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Blaszczyk B, Wichniak A, Wieckiewicz M, Brzecka A, Nowacki D, Michalek-Zrabkowska M, Lachowicz G, Mazur G, Martynowicz H. The clinical characteristic of catathrenia: a new look at an old issue-a systematic review of existing literature. Sleep Breath 2024; 28:1523-1537. [PMID: 38755507 PMCID: PMC11303500 DOI: 10.1007/s11325-024-03033-0] [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: 01/24/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024]
Abstract
STUDY OBJECTIVES The International Classification of Sleep Disorders categorized catathrenia as a respiratory disorder, but there are doubts whether episodes appear during rapid eye movement (REM) sleep or the non-rapid eye movement (NREM), their duration, and symptoms. The main objectives were to identify the most common features and relations of catathrenia. METHODS PubMed, Embase, and Web of Science were searched according to the PRISMA 2020 guidelines. The Joanna Briggs Institute and the ROBINS-I tools were chosen to assess the risk of bias. RESULTS A total of 288 records were identified, 31 articles were included. The majority of the studies had a moderate risk of bias. 49.57% of episodes occurred during the NREM sleep, while 46% took place during REM. In 60.34% females, catathrenia was more common in the NREM, while in 59.26% of males was in REM sleep (p < 0.05). Females and obese individuals were found to have shorter episodes (p < 0.05). Age was inversely correlated with minimal episodes duration (r = - 0.34). The continuous positive airway pressure (CPAP) therapy was inversely correlated with the maximal episode duration (r = - 0.48). CONCLUSIONS Catathrenia occurs with similar frequency in both genders. The most frequent symptoms embraced groaning, awareness of disturbing bedpartners, and daytime somnolence-not confirmed by the Epworth Sleepiness Scale. The episodes occur more frequently in NREM than in REM sleep. Catathrenia may be considered as a sex-specific condition. The effects of CPAP treatment leading to shortening episodes duration, which may indicate the respiratory origin of catathrenia.
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Affiliation(s)
- Bartlomiej Blaszczyk
- Student Research Club No K133, Faculty of Medicine, Wroclaw Medical University, 50-556, Wroclaw, Poland.
| | - Adam Wichniak
- Third Department of Psychiatry and Sleep Medicine Centre, Institute of Psychiatry and Neurology, 02-957, Warsaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-425, Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, 53-439, Wroclaw, Poland
| | - Dorian Nowacki
- Department of Human Nutrition, Wroclaw University of Environmental and Life Sciences, 51-630, Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | - Gabriella Lachowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556, Wroclaw, Poland
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Martel Q, Maranci JB, Philippe C, Arnulf I. Lamentations in the night: A systematic review on catathrenia. Sleep Med Rev 2024; 75:101944. [PMID: 38718707 DOI: 10.1016/j.smrv.2024.101944] [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: 01/24/2024] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 06/04/2024]
Abstract
Catathrenia is a loud expiratory moan during sleep that is a social embarrassment and is sometimes confused with central apnea on polysomnography. It affects about 4% of adults, but cases are rarely referred to sleep centers. Catathrenia affects males and females, children and adults, who are usually young and thin. A "typical" catathrenia begins with a deep inhalation, followed by a long, noisy exhalation, then a short, more pronounced exhalation, followed by another deep inhalation, often accompanied by arousal. The many harmonics of the sound indicate that it is produced by the vocal cords. It is often repeated in clusters, especially during REM sleep and at the end of the night. It does not disturb the sleepers, but their neighbors, and is associated with excessive daytime sleepiness in one-third of cases. The pathophysiology and treatment of typical catathrenia are still unknown. Later, a more atypical catathrenia was described, consisting of episodes of short (2 s), regular, semi-continuous expiratory moans during NREM sleep (mainly in stages N1 and N2) and REM sleep, often in people with mild upper airway obstruction. This atypical catathrenia is more commonly reduced by positive airway pressure and mandibular advancement devices that promote vertical opening.
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Affiliation(s)
- Quentin Martel
- Sleep Disorder Clinic, R3S Department, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France; Saint Joseph Hospital, Paris, France
| | - Jean-Baptiste Maranci
- Sleep Disorder Clinic, R3S Department, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France; Sorbonne University, Paris, France; Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, France
| | - Carole Philippe
- Sleep Disorder Clinic, R3S Department, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Isabelle Arnulf
- Sleep Disorder Clinic, R3S Department, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France; Sorbonne University, Paris, France; Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, France.
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Yu M, Hao Z, Xu L, Zhao L, Wen Y, Han F, Gao X. Differences in Polysomnographic and Craniofacial Characteristics of Catathrenia Phenotypes: A Cluster Analysis. Nat Sci Sleep 2024; 16:625-638. [PMID: 38831958 PMCID: PMC11144656 DOI: 10.2147/nss.s455705] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/04/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Catathrenia is a rare sleeping disorder characterized by repetitive nocturnal groaning during prolonged expirations. Patients with catathrenia had heterogeneous polysomnographic, comorbidity, craniofacial characteristics, and responses to treatment. Identifying phenotypes of catathrenia might benefit the exploration of etiology and personalized therapy. Patients and Methods Sixty-six patients diagnosed with catathrenia by full-night audio/video polysomnography seeking treatment with mandibular advancement devices (MAD) or continuous positive airway pressure (CPAP) were included in the cohort. Polysomnographic characteristics including sleep architecture, respiratory, groaning, and arousal events were analyzed. Three-dimensional (3D) and 2D craniofacial hard tissue and upper airway structures were evaluated with cone-beam computed tomography and lateral cephalometry. Phenotypes of catathrenia were identified by K-mean cluster analysis, and inter-group comparisons were assessed. Results Two distinct clusters of catathrenia were identified: cluster 1 (n=17) was characterized to have more males (71%), a longer average duration of groaning events (18.5±4.8 and 12.8±5.7s, p=0.005), and broader upper airway (volume 41,386±10,543 and 26,661±6700 mm3, p<0.001); cluster 2 (n=49) was characterized to have more females (73%), higher respiratory disturbance index (RDI) (median 1.0 [0.3, 2.0] and 5.2 [1.2, 13.3]/h, p=0.009), more respiratory effort-related arousals (RERA)(1 [1, 109] and 32 [13, 57)], p=0.005), smaller upper airway (cross-sectional area of velopharynx 512±87 and 339±84 mm2, p<0.001) and better response to treatment (41.2% and 82.6%, p=0.004). Conclusion Two distinct phenotypes were identified in patients with catathrenia, primary catathrenia, and catathrenia associated with upper airway obstruction, suggesting respiratory events and upper airway structures might be related to the etiology of catathrenia, with implications for its treatment.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, People’s Republic of China
- National Center for Stomatology, Beijing, 100081, People’s Republic of China
| | - Zeliang Hao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, People’s Republic of China
- National Center for Stomatology, Beijing, 100081, People’s Republic of China
| | - Liyue Xu
- Sleep Division, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Long Zhao
- Sleep Division, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Yongfei Wen
- Sleep Division, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Fang Han
- Sleep Division, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, People’s Republic of China
- National Center for Stomatology, Beijing, 100081, People’s Republic of China
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Buyse B, Kalkanis A, Testelmans D. Catathrenia in severe obstructive sleep apnea: A novel entity never described before. Sleep Med 2023; 112:239-245. [PMID: 37925850 DOI: 10.1016/j.sleep.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
STUDY OBJECTIVES Catathrenia, derived from the Greek κατά (kata) meaning below and θρηνώ (threnia) to lament, is characterized by expiratory groaning episodes during sleep. In a case series of nine patients with severe obstructive sleep apnea, we observed a peculiar groaning entity that has not been described before. METHODS We described and illustrated the cases with polysomnographic tracings and additional audio recordings. RESULTS All patients were men, obese (body mass index 39 ± 6 kg/m2) with an apnea-hypopnea index ranging from 47 to 125/h. In addition, we identified groaning events that were consistently preceded by a cortical arousal associated with a "rescue" respiration after an obstructive hypopnea or apnea. These events exhibited characteristics of "mixed apnea's", but the "central apnea-like part" was a prolonged expiratory groaning phase, with immediately after the terminal expiratory snort appearance of an obstructive apnea. In case the duration of this expiration was at least 10 s we calculated these events separately and the index was 8.4 ± 7.7/h. More rarely (index 0.6 ± 0.5/h) a "central apnea mimicking event" with groaning not followed by an obstruction, was observed. We also observed groaning episodes during expiration with a shorter duration (less than 10 s), not calculated separately. Positive airway pressure, which was well tolerated, eliminated these events. CONCLUSIONS This novel catathrenia entity preceded by a cortical arousal and "rescue" respiration in response to obstructive events is intriguing. Possible explanations for these observations are further discussed in this article.
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Affiliation(s)
- Bertien Buyse
- Department of Pulmonology, Leuven University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium.
| | - Alexandros Kalkanis
- Department of Pulmonology, Leuven University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium
| | - Dries Testelmans
- Department of Pulmonology, Leuven University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium
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Katz ES, D’Ambrosio C. Catathrenia in children: clinical presentation, polysomnographic features, natural history, and response to therapy. J Clin Sleep Med 2023; 19:1505-1511. [PMID: 37066744 PMCID: PMC10394357 DOI: 10.5664/jcsm.10582] [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: 11/11/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
STUDY OBJECTIVES To determine the clinical presentation, polysomnographic appearance, and the response to therapy of catathrenia in children. METHODS A retrospective analysis was performed in children referred or evaluated at the Boston Children's Hospital Sleep Center between 1998 and 2021 who were documented to have catathrenia either as a chief complaint or an incidental finding. RESULTS Catathrenia was identified in 21 children. The age of onset by parent report was 6.4 ± 4.4 years (range: birth-14 years), but the diagnosis was at 8.3 ± 3.8 years (range: 1.5-14 years). Catathrenia was the chief complaint for 24% of patients and was incidentally identified in 76% referred for breathing concerns. Bruxism was observed in 62% of patients. Catathrenia events most often occur following an electrocortical arousal (79%) and are most common in the second half of the night (73%). Catathrenia was observed exclusively in rapid eye movement (REM) sleep (16%), exclusively in non-REM sleep (32%), and in both sleep states (52%). Treatment of obstructive sleep apnea resulted in resolution or improvement in the obstructive sleep apnea in all patients, but the catathrenia persisted at a reduced level. CONCLUSIONS Most catathrenia in children is diagnosed incidentally during evaluation for sleep-disordered breathing, although the groaning often started many years earlier. Catathrenia events decreased considerably after treatment of obstructive sleep apnea, but persisted in all patients. Catathrenia was also observed in children without signs or symptoms of sleep-disordered breathing, indicating that these are distinct conditions. The majority of children with catathrenia had no sleepiness or behavioral concerns. CITATION Katz ES, D'Ambrosio C. Catathrenia in children: clinical presentation, polysomnographic features, natural history, and response to therapy. J Clin Sleep Med. 2023;19(8):1505-1511.
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Affiliation(s)
- Eliot S. Katz
- Division of Respiratory Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn D’Ambrosio
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine; New Haven, Connecticut
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Yu M, Hao Z, Xu L, Wen Y, Han F, Gao X. Mandibular advancement device as treatment trial for catathrenia (nocturnal groaning). J Clin Sleep Med 2021; 17:1767-1776. [PMID: 33843579 DOI: 10.5664/jcsm.9290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Catathrenia is a rare disease, classified as isolated symptoms and normal variants under sleep-related breathing disorders in the International Classification of Sleep Disorders, third edition. Because of its rarity, the research on its pathogenesis and treatment is insufficient. This study aimed to evaluate whether the mandibular advancement device (MAD) could be considered an alternative treatment trial and if so, to explore factors predicting its effectiveness. METHODS Thirty patients (12 males and 18 females, aged 16 to 67 years) with catathrenia participated in the study. They underwent standard clinical evaluation, questionnaires, physical examinations, craniofacial evaluations, video-polysomnography, and imaging of the upper airway before and after the insertion of the MAD. Groaning index (GI, groaning episodes per hour of sleep) and apnea-hypopnea index (AHI) were evaluated and anatomic factors predicting effectiveness were explored. RESULTS The sleep efficiency of most patients was higher than 80% and groaning was present throughout all stages of sleep. With the insertion of MAD, GI decreased significantly from 5.8 (2.7, 14.3) to 2.8 (1.3, 12.2) events/h (P = 0.014). Age had a negative effect on efficacy. Mandibular repositioning of MAD, especially the amount of vertical opening and changes of cross-sectional area of hypopharynx, was positively related with efficacy. CONCLUSIONS The MAD could be considered a possible treatment trial for those seeking treatment for groaning. CLINICAL TRIAL REGISTRATION Registry: Chinese Clinical Trial Registry; Identifier: ChiCTR-COC-17013239; URL: http://www.chictr.org.cn/showproj.aspx?proj=22286.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zeliang Hao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Liyue Xu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yongfei Wen
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Fang Han
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
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Argollo NS, Parreira DR, Pereira LC. The importance of audio-video documentation during polysomnography for diagnosis of catathrenia in a 6-year-old child: case report. Sleep Sci 2021; 14:390-393. [PMID: 35087639 PMCID: PMC8776265 DOI: 10.5935/1984-0063.20200122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/08/2021] [Indexed: 11/20/2022] Open
Abstract
Catathrenia is a rare disorder classified as a respiratory one and characterized by expiratory groans during sleep. We report a case of catathrenia in a 6-year-old male patient, with documented video and audio polysomnography. The diagnosis of catathrenia is made through a detailed analysis of video and audio recordings during the examination. Although there is no association with the risk of physical damage known today, catathrenia presents itself as a source of anxiety among patients and their families. The differentiation of catathrenia with central apnea, obstructive apnea, primary snoring, and parasomnias will influence both the prognosis and the diagnosis and treatment of the patient.
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Affiliation(s)
- Nubia Santana Argollo
- Instituto de Otorrino de Brasilia, Otorhinolaringology -
Brasília - Distrito Federal - Brazil
| | | | - Lucas Carneiro Pereira
- Universidade Católica de Brasilia, Otolarhinolaryngology -
Brasília - Distrito Federal – Brazil
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Yu M, Wen Y, Xu L, Han F, Gao X. Polysomnographic characteristics and acoustic analysis of catathrenia (nocturnal groaning). Physiol Meas 2020; 41:125012. [PMID: 33296889 DOI: 10.1088/1361-6579/abd235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Catathrenia is a sleep disorder characterized by nocturnal groaning sounds emitted during prolonged expiration. As a rare condition, its polysomnographic findings were inconsistent. We aimed to present polysomnographic characteristics of catathrenia patients and perform acoustic analysis of groaning sounds. APPROACH Twenty-three patients (eight males and 15 females) diagnosed with catathrenia by video-polysomnography were included. They underwent clinical evaluation and physical examination, and answered a questionnaire. Acoustic analyses (oscillograms and spectrograms) of catathrenia and snoring signals were performed by Praat 6.1.09. Sounds were classified according to Yanagihara criteria. MAIN RESULTS The average age of catathrenia patients was 29.6 ± 10.0 years, with a body mass index of 22.3 ± 5.1 kg m-2. A total of 3728 groaning episodes were documented. Catathrenia events of 16 patients (70%) were rapid eye movement (REM)-predominant. The average duration of groaning was 11.4 ± 4.6 s, ranging from 1.3 to 74.9 s. All signals of groaning were rhythmic or semi-rhythmic, classified as type I and type II, respectively, with formants and harmonics. Snoring events were observed in nine patients. Snoring mainly occurred in the non-REM stage, with a duration of less than 1.5 s. Signals of snoring were chaotic, classified as type III, without harmonics. SIGNIFICANCE Catathrenia occurred in all sleep stages but mainly in REM. Durations of groaning varied greatly across patients. Acoustic characteristics of catathrenia were typical. Groaning had rhythmic or semi-rhythmic waveform, formants and harmonics, indicating vocal origin, while snoring had chaotic waveform.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
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Ratneswaran C, Sagoo MK, Steier J. Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review. J Thorac Dis 2018; 10:S1-S23. [PMID: 29445524 PMCID: PMC5803052 DOI: 10.21037/jtd.2017.10.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Manpreet K Sagoo
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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