with ranked general linear model for repeated measures. We recruited 31 patients with moderate-to-severe OSA and 32 controls. Significant elevations in median concentrations of alanine, proline and kynurenine in OSA patients compared to controls were detected. Significant changes in the overnight dynamics of serum concentrations occurred in OSA: glutamine, serine, threonine, tryptophan, kynurenine and glycine levels increased, whereas a fall occurred in the same biomarker levels in controls. Phenylalanine and proline levels decreased slightly, compared to a steeper fall in controls. The study indicates that serum profiles of amino acid and biogenic amines are significantly altered in patients with OSA referring to vast pathophysiologic shifts reflected in the systemic metabolism.
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Chokroverty S, Bhat S, Gupta D. Respiratory-related leg movements vs periodic limb movements in sleep: a scoring conundrum. an editorial. Sleep Med 2020; 81:98-100. [PMID: 33647763 DOI: 10.1016/j.sleep.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Sudhansu Chokroverty
- Hackensack-Meridian Health-JFK University Medical Center, 65 James Street, Edison NJ 08820, USA.
| | - Sushanth Bhat
- Hackensack-Meridian Health-JFK University Medical Center, 65 James Street, Edison NJ 08820, USA
| | - Divya Gupta
- Hackensack-Meridian Health-JFK University Medical Center, 65 James Street, Edison NJ 08820, USA
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Brink-Kjaer A, Olesen AN, Peppard PE, Stone KL, Jennum P, Mignot E, Sorensen HBD. Automatic detection of cortical arousals in sleep and their contribution to daytime sleepiness. Clin Neurophysiol 2020; 131:1187-1203. [PMID: 32299002 PMCID: PMC8444626 DOI: 10.1016/j.clinph.2020.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/21/2020] [Accepted: 02/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Significant interscorer variability is found in manual scoring of arousals in polysomnographic recordings (PSGs). We propose a fully automatic method, the Multimodal Arousal Detector (MAD), for detecting arousals. METHODS A deep neural network was trained on 2,889 PSGs to detect cortical arousals and wakefulness in 1-second intervals. Furthermore, the relationship between MAD-predicted labels on PSGs and next day mean sleep latency (MSL) on a multiple sleep latency test (MSLT), a reflection of daytime sleepiness, was analyzed in 1447 MSLT instances in 873 subjects. RESULTS In a dataset of 1,026 PSGs, the MAD achieved an F1 score of 0.76 for arousal detection, while wakefulness was predicted with an accuracy of 0.95. In 60 PSGs scored by nine expert technicians, the MAD performed comparable to four and significantly outperformed five expert technicians for arousal detection. After controlling for known covariates, a doubling of the arousal index was associated with an average decrease in MSL of 40 seconds (p = 0.0075). CONCLUSIONS The MAD performed better or comparable to human expert scorers. The MAD-predicted arousals were shown to be significant predictors of MSL. SIGNIFICANCE This study validates a fully automatic method for scoring arousals in PSGs.
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Affiliation(s)
- Andreas Brink-Kjaer
- Center for Sleep Sciences and Medicine, Stanford University, CA, USA; Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark; Danish Center for Sleep Medicine, Glostrup University Hospital, Glostrup, Denmark.
| | - Alexander Neergaard Olesen
- Center for Sleep Sciences and Medicine, Stanford University, CA, USA; Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark; Danish Center for Sleep Medicine, Glostrup University Hospital, Glostrup, Denmark
| | - Paul E Peppard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Poul Jennum
- Danish Center for Sleep Medicine, Glostrup University Hospital, Glostrup, Denmark
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Stanford University, CA, USA
| | - Helge B D Sorensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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Howard ME, O'Donoghue FJ. Periodic leg movements: A marker of cardiovascular risk? Respirology 2020; 25:793-794. [PMID: 32147897 DOI: 10.1111/resp.13795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Stefani A, Högl B. Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep. Curr Treat Options Neurol 2019; 21:1. [PMID: 30661130 PMCID: PMC6339673 DOI: 10.1007/s11940-019-0543-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose of review Sleep-related movement disorders (SRMD) include several different motor activities during sleep. Few of them are well known and well classified, whereas others are minor motor disorders of sleep which are neither thoroughly characterized and classified nor have been extensively investigated to clarify their pathogenesis and clinical relevance. This review will focus on those minor sleep-related movement disorders. Recent findings Before diagnosing periodic limb movement (PLM) disorder in patients with PLM during polysomnography, other disorders associated with PLM need to be excluded, namely restless legs syndrome (RLS), narcolepsy, REM sleep behavior disorder (RBD), and sleep-related breathing disorder. For the diagnosis of propriospinal myoclonus at sleep-onset, multi-channel surface electromyography recording during polysomnography is required and a possible psychogenic origin of the movement disorder has to be considered. Excessive fragmentary myoclonus (EFM) does not require symptomatic treatment, but further evaluation is suggested as electrophysiological abnormalities are present in 50% of cases. Nine percent of healthy sleepers meet the criteria for EFM, raising the question if current, arbitrarily defined, cutoffs are valid. Hypnagogic foot tremor, rhythmic feet movements, alternating leg muscle activation, and high-frequency leg movements are somewhat overlapping minor motor activities during sleep which may exist on their own or represent stereotyped movements to relieve RLS-like symptoms. Neck myoclonus is probably a physiological phenomenon related to REM twitching. RBD is formally a parasomnia but a relevant differential diagnosis when evaluating sleep-related movement disorders. In particular, prodromal RBD is characterized by electromyographic and behavioral findings on video-polysomnography which needs to be differentiated by minor sleep-related movement disorders. Summary Minor SRMD beyond the well-known main motor disorders of sleep should be correctly diagnosed, distinguished from differential diagnosis, and understood in their potential clinical relevance, in order also to start an appropriate treatment if needed.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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McCall CA, Winkelman JW. Respiratory-Related Leg Movements of Sleep Are Associated With Serotonergic Antidepressants But Not Bupropion. J Clin Sleep Med 2018; 14:1569-1576. [PMID: 30176966 PMCID: PMC6134249 DOI: 10.5664/jcsm.7338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Respiratory-related leg movements (RRLMs) may contribute to the cardiovascular risk associated with obstructive sleep apnea (OSA). Selective serotonin reuptake inhibitors (SSRIs), but not bupropion, increase periodic leg movements in sleep. This study examines whether patients with OSA using SSRIs have more RRLMs than those taking bupropion or no antidepressant. METHODS Patients with an apnea-hypopnea index (AHI) of at least 10 events/h during a full-night diagnostic study or split-night study, who were taking bupropion (n = 32), an SSRI (n = 31), or no antidepressant (n = 31), were selected from a database of prestudy questionnaires. RRLMs were scored according to World Association of Sleep Medicine 2016 standards. RESULTS Patients using SSRIs had significantly greater overall RRLM% (defined as the percentage of respiratory events associated with a leg movement, including apneas, hypopneas, and respiratory effort-related arousals), RRLM index, and periodic limb movement index relative to patients using bupropion and control patients. The difference between the RRLM% in the SSRI and bupropion groups was limited to patients undergoing split-night studies, and that of the SSRI and control groups was limited to patients undergoing full-night diagnostic studies. CONCLUSIONS The greater number of RRLMs and PLMs in the SSRI group may contribute to treatment-emergent insomnia often seen with SSRI use. Fragmented sleep and elevated autonomic nervous system activation associated with increased RRLMs in patients with OSA taking SSRIs might also limit the tolerability of antidepressant treatment, as well as increase the risk for cardiovascular disease.
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Affiliation(s)
| | - John W. Winkelman
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Schipper M, Jellema K, Alvarez-Estevez D, Verbraecken J, Rijsman R. Sleep-Related Leg Movements in Patients with Transient Ischemic Attack and Controls. Eur Neurol 2018. [DOI: 10.1159/000487666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Periodic leg movements during sleep (PLMS) have been associated with an increased risk for cardiovascular diseases and there is a high prevalence of PLMS found in patients with obstructive sleep apnea syndrome (OSAS). We evaluated patients with transient ischemic attack (TIA) for PLMS and respiratory related leg movements (RRLM), versus a control group without TIA. Methods: Twenty-five patients with TIA and 34 patients with no vascular diagnosis were referred for polysomnography. Diagnosis of PLMS was made if the periodic leg movement index (PLMI) was ≥5 and clinical significant as PLMI ≥15. Results: There was no significant difference in PLMI ≥5 and ≥15 between patients with and without TIA. In the absence of OSAS, 2 out of 5 TIA patients (40%) had a PLMI ≥15 compared to 1 of the 19 patients without TIA (5%; p = 0.037). There was no increase in RRLMs when OSAS was present. Conclusions: TIA patients did not have higher PLMI compared to controls, and in the presence of OSAS, there was no increase in RRLMs compared to patients without TIA. In selective patients, PLMS could be associated with cardiovascular diseases, since PLMS was clinically more often found in the TIA group without OSAS.
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Fatigue and disturbances of sleep in patients with osteogenesis imperfecta - a cross-sectional questionnaire study. BMC Musculoskelet Disord 2018; 19:3. [PMID: 29310646 PMCID: PMC5759205 DOI: 10.1186/s12891-017-1922-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
Background Persisting fatigue has been reported to be a common complaint by individuals with connective tissue disorders, including Osteogenesis imperfecta (OI). This controlled study evaluated in an adult OI population the subjective experience of fatigue, affecting daily life. Sleep disturbances and chronic pain were examined as hypothesized underlying factors. Methods This cross-sectional study analyzed the answers of 56 OI patients and 56 matched healthy controls to a questionnaire, designed to evaluate levels of experienced fatigue and bodily pain, as well as the presence or absence of symptoms related to sleep disturbances or sleep apnea. The relationships between fatigue, pain, and sleep disturbances were evaluated with correlation analysis and regression analysis. Results Fatigue was reported by 96%, and daily pain by 87% of the individuals with OI. Notably, the level of fatigue was similarly experienced by patient respondents and controls. In total, 95% of the patients and 77% of the controls reported one to several sleep disturbance symptoms. These symptoms as well as previously diagnosed sleep apnea were statistically significantly more prevalent in the patient group than in the controls (p < 0.05). Likewise, the experienced bodily pain was statistically highly significantly more severe among the respondents with OI (p < 0.001), and correlated with the reported fatigue. Conclusions In comparison with age-matched controls, adults with OI do not differ in experienced fatigue, unlike hypothesized. Therefore, sleep disturbances, which based on the frequency of reported related symptoms and previous sleep apnea diagnoses appear to be common in OI patients, may remain undiagnosed. Electronic supplementary material The online version of this article (10.1186/s12891-017-1922-5) contains supplementary material, which is available to authorized users.
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Fulda S, Heinzer R, Haba-Rubio J. Characteristics and Determinants of Respiratory Event–Associated Leg Movements. Sleep 2017; 41:4747916. [DOI: 10.1093/sleep/zsx206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephany Fulda
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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Ferri R, Koo BB, Picchietti DL, Fulda S. Periodic leg movements during sleep: phenotype, neurophysiology, and clinical significance. Sleep Med 2017; 31:29-38. [DOI: 10.1016/j.sleep.2016.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/26/2016] [Accepted: 05/07/2016] [Indexed: 01/09/2023]
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Bianchi MT, Russo K, Gabbidon H, Smith T, Goparaju B, Westover MB. Big data in sleep medicine: prospects and pitfalls in phenotyping. Nat Sci Sleep 2017; 9:11-29. [PMID: 28243157 PMCID: PMC5317347 DOI: 10.2147/nss.s130141] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Clinical polysomnography (PSG) databases are a rich resource in the era of "big data" analytics. We explore the uses and potential pitfalls of clinical data mining of PSG using statistical principles and analysis of clinical data from our sleep center. We performed retrospective analysis of self-reported and objective PSG data from adults who underwent overnight PSG (diagnostic tests, n=1835). Self-reported symptoms overlapped markedly between the two most common categories, insomnia and sleep apnea, with the majority reporting symptoms of both disorders. Standard clinical metrics routinely reported on objective data were analyzed for basic properties (missing values, distributions), pairwise correlations, and descriptive phenotyping. Of 41 continuous variables, including clinical and PSG derived, none passed testing for normality. Objective findings of sleep apnea and periodic limb movements were common, with 51% having an apnea-hypopnea index (AHI) >5 per hour and 25% having a leg movement index >15 per hour. Different visualization methods are shown for common variables to explore population distributions. Phenotyping methods based on clinical databases are discussed for sleep architecture, sleep apnea, and insomnia. Inferential pitfalls are discussed using the current dataset and case examples from the literature. The increasing availability of clinical databases for large-scale analytics holds important promise in sleep medicine, especially as it becomes increasingly important to demonstrate the utility of clinical testing methods in management of sleep disorders. Awareness of the strengths, as well as caution regarding the limitations, will maximize the productive use of big data analytics in sleep medicine.
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Affiliation(s)
- Matt T Bianchi
- Neurology Department, Massachusetts General Hospital
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Kathryn Russo
- Neurology Department, Massachusetts General Hospital
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Moro M, Goparaju B, Castillo J, Alameddine Y, Bianchi MT. Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring. Nat Sci Sleep 2016; 8:277-89. [PMID: 27540316 PMCID: PMC4982487 DOI: 10.2147/nss.s101753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Periodic limb movements of sleep (PLMS) may increase cardiovascular and cerebrovascular morbidity. However, most people with PLMS are either asymptomatic or have nonspecific symptoms. Therefore, predicting elevated PLMS in the absence of restless legs syndrome remains an important clinical challenge. METHODS We undertook a retrospective analysis of demographic data, subjective symptoms, and objective polysomnography (PSG) findings in a clinical cohort with or without obstructive sleep apnea (OSA) from our laboratory (n=443 with OSA, n=209 without OSA). Correlation analysis and regression modeling were performed to determine predictors of periodic limb movement index (PLMI). Markov decision analysis with TreeAge software compared strategies to detect PLMS: in-laboratory PSG, at-home testing, and a clinical prediction tool based on the regression analysis. RESULTS Elevated PLMI values (>15 per hour) were observed in >25% of patients. PLMI values in No-OSA patients correlated with age, sex, self-reported nocturnal leg jerks, restless legs syndrome symptoms, and hypertension. In OSA patients, PLMI correlated only with age and self-reported psychiatric medications. Regression models indicated only a modest predictive value of demographics, symptoms, and clinical history. Decision modeling suggests that at-home testing is favored as the pretest probability of PLMS increases, given plausible assumptions regarding PLMS morbidity, costs, and assumed benefits of pharmacological therapy. CONCLUSION Although elevated PLMI values were commonly observed, routinely acquired clinical information had only weak predictive utility. As the clinical importance of elevated PLMI continues to evolve, it is likely that objective measures such as PSG or at-home PLMS monitors will prove increasingly important for clinical and research endeavors.
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Affiliation(s)
- Marilyn Moro
- Neurology Department, Massachusetts General Hospital
| | | | | | | | - Matt T Bianchi
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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