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Pan Y, Zhao D, Zhang X, Yuan N, Yang L, Jia Y, Guo Y, Chen Z, Wang Z, Qu S, Bao J, Liu Y. Machine learning-Based model for prediction of Narcolepsy Type 1 in Patients with Obstructive Sleep Apnea with Excessive Daytime Sleepiness. Nat Sci Sleep 2024; 16:639-652. [PMID: 38836216 PMCID: PMC11149636 DOI: 10.2147/nss.s456903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/25/2024] [Indexed: 06/06/2024] Open
Abstract
Background Excessive daytime sleepiness (EDS) forms a prevalent symptom of obstructive sleep apnea (OSA) and narcolepsy type 1 (NT1), while the latter might always be overlooked. Machine learning (ML) models can enable the early detection of these conditions, which has never been applied for diagnosis of NT1. Objective The study aimed to develop ML prediction models to help non-sleep specialist clinicians identify high probability of comorbid NT1 in patients with OSA early. Methods Totally, clinical features of 246 patients with OSA in three sleep centers were collected and analyzed for the development of nine ML models. LASSO regression was used for feature selection. Various metrics such as the area under the receiver operating curve (AUC), calibration curve, and decision curve analysis (DCA) were employed to evaluate and compare the performance of these ML models. Model interpretability was demonstrated by Shapley Additive explanations (SHAP). Results Based on the analysis of AUC, DCA, and calibration curves, the Gradient Boosting Machine (GBM) model demonstrated superior performance compared to other machine learning (ML) models. The top five features used in the GBM model, ranked by feature importance, were age of onset, total limb movements index, sleep latency, non-REM (Rapid Eye Movement) sleep stage 2 and severity of OSA. Conclusion The study yielded a simple and feasible screening ML-based model for the early identification of NT1 in patients with OSA, which warrants further verification in more extensive clinical practices.
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Affiliation(s)
- Yuanhang Pan
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Di Zhao
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Xinbo Zhang
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Na Yuan
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Lei Yang
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Yuanyuan Jia
- Encephalopathy Department No.2, Baoji Hospital of Traditional Chinese Medicine, Baoji, People's Republic of China
| | - Yanzhao Guo
- Encephalopathy Department No.10, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, People's Republic of China
| | - Ze Chen
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Zezhi Wang
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Shuyi Qu
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
| | - Junxiang Bao
- Department of Aerospace Hygiene, Air Force Medical University, Xi'an, People's Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Air Force Medical University, Xi'an, People's Republic of China
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Gomes DS, Seixas C, Cravo J. Performance of the Alice PDx Device With the Somnolyzer Automated Scoring Algorithm for the Diagnosis of Obstructive Sleep Apnea. Cureus 2024; 16:e52654. [PMID: 38380197 PMCID: PMC10877226 DOI: 10.7759/cureus.52654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Objective Automated scoring of respiratory events could allow a swifter obstructive sleep apnea (OSA) identification. We assessed the accuracy of the Alice PDx device with the Somnolyzer automated scoring algorithm, compared to the manually reviewed scoring by a trained sleep technician, for the diagnosis of OSA. Methods A prospective study was conducted between March 2021 and March 2022 in Centro Hospitalar do Baixo Vouga, a level 2 hospital in Aveiro, Portugal. Patients with high pre-test probability for OSA performed a type III home sleep apnea testing with the Alice PDx device. Data were scored automatedly by the Sleepware G3 with the Somnolyzer digital system and manually by a trained sleep technician. Correlation and dependent t-tests were used. Sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs), and area under the receiver operating characteristic curve (AUROC) of automated scoring were calculated. Data were analyzed using the Stata Statistical Software (Release 17, StataCorp., 2023, College Station, TX: StataCorp LLC). Results In 150 participants (mean age 57.8 ± 13.9 years), the mean apnea-hypopnea index (AHI) was 21.9 ± 21.8 events/hour by manual scoring and 25.4 ± 21.6 events/hour by automated scoring. The mean difference was 3.4 ± 4.4 events/hour, and a strong, positive, linear correlation was found between the two scores (r = 0.98). At the altered AHI (AHI ≥ 5 events/hour), mild, moderate, and severe OSA, the automated scoring sensitivity/specificity values were 91.2%/100.0%, 80.0%/68.6%, 91.6%/41.9%, and 98.1%/80.9%, respectively. The PPVs/NPVs for the same categories were 100.0%/69.4%, 89.3%/51.1%, 79.7%/66.7%, and 91.8%/95.0%, respectively. Finally, the AUROC was 0.85, 0.70, 0.73, and 0.93, respectively. Conclusion The automated scoring obtained from the Alice PDx portable device, using Sleepware G3 with the Somnolyzer digital system, seems accurate enough to diagnose OSA and validate the initiation of PAP therapy in the correct clinical setting. Nevertheless, it does not replace manual reviewing by a trained sleep technician in the case of mild and moderate OSA, to obtain a correct severity classification. With this valuable time-saving tool, we expect to hasten OSA diagnosis and treatment and thus tackle the underdiagnosis problem.
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Affiliation(s)
- David S Gomes
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
| | - Carlos Seixas
- Department of Research on Economics Management and Information Technologies, Portucalense University, Porto, PRT
| | - João Cravo
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
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Truong N, Sciscent B, Lorenz FJ, Goldrich D, Goyal N. Letter to the Editor of Journal of Otolaryngology regarding "Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study". J Otolaryngol Head Neck Surg 2023; 52:61. [PMID: 37726813 PMCID: PMC10510124 DOI: 10.1186/s40463-023-00662-5] [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: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O'Connor-Reina et al. recently published a paper titled "Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study." In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients.
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Affiliation(s)
| | - Bao Sciscent
- Penn State College of Medicine, Hershey, PA, USA
| | - F Jeffrey Lorenz
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - David Goldrich
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, PA, USA.
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Jaffuel D, Mallet JP, Sabil A. Accuracy of continuous positive airway pressure devices: the devil is in the details, the best is yet to come. Sleep Breath 2023; 27:1651-1654. [PMID: 36394693 DOI: 10.1007/s11325-022-02741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Dany Jaffuel
- Department of Respiratory Diseases, CHU Montpellier, 371, Avenue Doyen GiraudMontpellier Cedex 5, 34295, Montpellier, France.
- PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, France.
| | - Jean-Pierre Mallet
- Department of Respiratory Diseases, CHU Montpellier, 371, Avenue Doyen GiraudMontpellier Cedex 5, 34295, Montpellier, France
- PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, France
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Foresi A, Vitale T, Prestigiacomo R, Ranieri P, Bosi M. Accuracy of positive airway pressure titration through telemonitoring of auto-adjusting positive airway pressure device connected to a pulse oximetry in patients with obstructive sleep apnea. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:740-747. [PMID: 37385297 PMCID: PMC10435960 DOI: 10.1111/crj.13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE In COVID-19 era, all forms of access of patients to the sleep units should be reduced as much as possible when implementing telemedicine. In the field of obstructive sleep apnea (OSA) therapy with positive airway pressure (PAP) devices, telemedicine includes the use of built-in software (BIS) and storage of PAPs and remote-controlled data (BISrc data) that are processed and transmitted daily to sleep units. We compared two methods of evaluating the final residual severity of OSA patients in home PAP titration: BISrc data versus nocturnal portable multichannel monitoring (PM) data in PAP (reference method) and to verify whether the efficacy PAP therapy guided by BISrc data was clinically adequate. METHODS We conducted a real-life prospective study in newly diagnosed patients with OSA. Patients used an auto-adjusting positive airway pressure (AirSense 10 ResMed) with a pulse oximeter that allows daily transfer of BISrc data (apnea hypopnea index [AHI] and SaO2 ) and remote changes in ventilator setting. Once the PAP titration was completed, the pressure value or ranges were kept constant for 3 days and home PM was repeated. RESULTS There were 41 patients with moderate to severe OSA who completed the study. When considering AHI only, the diagnostic accuracy of BISrc on the third day was equal to 97.5%; when considering AHI > 10/h, ODI > 10/h, and SaO2 < 90%, the diagnostic accuracy slightly decreased to 90.2%. CONCLUSION In clinical practice, the two measurement methods are equivalent. The use of BISrc data for home titration would reduce the access to sleep units. We urge that widespread use of BISrc be promoted in the current practice of management of OSA.
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Affiliation(s)
- Antonio Foresi
- Lung Function and Sleep UnitASST Nord‐Milano, Sesto San Giovanni HospitalMilanItaly
| | - Tommaso Vitale
- Lung Function and Sleep UnitASST Nord‐Milano, Sesto San Giovanni HospitalMilanItaly
| | | | - Piera Ranieri
- Department of Medicine and RehabilitationIstituto Clinico Sant'AnnaBresciaItaly
| | - Marcello Bosi
- Sleep UnitVilla Igea, Ospedali Privati ForlìForlìItaly
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Grote L, Anderberg CP, Friberg D, Grundström G, Hinz K, Isaksson G, Murto T, Nilsson Z, Spaak J, Stillberg G, Söderberg K, Tegelberg Å, Theorell-Haglöw J, Ulander M, Hedner J. National Knowledge-Driven Management of Obstructive Sleep Apnea-The Swedish Approach. Diagnostics (Basel) 2023; 13:diagnostics13061179. [PMID: 36980487 PMCID: PMC10047173 DOI: 10.3390/diagnostics13061179] [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: 01/30/2023] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION This paper describes the development of "Swedish Guidelines for OSA treatment" and the underlying managed care process. The Apnea Hypopnea Index (AHI) is traditionally used as a single parameter for obstructive sleep apnea (OSA) severity classification, although poorly associated with symptomatology and outcome. We instead implement a novel matrix for shared treatment decisions based on available evidence. METHODS A national expert group including medical and dental specialists, nurses, and patient representatives developed the knowledge-driven management model. A Delphi round was performed amongst experts from all Swedish regions (N = 24). Evidence reflecting treatment effects was extracted from systematic reviews, meta-analyses, and randomized clinical trials. RESULTS The treatment decision in the process includes a matrix with five categories from a "very weak"" to "very strong" indication to treat, and it includes factors with potential influence on outcome, including (A) OSA-related symptoms, (B) cardiometabolic comorbidities, (C) frequency of respiratory events, and (D) age. OSA-related symptoms indicate a strong incitement to treat, whereas the absence of symptoms, age above 65 years, and no or well-controlled comorbidities indicate a weak treatment indication, irrespective of AHI. CONCLUSIONS The novel treatment matrix is based on the effects of treatments rather than the actual frequency of respiratory events during sleep. A nationwide implementation of this matrix is ongoing, and the outcome is monitored in a prospective evaluation by means of the Swedish Sleep Apnea Registry (SESAR).
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Affiliation(s)
- Ludger Grote
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Pulmonary Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | | | - Danielle Friberg
- Department of Otorhinolaryngology, Surgical Sciences, Uppsala University, 752 36 Uppsala, Sweden
| | - Gert Grundström
- Sleep Apnea Patient Organisation (Apne Sverige), 13332 Saltsjoebaden, Sweden
| | - Kerstin Hinz
- Department for Health Care Development, Region of Västra Götaland, 40544 Gothenburg, Sweden
| | | | - Tarmo Murto
- Sleep Apnea Unit, Respiratory Medicine, Umeå University Hospital, 90185 Umeå, Sweden
| | - Zarita Nilsson
- Sleep Apnea Unit, ENT Department, Ystad Hospital, 271 82 Ystad, Sweden
| | - Jonas Spaak
- Department of Cardiology and Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, 18288 Danderyd, Sweden
| | | | - Karin Söderberg
- Sleep Apnea Patient Organisation (Apne Sverige), 13332 Saltsjoebaden, Sweden
| | - Åke Tegelberg
- Sleep Apnea Patient Association (Apnefoereningen Syd), 14630 Tullinge, Sweden
| | | | - Martin Ulander
- Department for Clinical Neurophysiology, 58185 Linköping, Sweden
| | - Jan Hedner
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Pulmonary Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Krüger M, Obst A, Ittermann T, Bernhardt O, Ivanovska T, Zygmunt M, Ewert R, Fietze I, Penzel T, Biffar R, Daboul A. Menopause Is Associated with Obstructive Sleep Apnea in a Population-Based Sample from Mecklenburg–Western Pomerania, Germany. J Clin Med 2023; 12:jcm12062101. [PMID: 36983104 PMCID: PMC10052671 DOI: 10.3390/jcm12062101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/10/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
Objective: Menopause is associated with multiple health risks. In several studies, a higher incidence or a higher risk for obstructive sleep apnea (OSA) in post-menopausal than pre-menopausal women is reported. This study was designed to verify such a connection between menopause and OSA in a population-based sample. Methods: For a subsample (N = 1209) of the Study of Health in Pomerania (N = 4420), complete polysomnography data was available. Of these, 559 females completed a structured interview about their menstrual cycle. Splines and ordinal regression analysis were used to analyze the resulting data. Results: In the ordinal regression analysis, a significant association between the apnea–hypopnea index (AHI) and menopause indicated that post-menopausal women had a substantially higher risk of OSA. In accordance with previous studies, risk indicators such as body mass index (BMI), age, and the influence of hysterectomies or total oophorectomies were included in the model. Conclusions: Our results clearly confirmed the assumed connection between menopause and OSA. This is important because OSA is most often associated with male patients, and it warrants further research into the underlying mechanisms.
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Affiliation(s)
- Markus Krüger
- Poliklinik für Zahnärztliche Prothetik, Alterszahnmedizin und Medizinische Werkstoffkunde, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
- Correspondence:
| | - Anne Obst
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Olaf Bernhardt
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pediatric Dentistry, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Tatyana Ivanovska
- Fakultät für Elektrotechnik, Medien und Informatik, Ostbayerische Technische Hochschule Amberg-Weiden, 92224 Amberg, Germany
| | - Marek Zygmunt
- Department of Obstetrics and Gynecology, University of Greifswald, 17489 Greifswald, Germany
| | - Ralf Ewert
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
| | - Ingo Fietze
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Reiner Biffar
- Poliklinik für Zahnärztliche Prothetik, Alterszahnmedizin und Medizinische Werkstoffkunde, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
| | - Amro Daboul
- Poliklinik für Zahnärztliche Prothetik, Alterszahnmedizin und Medizinische Werkstoffkunde, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
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Rokou A, Eleftheriou A, Tsigalou C, Apessos I, Nena E, Dalamaga M, Voulgaris A, Steiropoulos P. Effect of the Implementation of a Structured Diet Management Plan on the Severity of Obstructive Sleep Apnea: A Systematic Review. Curr Nutr Rep 2023; 12:26-38. [PMID: 36435894 PMCID: PMC9974698 DOI: 10.1007/s13668-022-00445-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The prevalence of obstructive sleep apnea (OSA) is increasing worldwide, in line with the increase in obesity prevalence. Taken into consideration the low compliance rates to continuous positive airway pressure (CPAP) treatment, and since obesity is a risk factor for OSA, these patients should receive additional counseling for weight loss through a diet plan. The aim of this review is to examine the role of a structured diet management plan on OSA severity, nocturnal oxygen indices, and subjective sleep parameters. RECENT FINDINGS Τhis systematic review of the literature resulted in four studies and demonstrated that severity of OSA, assessed by the apnea-hypopnea index, is reduced by a dietary management plan when delivered through an educational program. Moreover, nocturnal oxygenation is improved, as well as subjective sleep parameters, when initiating a diet on top of CPAP use. In summary, the present systematic review reports on the beneficial effects of a structured diet management plan in patients with OSA. Although CPAP remains the gold standard of OSA treatment, a specific dietary plan should be sought when managing patients with OSA. Nevertheless, still the evidence is low, and further research on this field is needed to reduce the burden of OSA.
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Affiliation(s)
- Aikaterini Rokou
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anna Eleftheriou
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioulianos Apessos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Voulgaris
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Telemedizin und Telemonitoring“. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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