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Thorisdottir K, Hrubos-Strøm H, Karhu T, Nikkonen S, Dammen T, Nordhus IH, Leppänen T, Jónsdóttir MK, Arnardottir ES. Verbal memory is linked to average oxygen saturation during sleep, not the apnea-hypopnea index nor novel hypoxic load variables. Sleep Med 2024; 123:29-36. [PMID: 39232262 DOI: 10.1016/j.sleep.2024.08.028] [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: 06/28/2023] [Revised: 07/15/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION The apnea-hypopnea index (AHI) is the current diagnostic parameter for diagnosing and estimating the severity of obstructive sleep apnea (OSA). It is, however, poorly associated with the main clinical symptom of OSA, excessive daytime sleepiness, and with the often-seen cognitive decline among OSA patients. To better evaluate OSA severity, novel hypoxic load parameters have been introduced that consider the duration and depth of oxygen saturation drops associated with apneas or hypopneas. The aim of this paper was to compare novel hypoxic load parameters and traditional OSA parameters to verbal memory and executive function in OSA patients. METHOD A total of 207 adults completed a one-night polysomnography at sleep laboratory and two neuropsychological assessments, the Rey Auditory Verbal Learning Test and Stroop test. RESULTS Simple linear regression analyses were used to evaluate independent associations between each OSA parameter and cognitive performance. Associations were found between immediate recall and arousal index, hypoxia <90 %, average SpO2 during sleep, and DesSev100+RevSev100. Total recall was associated with all OSA parameters, and no associations were found with the Stroop test. Subsequently, sex, age, and education were included as covariates in multiple linear regression analyses for each OSA parameter and cognitive performance. The main findings of the study were that average SpO2 during sleep was a significant predictor of total recall (p < .007, β = -.188) with the regression model explaining 21.2 % of performance variation. Average SpO2 during sleep was also a significant predictor of immediate recall (p < .022, β = -.171) with the regression model explaining 11.4 % of performance variation. Neither traditional OSA parameters nor novel hypoxic load parameters predicted cognitive performance after adjustment for sex, age, and education. CONCLUSION The findings validate that the AHI is not an effective indicator of cognitive performance in OSA and suggest that average oxygen saturation during sleep may be the strongest PSG predictor of cognitive decline seen in OSA. The results also underline the importance of considering age when choosing neurocognitive tests, the importance of including more than one test for each cognitive domain as most tests are not pure measures of a single cognitive factor, and the importance of including tests that cover all cognitive domains as OSA is likely to have diffuse cognitive effects.
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Affiliation(s)
- K Thorisdottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland; Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - H Hrubos-Strøm
- Akershus University Hospital, Akershus, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Karhu
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - S Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - T Dammen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - I H Nordhus
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - T Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - M K Jónsdóttir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland; Department of Psychology, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Iceland
| | - E S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Iceland
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Costa IOM, Cunha MO, Bussi MT, Cassetari AJ, Zancanella E, Bagarollo MF. Impacts of conservative treatment on the clinical manifestations of obstructive sleep apnea-systematic review and meta-analysis. Sleep Breath 2024; 28:1563-1574. [PMID: 38642201 DOI: 10.1007/s11325-024-03034-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: 12/13/2023] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a chronic disease with a high populational prevalence that is characterized as airway closure during sleep. Treatment is multidisciplinary and varies according to each case. Continuous positive airway pressure (CPAP), oral appliances, and surgery are the primary therapeutic options. Non-invasive conservative treatments such as sleep hygiene, positional therapy, physical exercises, and weight loss aim to reduce the worsening of the disease while being complementary to the invasive primary treatment. OBJECTIVE To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions. METHOD This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18 years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ). RESULTS A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD. CONCLUSION The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.
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Affiliation(s)
- I O M Costa
- Department of Otorhinolaryngology, University of Campinas, Campinas, Brazil.
- Department of Human Development and Rehabilitation, University of Campinas, Campinas, Brazil.
| | - M O Cunha
- Department of Otorhinolaryngology, University of Campinas, Campinas, Brazil
| | - M T Bussi
- Department of Otorhinolaryngology, University of Campinas, Campinas, Brazil
| | - A J Cassetari
- Department of Otorhinolaryngology, University of Campinas, Campinas, Brazil
| | - E Zancanella
- Department of Otorhinolaryngology, University of Campinas, Campinas, Brazil
| | - M F Bagarollo
- Department of Human Development and Rehabilitation, University of Campinas, Campinas, Brazil
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Harding CD, Fuentes AL, Malhotra A. Tackling obstructive sleep apnea with pharmacotherapeutics: expert guidance. Expert Opin Pharmacother 2024; 25:1019-1026. [PMID: 38913403 PMCID: PMC11227253 DOI: 10.1080/14656566.2024.2365329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The efficacy of non-pharmacotherapeutic treatment of obstructive sleep apnea, a highly prevalent condition with serious cardiometabolic and neurocognitive health consequences, is well established. Supplementing traditional treatment strategies with medications can improve symptoms and reduce side effects. Efforts to identify medications that target the causes of sleep apnea have met with mixed success. However, this remains a worthwhile objective for researchers to pursue, given the potential benefit pharmacotherapy could bring to those patients who reject or struggle to adhere to existing treatments. AREAS COVERED This article presents the case for obstructive sleep apnea pharmacotherapy including drugs that reduce the occurrence of apnea events, such as weight loss agents, ventilation activators and muscle and nervous system stimulants, drugs that alleviate symptoms, such as wake-promoting agents for excessive daytime sleepiness, and drugs that improve adherence to existing treatments, such as hypnotics. Literature was accessed from PubMed between 1 March 2024 and 18 April 2024. EXPERT OPINION Exciting recent advances in both our understanding of obstructive sleep apnea pathology and in the techniques used to identify therapeutic agents and their targets combine to embolden a positive outlook for the expanded use of drugs in tackling this consequential disease.
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Affiliation(s)
- Christian D. Harding
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Ana Lucia Fuentes
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
- Pulmonary and Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
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Yang C, Yu W, Yao K, He Y, Sun H, Xu B, Ni J, Hu M, Gu F, Lu X, Zhu M, Wang B. Concurrent laparoscopic sleeve gastrectomy with uvulopalatopharyngoplasty in the treatment of morbid obesity comorbid with severe obstructive sleep apnea: a retrospective cohort study. J Clin Sleep Med 2024; 20:555-564. [PMID: 38059337 PMCID: PMC10985300 DOI: 10.5664/jcsm.10924] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
STUDY OBJECTIVES This study aimed to evaluate the safety and short-term effect of contemporaneous surgeries (bariatric surgery plus uvulopalatopharyngoplasty [UPPP]) in the treatment of morbid obesity comorbid with severe obstructive sleep apnea (OSA). METHODS A retrospective cohort study was performed to identify patients with obesity and severe OSA who underwent laparoscopic sleeve gastrectomy (LSG) with or without UPPP surgeries between December 2019 and December 2021 in our center. Patients were divided into 2 groups according to different surgical methods (contemporaneous group [LSG with UPPP] vs LSG-only group). Data about surgical safety, OSA remission, and effectiveness of weight loss were collected and analyzed between the 2 groups before and 12 months after surgery. RESULTS A total of 101 patients were included in this study (contemporaneous group [LSG with UPPP], n = 42 vs LSG only group, n = 59). There was no significant difference in surgical safety between the 2 groups, and both OSA and obesity were significantly improved at 12.5 ± 2.1 months postoperative follow-up. The apnea-hypopnea index decreased from 68.7 ± 30.4 events/h to 10.2 ± 7.0 events/h in the contemporaneous group (P < .001) and from 64.7 ± 26.2 events/h to 18.9 ± 9.8 events/h in the LSG group (P < .001). Moreover, the apnea-hypopnea index decreased to below 5 events/h in 50% of patients (21/42) in the contemporaneous group but only in 13.5% of patients in the LSG group (P < .001). In the LSG group 20 (34%) patients achieved a reduction in apnea-hypopnea index < 15 events/h and resolution of daytime sleepiness. CONCLUSIONS Contemporaneous surgery (concurrent bariatric and UPPP surgeries) is feasible and an effective option for patients with obesity and severe OSA. However, our finding suggests that approximately a third of patients undergoing LSG with UPPP may not derive significant benefit from the UPPP portion of the contemporaneous surgical approach. CITATION Yang C, Yu W, Yao K, et al. Concurrent laparoscopic sleeve gastrectomy with uvulopalatopharyngoplasty in the treatment of morbid obesity comorbid with severe obstructive sleep apnea: a retrospective cohort study. J Clin Sleep Med. 2024;20(4):555-564.
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Affiliation(s)
- Chengcan Yang
- Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwen Yu
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kan Yao
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yining He
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongxia Sun
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Xu
- Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Ni
- Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Hu
- Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fen Gu
- Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of ENT & Oral Maxillofacial Surgery, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhu
- Department of Oral and Cranio-maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Wang
- Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kattimani V, Panneerselvam E, Tiwari R, Panga GSK, Sreeram RR. An Overview of Systematic Reviews on the Surgical Management of Obstructive Sleep Apnoea. J Maxillofac Oral Surg 2023; 22:781-793. [PMID: 38105854 PMCID: PMC10719205 DOI: 10.1007/s12663-023-02051-x] [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: 08/24/2023] [Accepted: 10/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) is a common sleep disorder marked by partial or total obstruction of the upper airway while a person is asleep leading to breathing difficulty, reduced oxygenation and frequent awakenings. This condition affects the general health significantly compromising quality of life. The objective of this overview is to thoroughly assess the systematic reviews on current surgical therapies for the management of OSA in terms of patient outcomes. Methods A thorough literature search was performed from inception till 31st December 2022 using PubMed, and Cochrane databases. Studies evaluating the effectiveness and safety of different surgical techniques for the management of OSA were considered. The quality of articles was assessed using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and Glenny et al. checklist. Results Out of eighteen studies, only seven studies met the inclusion and exclusion criteria. Results showed that the majority of studies were in the pediatric age group except one systematic review which assessed the adult age group. Conclusion None of the published articles had compared all surgical procedures based on the standard evaluating procedure nor followed all reporting guidelines in the primary studies. For better implementation, further multi center studies are warranted with unique reporting criteria and guidelines about pre- as well as post-operative phases. Future research should concentrate on contrasting strategies, combination therapies, and evaluating long-term effects. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-023-02051-x.
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Affiliation(s)
- Vivekanand Kattimani
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
| | | | - Rahul Tiwari
- Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat India
| | | | - Roopa Rani Sreeram
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
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DeVettori G, Troxel WM, Duff K, Baron KG. Positive airway pressure adherence among patients with obstructive sleep apnea and cognitive impairment: A narrative review. Sleep Med 2023; 111:28-35. [PMID: 37716335 PMCID: PMC10613340 DOI: 10.1016/j.sleep.2023.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
Adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) have increased rates of Obstructive Sleep Apnea (OSA). Positive Airway Pressure (PAP) is the first-line treatment for OSA and may have potential benefits for slowing cognitive decline in these individuals. However, adherence is low in PAP users overall and those with cognitive impairment may have unique challenges. Furthermore, there has been little systematic study of the use of PAP or strategies to enhance PAP adherence among those with AD or MCI. The aim of this review is to examine existing observational, quasi-experimental and experimental studies of the effects of PAP on cognitive function. In addition, our goal was to gather evidence about the adherence rates, and support for PAP among adults with MCI and mild to moderate AD. Through searches of electronic databases (University of Utah Library, SAGE Publishing, PubMed, Wiley, EBSCO, Science Direct, ProQuest, and NCBI), we identified 11 articles that fit our study inclusion criteria. Synthesis of data was performed with a focus on cognitive outcomes of PAP interventions and adherence. Findings from the studies showed that multiple indices of memory improved with PAP use. Adherence in MCI and AD populations was largely comparable to adherence reported in general adult populations, but more research is needed to optimize systems for providing support for PAP users and caregivers. Results support PAP as a promising intervention in this population but more research is needed to make definitive conclusions about the relationship between PAP use and improved cognitive function. Furthermore, research is needed to determine if additional interventions are needed to support patients and caregivers.
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Affiliation(s)
- Giulia DeVettori
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Wendy M Troxel
- Rand Corporation, Division of Behavior and Policy Sciences, Pittsburgh, PA, USA
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Kelly G Baron
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
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Cho Y, Kwon Y, Ruth C, Cheng S, DelRosso LM. The burden of sleep disordered breathing in infants with Down syndrome referred to tertiary sleep center. Pediatr Pulmonol 2023; 58:1122-1126. [PMID: 36588294 PMCID: PMC10349798 DOI: 10.1002/ppul.26302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/29/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Children with Down Syndrome (DS) are at high risk of sleep disordered breathing (SDB). We aimed to examine the burden of SDB in infants with DS referred to tertiary sleep center. METHODS Infants (≤12 months old) with DS who underwent consecutive polysomnography (PSG) at a single academic sleep center over a 6-year period were included. obstructive sleep apnea (OSA) (obstructive apnea hypopnea index [oAHI]>1/hr), central sleep apnea (central apnea index > 5/h) and the presence of hypoventilation (% time spent with CO2 > 50 mmHg either by end-tidal or transcutaneous> 25% of total sleep time) and hypoxemia (time spent with O2 saturation <88% >5 min) were ascertained. RESULTS A total of 40 infants were included (Mean age 6.6 months, male 66%). PSGs consisted of diagnostic (n = 13) and split night (n = 27, 68%) studies. All met criteria for OSA with mean oAHI 34.6/h (32.3). Central sleep apnea was present in 11 (27.5%) of infants. A total of 11 (27.5%) had hypoxemia. Hypoventilation was present in 10 (25%) infants. CONCLUSION This study highlights the high prevalence of SDB in infants with DS referred to a sleep center, and supports early PSG assessment in this patient population.
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Affiliation(s)
| | | | | | | | - Lourdes M. DelRosso
- University of Washington Pediatric Pulmonary and Sleep Medicine Division, Seattle Children’s Hospital, Seattle WA
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Vanek J, Prasko J, Genzor S, Mizera J. The Management of Sleep Disturbances in Patients with Schizophrenia: A Case Series. Psychol Res Behav Manag 2022; 15:3673-3681. [PMID: 36544913 PMCID: PMC9762406 DOI: 10.2147/prbm.s388702] [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: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with schizophrenia commonly encounter a variety of sleep disorders. Disturbed sleep can be found in 30-80% of patients, depending on the degree of psychotic symptomatology. Difficulty falling asleep, maintaining, or achieving restful sleep is associated with symptom severity and has been reported as a prodromal symptom of psychotic relapse. Although some sleep disorders improve with antipsychotic treatment, in many cases, even during disease remission, sleep continues to be fragmented, or even different pathophysiological mechanism is causing sleep disruption. Moreover, it may be complicated if the patient needs specific treatment, such as positive airway pressure (PAP) therapy, due to sleep-disordered breathing. The article presents case reports of patients with schizophrenia with sleep disturbances. As presented in our case reports, cognitive behavioral therapy seems effective in treating comorbid insomnia, even in patients with schizophrenia. The second and third case reports emphasise the need for broader clinical considerations, a cross-diagnostic approach, and cooperation in care for patients with severe mental disorders.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic,Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic,Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic,Rehabilitation Hospital Beroun, Jessenia Inc, Akeso Holding, Závodí, The Czech Republic,Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, I. P. Pavlova 6, Olomouc, 77900, The Czech Republic, Email
| | - Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, The Czech Republic
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, The Czech Republic
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D'Rozario AL, Hoyos CM, Wong KKH, Unger G, Kim JW, Vakulin A, Kao CH, Naismith SL, Bartlett DJ, Grunstein RR. Improvements in cognitive function and quantitative sleep electroencephalogram in obstructive sleep apnea after six months of continuous positive airway pressure treatment. Sleep 2022; 45:6507350. [PMID: 35029691 PMCID: PMC9189957 DOI: 10.1093/sleep/zsac013] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Untreated obstructive sleep apnea (OSA) is associated with cognitive deficits and altered brain electrophysiology. We evaluated the effect of continuous positive airway pressure (CPAP) treatment on quantitative sleep electroencephalogram (EEG) measures and cognitive function. METHODS We studied 167 patients with OSA (age 50 ± 13, AHI 35.0 ± 26.8) before and after 6 months of CPAP. Cognitive tests assessed working memory, sustained attention, visuospatial scanning, and executive function. All participants underwent overnight polysomnography at baseline and after CPAP. Power spectral analysis was performed on EEG data (C3-M2) in a sub-set of 90 participants. Relative delta EEG power and sigma power in NREM and EEG slowing in REM were calculated. Spindle densities (events/min) in N2 were also derived using automated spindle event detection. All outcomes were analysed as change from baseline. RESULTS Cognitive function across all cognitive domains improved after six months of CPAP. In our sub-set, increased relative delta power (p < .0001) and reduced sigma power (p = .001) during NREM were observed after the 6-month treatment period. Overall, fast and slow sleep spindle densities during N2 were increased after treatment. CONCLUSIONS Cognitive performance was improved and sleep EEG features were enhanced when assessing the effects of CPAP. These findings suggest the reversibility of cognitive deficits and altered brain electrophysiology observed in untreated OSA following six months of treatment.
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Affiliation(s)
- Angela L D'Rozario
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Keith K H Wong
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Gunnar Unger
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Jong Won Kim
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Department of Healthcare IT, Inje University, Inje-ro 197, Kimhae, Kyunsangnam-do, 50834,South Korea
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Chien-Hui Kao
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Delwyn J Bartlett
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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10
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Huang Q, Wang P, Liu H, Li M, Yue Y, Xu P. Inhibition of ERK1/2 regulates cognitive function by decreasing expression levels of PSD-95 in the Hippocampus of CIH Rats. Eur J Neurosci 2022; 55:1471-1482. [PMID: 35243702 DOI: 10.1111/ejn.15635] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a potentially severe sleep disorder characterized by intermittent hypoxia, and there is growing evidence that OSAS can lead to cognitive decline. Extracellular signal-regulated protein kinase 1/2 (ERK1/2) plays a key role in synaptic plasticity. We established CIH model in male SD rats and examined their expression of p-ERK1/2 and PSD-95, as well as in CIH group, the effect of SL327 on the expression of p-ERK1/2 and PSD-95 in hippocampus of CIH model rats was observed by pretreating the experimental rats with SL327 during peak time of p-ERK1/2 expression. Mean oxygen saturation in the tail artery was lower in the CIH group. In the CIH groups exhibited increased escape latencies in the navigation test and decreased numbers of platform crossings in the space exploration test. Reduced volume, irregular structure, deepened cytoplasmic eosinophilic staining in the cytoplasm, and decreased nuclear size were found in hippocampal neurons in the 28-d CIH 、28-d CIH + SL327 group. The hippocampus of CIH rats, p-ERK expressions gradually increased with prolonged CIH exposure but decreased after SL327 treatment. Moreover, PSD-95 expressions gradually reduced in the 14-d CIH, 21-d CIH, and 28-d CIH groups but increased in the SL327-treated group. The SL327 intervention decreased p-ERK1/2 expression, increased PSD-95 expression, and improved cognitive function in CIH rats. The present findings provide some insights into the mechanisms underlying OSAS-associated cognitive impairment.
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Affiliation(s)
- Qin Huang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,The second affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Pei Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China.,Department of Neurology, Central Hospital of Chongqing University, Chongqing, China
| | - Haijun Liu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Key Laboratory of Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
| | - Mingjian Li
- The second affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yujiao Yue
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ping Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Key Laboratory of Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
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11
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Kallweit U, Pevernagie D, Lammers GJ. “Sleepiness” in obstructive sleep apnea: getting into deep water. Sleep Med 2022; 92:64-66. [DOI: 10.1016/j.sleep.2022.02.015] [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: 01/16/2022] [Revised: 02/12/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022]
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12
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Sum-Ping O, Geng YJ. Impact of Sleep on Cardiovascular Health: A Narrative Review. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Falck RS, Davis JC, Best JR, Chan PCY, Li LC, Wyrough AB, Bennett KJ, Backhouse D, Liu-Ambrose T. Effect of a Multimodal Lifestyle Intervention on Sleep and Cognitive Function in Older Adults with Probable Mild Cognitive Impairment and Poor Sleep: A Randomized Clinical Trial. J Alzheimers Dis 2021; 76:179-193. [PMID: 32444553 DOI: 10.3233/jad-200383] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Poor sleep is common among older adults with mild cognitive impairment (MCI) and may contribute to further cognitive decline. Whether multimodal lifestyle intervention that combines bright light therapy (BLT), physical activity (PA), and good sleep hygiene can improve sleep in older adults with MCI and poor sleep is unknown. OBJECTIVE To assess the effect of a multimodal lifestyle intervention on sleep in older adults with probable MCI and poor sleep. METHODS This was a 24-week proof-of-concept randomized trial of 96 community-dwelling older adults aged 65-85 years with probable MCI (<26/30 on the Montreal Cognitive Assessment) and poor sleep (>5 on the Pittsburgh Sleep Quality Index [PSQI]). Participants were allocated to either a multimodal lifestyle intervention (INT); or 2) education + attentional control (CON). INT participants received four once-weekly general sleep hygiene education classes, followed by 20-weeks of: 1) individually-timed BLT; and 2) individually-tailored PA promotion. Our primary outcome was sleep efficiency measured using the MotionWatch8© (MW8). Secondary outcomes were MW8-measured sleep duration, fragmentation index, wake-after-sleep-onset, latency, and PSQI-measured subjective sleep quality. RESULTS There were no significant between-group differences in MW8 measured sleep efficiency at 24-weeks (estimated mean difference [INT -CON]: 1.18%; 95% CI [-0.99, 3.34]), or any other objective-estimate of sleep. However, INT participants reported significantly better subjective sleep quality at 24-weeks (estimated mean difference: -1.39; 95% CI [-2.72, -0.06]) compared to CON. CONCLUSION Among individuals with probable MCI and poor sleep, a multimodal lifestyle intervention improves subjective sleep quality, but not objectively estimated sleep.
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Affiliation(s)
- Ryan S Falck
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick C Y Chan
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne B Wyrough
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly J Bennett
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Backhouse
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Banghøj AM, Krogager C, Kristensen PL, Hansen KW, Laugesen E, Fleischer J, Lebech Cichosz S, Poulsen PL, Glymer Kirkegaard M, Thorsteinsson B, Tarnow L. Effect of 12-week continuous positive airway pressure therapy on glucose levels assessed by continuous glucose monitoring in people with type 2 diabetes and obstructive sleep apnoea; a randomized controlled trial. Endocrinol Diabetes Metab 2021; 4:e00148. [PMID: 33855195 PMCID: PMC8029513 DOI: 10.1002/edm2.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 12/18/2022] Open
Abstract
Aim Obstructive sleep apnoea (OSA) is frequent in type 2 diabetes (T2D). The aim was to investigate the effect of a 12-week treatment with continuous positive airway pressure (CPAP) on glycaemic control assessed by continuous glucose monitoring (CGM), HbA1c and fasting blood glucose in patients with T2D and newly detected OSA. Methods In a randomized controlled multicentre study, 72 participants with T2D and moderate to severe OSA (78% male, age 62 ± 7, AHI 35 ± 15) were recruited from outpatient clinics in three Danish hospitals and were randomized to CPAP intervention or control. The main outcome was glycaemic control assessed by 6 days CGM at baseline and after 12-week therapy, as well as by HbA1c and fasting blood glucose. Results No significant changes were found in average glucose levels, time in glucose range, time with hypoglycaemia, time with hyperglycaemia or coefficient of variability. HbA1c decreased 0.7 mmol/mol (0.07%; P = .8) in the CPAP group and increased 0.8 mmol/mol (0.08%; P = .6) in the control group (intergroup difference, P = .6). Fasting blood glucose increased by 0.2 mmol/L (P = .02) in the CPAP group and by 0.4 mmol/L (P = .01) in the control group (intergroup difference, P = .7). In a prespecified subgroup analysis comparing participants with high adherence (minimum usage of four hours/night for 70% of all nights) to CPAP to the control group, no significant changes were observed either, although these participants had a tendency towards better glycaemic indices. Conclusions CPAP treatment for 12 weeks does not significantly change glycaemic control in patients with type 2 diabetes and OSA.
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Affiliation(s)
| | - Christoffer Krogager
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Diagnostic CentreRegional HospitalSilkeborgDenmark
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | | | | | - Esben Laugesen
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
| | - Jesper Fleischer
- Steno Diabetes Center AarhusAarhusDenmark
- Steno Diabetes Center SjællandHolbækDenmark
| | | | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal MedicineAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhusDenmark
| | | | - Birger Thorsteinsson
- Department of Endocrinology and NephrologyNordsjællands HospitalHillerødDenmark
- Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Lise Tarnow
- Steno Diabetes Center SjællandHolbækDenmark
- Department of Clinical ResearchNordsjællands HospitalHillerødDenmark
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15
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Scarpina F, Bastoni I, Cappelli S, Priano L, Giacomotti E, Castelnuovo G, Molinari E, Tovaglieri IMA, Cornacchia M, Fanari P, Mauro A. Psychological Well-Being in Obstructive Sleep Apnea Syndrome Associated With Obesity: The Relationship With Personality, Cognitive Functioning, and Subjective and Objective Sleep Quality. Front Psychol 2021; 12:588767. [PMID: 33679512 PMCID: PMC7933550 DOI: 10.3389/fpsyg.2021.588767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Obstructive sleep apnea (OSA) syndrome severely affects psychological well-being. This syndrome frequently occurs in obesity; however, no previous study has investigated the level of psychological well-being in the case of OSA syndrome associated with obesity. In this work, we assessed the level of psychological well-being in fifty-two individuals affected by OSA syndrome and obesity through the Psychological General Well-Being Index. Moreover, we investigated the role of personality, cognitive functioning and attentional capabilities, subjective perception and objective measurement about sleeping, on the subjective perception of psychological well-being. Our sample reported a lower level of psychological well-being; the participants' scores were below the normative cut-off in all components, except for depression symptoms. A lower expression of harm avoidance temperament and a lower level of daily sleepiness predicted a higher level of psychological well-being. Psychological well-being seemed to be severely affected in individuals affected by OSA syndrome and obesity. The temperament and subjective perception of daily alertness and sleepiness, rather than the syndrome severity, seemed to play a crucial role in the individual perception of the psychological well-being.
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Affiliation(s)
- Federica Scarpina
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Ilaria Bastoni
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Simone Cappelli
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Lorenzo Priano
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Emanuela Giacomotti
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Gianluca Castelnuovo
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Enrico Molinari
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Mauro Cornacchia
- IRCCS, U.O. di Riabilitazione Pneumologica, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Paolo Fanari
- IRCCS, U.O. di Riabilitazione Pneumologica, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Alessandro Mauro
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
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16
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Stevens D, Leong CWY, Cheung H, Arciuli J, Vakulin A, Kim JW, Openshaw HD, Rae CD, Wong KKH, Dijk DJ, Siong Leow JW, Saini B, Grunstein RR, D'Rozario AL. Sleep spindle activity correlates with implicit statistical learning consolidation in untreated obstructive sleep apnea patients. Sleep Med 2021; 86:126-134. [PMID: 33707093 DOI: 10.1016/j.sleep.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE/BACKGROUND The aim of this study was to examine the relationship between overnight consolidation of implicit statistical learning with spindle frequency EEG activity and slow frequency delta power during non-rapid eye movement (NREM) sleep in obstructive sleep apnea (OSA). PATIENTS/METHODS Forty-seven OSA participants completed the experiment. Prior to sleep, participants performed a reaction time cover task containing hidden patterns of pictures, about which participants were not informed. After the familiarisation phase, participants underwent overnight polysomnography. 24 h after the familiarisation phase, participants performed a test phase to assess their learning of the hidden patterns, expressed as a percentage of the number of correctly identified patterns. Spindle frequency activity (SFA) and delta power (0.5-4.5 Hz), were quantified from NREM electroencephalography. Associations between statistical learning and sleep EEG, and OSA severity measures were examined. RESULTS SFA in NREM sleep in frontal and central brain regions was positively correlated with statistical learning scores (r = 0.41 to 0.31, p = 0.006 to 0.044). In multiple regression, greater SFA and longer sleep onset latency were significant predictors of better statistical learning performance. Delta power and OSA severity were not significantly correlated with statistical learning. CONCLUSIONS These findings suggest spindle activity may serve as a marker of statistical learning capability in OSA. This work provides novel insight into how altered sleep physiology relates to consolidation of implicitly learnt information in patients with moderate to severe OSA.
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Affiliation(s)
- David Stevens
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Helena Cheung
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Joanne Arciuli
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Andrew Vakulin
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Jong-Won Kim
- Department of Healthcare IT, Inje University, Inje-ro 197, Kimhae, Kyunsangnam-do, 50834, South Korea
| | - Hannah D Openshaw
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - Caroline D Rae
- Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK; UK Dementia Research Institute at the University of Surrey, UK
| | - Josiah Wei Siong Leow
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - Bandana Saini
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; The University of Sydney, School of Psychology, Brain and Mind Centre and Charles Perkins Centre, Australia.
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17
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Miskedaki A, Vagiakis E, Bacopoulou F, Vlachakis D, Artemiadis A, Chrousos GP, Darviri C. The Role of Pythagorean Self-Awareness Intervention in Obstructive Sleep Apnea. A Randomized Controlled Trial. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:83-87. [DOI: 10.1007/978-3-030-78771-4_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Effects of Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea-Hypopnea Syndrome on Corneal Morphological Characteristics. Cornea 2020; 40:988-994. [PMID: 33201053 DOI: 10.1097/ico.0000000000002581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effects of continuous positive airway pressure (CPAP) therapy on corneal endothelial morphometry and pachymetry in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS This prospective, observational study included patients with OSAHS who were evaluated right before and after the commencement of CPAP treatment. Each patient underwent a detailed ophthalmologic examination and assessment of their corneal endothelium with a noncontact specular microscope (Tomey EM-3000; Tomey Corp). Endothelial cell density, coefficient of variation of cell area (CV), hexagonal cell appearance ratio (%Hex), and central corneal thickness were measured. The post-CPAP results were compared with the results of a control group. The differences in the corneal parameters between pre- and post-CPAP therapy of the OSAHS group were correlated with the pretreatment polysomnography results. RESULTS Twenty-seven distinct eyes of 27 patients recently diagnosed with OSAHS and 30 eyes of 30 healthy individuals were used for the statistical analysis. The mean age of patients with OSAHS was 54.2 ± 11.8 years, and after 9.6 months (range 3-18 mo) of good adherence to CPAP treatment, their CV values, indicating polymegathism, decreased from 41.7 ± 8.7 to 38.3 ± 5.8 (P = 0.04), whereas %Hex, indicating pleomorphism, increased from 45.8% ± 8.2% to 48.4% ± 6.6% (P = 0.008). Their post-CPAP corneal parameters did not differ significantly from those of the control group (P > 0.05). A significant positive correlation was observed between the decrease in CV and the duration of the treatment (Rs = 0.566, P = 0.002), as well as the pre-CPAP nonrapid eye movement (NREM) sleep percentage (Rs = 0.459, P = 0.02). A negative correlation was noted between the decrease in CV and the percentage of rapid eye movement (REM) sleep (Rs = -0.459, P = 0.02). CONCLUSIONS Better oxygenation during sleep, resulting from increased CPAP adherence, had a significant influence on corneal endothelium, providing an improvement in corneal polymegathism and pleomorphism, with a potential return of CV and %Hex to their normal values. Greater improvement in polymegathism was observed in patients with greater proportion of NREM sleep.
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19
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Olaithe M, Pushpanathan M, Hillman D, Eastwood PR, Hunter M, Skinner T, James A, Wesnes KA, Bucks RS. Cognitive profiles in obstructive sleep apnea: a cluster analysis in sleep clinic and community samples. J Clin Sleep Med 2020; 16:1493-1505. [PMID: 32400387 PMCID: PMC7970596 DOI: 10.5664/jcsm.8564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although cognitive dysfunction is a recognized consequence of untreated obstructive sleep apnea (OSA), the deficit pattern is heterogeneous. Understanding this heterogeneity may identify those at risk of cognitive deficits and guide intervention strategies. To facilitate understanding, we examined whether distinct profiles of neuropsychological performance were present in OSA and, if so, how they are related to other OSA features. METHODS We studied sleep clinic (n = 121) and community (n = 398) samples with moderate-severe OSA (apnea-hypopnea index ≥ 15 events/h). Attention and memory were assessed using the Cognitive Drug Research system. Sleep was assessed using polysomnography in the clinic sample and dual channel (flow, oximetry) portable monitoring in the community sample. Latent profile analysis was used to determine structure of cognitive clusters. Discriminant function analysis was used to examine associations between nocturnal and diurnal features of OSA and profile membership. RESULTS Both samples were best characterized by a 3-profile solution: (1) strong thinkers (performed well across most domains and showed greater cognitive reserve); (2) inattentive fast thinkers (strong processing speed but poor ability to maintain attention); and (3) accurate slow thinkers (strengths in maintaining attention but poor processing speed). Profile membership was associated with mean overnight oxygen saturation and cognitive reserve in the clinic sample and the presence of cardiovascular disease and/or diabetes in the community sample. CONCLUSIONS These findings help explain the diversity of outcomes in previous studies of cognitive dysfunction in OSA by demonstrating that individual differences in cognitive reserve, nocturnal oxygen saturation, and comorbidities affect how cognition is impacted by OSA.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Maria Pushpanathan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter R. Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Alan James
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
| | - Keith A. Wesnes
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Romola S. Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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20
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Baril AA, Gagnon K, Brayet P, Montplaisir J, Carrier J, Soucy JP, Lafond C, Blais H, d'Aragon C, Gagnon JF, Gosselin N. Obstructive sleep apnea during REM sleep and daytime cerebral functioning: A regional cerebral blood flow study using high-resolution SPECT. J Cereb Blood Flow Metab 2020; 40:1230-1241. [PMID: 30465610 PMCID: PMC7238367 DOI: 10.1177/0271678x18814106] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea (OSA) predominantly during rapid eye movement (REM) sleep may have impacts on brain health, even in milder OSA cases. Here, we evaluated whether REM sleep OSA is associated with abnormal daytime cerebral functioning using high-resolution single-photon emission computed tomography (SPECT). We tested 96 subjects (25 F, age: 65.2 ± 6.4) with a wide range of OSA severity from no OSA to severe OSA (apnea-hypopnea index: 0-97 events/h). More respiratory events during REM sleep were associated with reduced daytime regional cerebral blood flow (rCBF) in the bilateral ventromedial prefrontal cortex and in the right insula extending to the frontal cortex. More respiratory events during non-REM (NREM) sleep were associated with reduced daytime rCBF in the left sensorimotor and temporal cortex. In subjects with a lower overall OSA severity (apnea-hypopnea index<15), more respiratory events during REM sleep were also associated with reduced daytime rCBF in the insula and extending to the frontal cortex. Respiratory events that characterized OSA during NREM versus REM sleep are associated with distinct patterns of daytime cerebral perfusion. REM sleep OSA could be more detrimental to brain health, as evidenced by reduced daytime rCBF in milder forms of OSA.
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Affiliation(s)
- Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Pauline Brayet
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Jean-Paul Soucy
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Chantal Lafond
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada
| | - Caroline d'Aragon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
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21
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Pilot cohort study of obstructive sleep apnoea in community-dwelling people with schizophrenia. Ir J Psychol Med 2020; 38:23-29. [DOI: 10.1017/ipm.2020.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:We aimed to assess the incidence of obstructive sleep apnoea (OSA) in people with schizophrenia, to explore clinical associates with OSA and how well OSA screening tools perform in this population.Methods:All patients registered in a community outpatient Clozapine clinic, between January 2014 and March 2016, were consecutively approached to participate. Participants were screened for OSA using at home multichannel polysomnography (PSG) and were diagnosed with OSA if the apnoea-hypopnoea index (AHI) was >10 events/hr. Univariate comparison of participants to determine whether AHI > 10 events/hr was associated with demographic factors, anthropometric measures and psychiatric symptoms and cognition was performed. The sensitivity, specificity, positive predictive value and negative predictive value of the commonly used sleep symptoms scales and OSA screening tools were also determined.Results:Thirty participants were recruited, 24 men and 6 women. Mean age was 38.8 (range: 25–60), and mean body mass index (BMI) was 35.7 (range 19.9–62.1). The proportion of participants with OSA (AHI > 10 events/hr) was 40%, 18 (60%) had no OSA, 4 (13%) had mild OSA (AHI 10.1–20), zero participants had moderate OSA (AHI 20.1–30) and 8 (27%) had severe OSA (AHI > 30). Diagnosis of OSA was significantly associated with increased weight, BMI, neck circumference and systolic blood pressure. Diagnosis of OSA was not significantly associated with Positive and Negative Symptoms Scale, Montgomery Asperger’s Depression Rating Scale, Personal and Social Performance scale or Brief Assessment of Cognition for Schizophrenia scores. All OSA screening tools demonstrated poor sensitivity and specificity for a diagnosis of OSA.Conclusion:OSA was highly prevalent in this cohort of people with schizophrenia and was associated with traditional anthropometric OSA risk factors.
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Carneiro-Barrera A, Amaro-Gahete FJ, Sáez-Roca G, Martín-Carrasco C, R. Ruiz J, Buela-Casal G. Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study. J Clin Med 2019; 8:jcm8122099. [PMID: 31805748 PMCID: PMC6947599 DOI: 10.3390/jcm8122099] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/19/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
The prevalence and treatment response of depression and anxiety symptoms in obstructive sleep apnoea (OSA), although widely addressed in research and clinical settings, still remain unclear due to overlapping symptoms. The ADIPOSA study sought to elucidate the presence of non-overlapping symptoms of depression and anxiety in patients with moderate to severe OSA before and after continuous positive airway pressure (CPAP) treatment. Forty-eight adults aged 18-80 (68.75% men) with moderate to severe OSA were enrolled in this twelve-week longitudinal single-arm trial and completed a full-night ambulatory sleep diagnostic test and an assessment of cognitive-affective depression and anxiety symptoms using the Beck-Depression Inventory-Fast Screen (BDI-FS), the State-Trait Depression Inventory (IDER) and the State-Trait Anxiety Inventory (STAI). We found no cognitive-affective depression or anxiety symptoms of clinical relevance at baseline. The amelioration of depression and anxiety symptoms after CPAP use was only statistically significant when considering anxiety-trait (p < 0.01; d = 0.296) and euthymia (p < 0.05; d = 0.402), the distinctive component of depression. Although dysthymia or high negative affect remained unchanged, CPAP may be effective at reducing the lack of positive affect, a well-established health-protective factor. However, not until depression and anxiety disorders related to OSA are accurately measured in clinical and research settings will it be possible to obtain robust conclusions on the occurrence and amelioration of these symptoms after treatment.
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Affiliation(s)
- Almudena Carneiro-Barrera
- Sleep and Health Promotion Laboratory, Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain;
- Correspondence:
| | - Francisco J. Amaro-Gahete
- EFFECTS-262 Research group, Department of Medical Physiology, School of Medicine, University of Granada, 18071 Granada, Spain;
- PROmoting FITness and Health through physical activity research group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain;
| | - Germán Sáez-Roca
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, “Virgen de las Nieves” University Hospital, 18014 Granada, Spain; (G.S.-R.); (C.M.-C.)
| | - Carlos Martín-Carrasco
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, “Virgen de las Nieves” University Hospital, 18014 Granada, Spain; (G.S.-R.); (C.M.-C.)
| | - Jonatan R. Ruiz
- PROmoting FITness and Health through physical activity research group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain;
| | - Gualberto Buela-Casal
- Sleep and Health Promotion Laboratory, Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, 18011 Granada, Spain;
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23
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Kim JY, Ko I, Kim DK. Association of Obstructive Sleep Apnea With the Risk of Affective Disorders. JAMA Otolaryngol Head Neck Surg 2019; 145:1020-1026. [PMID: 31513273 DOI: 10.1001/jamaoto.2019.2435] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Obstructive sleep apnea (OSA) is a common subtype of sleep breathing disorder; however, the association between OSA and the psychological health of affected individuals has not been fully evaluated. Objective To investigate the association between OSA and development of affective disorders. Design, Setting, and Participants This study used a nationwide representative cohort sample from the Korea National Health Insurance Service-National Sample Cohort database comprising data from 1 025 340 patients. The study included 197 patients with OSA diagnosed between January 2004 and December 2006 and 780 individuals without OSA who were matched using propensity score matching. Data were analyzed from September 28, 2018, to March 30, 2019. Main Outcomes and Measures Affective disorder events over a 9-year follow-up period. Kaplan-Meier survival curves with log-rank tests and Cox proportional hazards regression models were used to calculate cumulative incidence and hazard ratios (HRs) of affective disorders for each group. Results Of the total population of 985 (860 male [87.3%], 540 [54.8%] were aged <45 years), the incidences per 1000 person-years of affective disorders were 49.57 and 27.18 in the OSA and comparison groups, respectively. A total of 1371.7 person-years in the OSA group and 6328.6 person-years in the comparison group were evaluated for affective disorder events. After adjustment for sociodemographic factors (age, residential area, and household income), disability, and comorbidities, the adjusted HRs for patients with OSA developing affective disorders in patients with OSA during the 9-year follow-up period was 2.04 (95% CI, 1.53-2.70). In a subgroup analysis, the adjusted HRs for patients with OSA who developed depressive and anxiety disorders were 2.90 (95% CI, 1.98-4.24) and 1.75 (95% CI, 1.26-2.44), respectively. Moreover, female patients with OSA had a significant likelihood of prospective development of depression and anxiety (adjusted HR for depression, 3.97 [95% CI, 1.54-10.19]; adjusted HR for anxiety, 2.42 [95% CI, 1.17-5.02]) compared with male patients with OSA (adjusted HR for depression, 2.74 [95% CI, 1.80-4.17]; adjusted HR for anxiety, 1.64 [95% CI, 1.13-2.39]). Conclusions and Relevance This observational study using nationwide data suggests that OSA is associated with an increased incidence of affective disorder, such as depression and anxiety. Further studies appear to be needed to confirm our findings and, if validated, then studies are needed to explore the nature of the observed association, including potential causality, between OSA and affective symptoms.
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Affiliation(s)
- Jong-Yeup Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea.,Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
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24
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Interdisciplinary Weight Loss and Lifestyle Intervention for Obstructive Sleep Apnoea in Adults: Rationale, Design and Methodology of the INTERAPNEA Study. Nutrients 2019; 11:nu11092227. [PMID: 31540168 PMCID: PMC6770131 DOI: 10.3390/nu11092227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022] Open
Abstract
Obesity is a major risk factor for obstructive sleep apnoea (OSA), the most common sleep-disordered breathing related to neurocognitive and metabolic syndromes, type II diabetes, and cardiovascular diseases. Although strongly recommended for this condition, there are no studies on the effectiveness of an interdisciplinary weight loss and lifestyle intervention including nutrition, exercise, sleep hygiene, and smoking and alcohol cessation. INTERAPNEA is a randomised controlled trial with a two-arm parallel design aimed at determining the effects of an interdisciplinary tailored weight loss and lifestyle intervention on OSA outcomes. The study will include 84 males aged 18–65 with a body mass index of ≥25 kg/m2 and severe to moderate OSA randomly assigned to usual care (i.e., continuous positive airway pressure), or interdisciplinary weight loss and lifestyle intervention combined with usual care. Outcomes will be measured at baseline, intervention end-point, and six-month post-intervention, including apnoea-hypopnoea index (primary outcome), other neurophysical and cardiorespiratory polysomnographic outcomes, sleep quality, daily functioning and mood, body weight and composition, physical fitness, blood biomarkers, health-related quality of life, and cost-effectiveness. INTERAPNEA may serve to establish a cost-effective treatment not only for the improvement of OSA and its vast and severe comorbidities, but also for a potential remission of this condition.
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25
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Lynch MK, Elliott LC, Avis KT, Schwebel DC, Goodin BR. Quality of Life in Youth With Obstructive Sleep Apnea Syndrome (OSAS) Treated With Continuous Positive Airway Pressure (CPAP) Therapy. Behav Sleep Med 2019; 17:238-245. [PMID: 28557581 PMCID: PMC7032644 DOI: 10.1080/15402002.2017.1326918] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE/BACKGROUND Improvement is sought for youth with obstructive sleep apnea syndrome (OSAS) who have poor quality of life (QoL), which resolves somewhat following treatment. One mitigating factor in improved QoL following treatment may be adherence to the CPAP protocol, which presents a barrier to most youth. This study explored relations between CPAP adherence and QoL in youth with OSAS. PARTICIPANTS We recruited 42 youth-caregiver dyads in which youth between the ages of 8 and 16 years were diagnosed with OSAS and required CPAP use as part of their treatment plan. METHODS Following diagnosis of OSAS requiring treatment with CPAP therapy, caregivers completed baseline measures of OSAS-specific QoL. The OSAS-specific QoL domains assessed included sleep disturbance, physical symptoms, emotional distress, daytime function, and caregiver concern. Families received routine CPAP care for three months, after which caregivers again completed measures of OSAS-specific QoL. Adherence data were collected from smartcards within the CPAP machine after three months of treatment. RESULTS Fifteen youth were adherent to CPAP therapy and 10 were not adherent. CPAP-adherent youth demonstrated significant changes in two domains of OSAS-specific QoL when compared to nonadherent youth: decreased sleep disturbance and decreased caregiver concern. CONCLUSIONS CPAP adherence appears to be associated with positive changes in OSAS-specific QoL domains. It will be important for future research and clinical work to examine strategies for improving CPAP adherence in youth with OSAS.
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Affiliation(s)
- Mary K. Lynch
- University of Alabama at Birmingham, Department of Psychology
| | | | - Kristin T. Avis
- University of Alabama at Birmingham, Department of Pediatrics
| | | | - Burel R. Goodin
- University of Alabama at Birmingham, Department of Psychology
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26
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Abstract
BACKGROUND The modalities of therapy for obstructive sleep apnoea (OSA) include behavioural and lifestyle modifications, positional therapy, oral appliances, surgery and continuous positive airway pressure therapy (CPAP). Though CPAP has proven efficacy in treating OSA, adherence with CPAP therapy is suboptimal. Positional therapy (to keep people sleeping on their side) is less invasive and therefore expected to have better adherence. This review considered the efficacy of positional therapy compared to CPAP as well as positional therapy against no positional therapy. Devices designed for positional therapy include lumbar or abdominal binders, semi-rigid backpacks, full-length pillows, a tennis ball attached to the back of nightwear, and electrical sensors with alarms that indicate change in position. OBJECTIVES To compare the efficacy of positional therapy versus CPAP and positional therapy versus inactive control (sham intervention or no positional therapy intervention) in people with OSA. SEARCH METHODS We identified studies from the Cochrane Airways' Specialised Register (including CENTRAL, MEDLINE, Embase, CINAHL, AHMED and PsycINFO), ClinicalTrials.gov, and the World Health Organization trials portal (ICTRP). It also contains results derived from handsearching of respiratory journals and abstract books of major annual meetings. We searched all databases from their inception to September 2018, with no restrictions on language of publication or publication type. SELECTION CRITERIA We included randomised controlled trials comparing positional therapy with CPAP and positional therapy with inactive control. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted the data. We used a random-effects model in the meta-analysis to estimate mean differences and confidence intervals. We assessed certainty of evidence using the GRADE approach. MAIN RESULTS We included eight studies. The studies randomised 323 participants into two types of interventions. The comparison between positional therapy and CPAP included 72 participants, while the comparison between positional therapy and inactive control included 251 participants. Three studies used supine vibration alarm devices, while five studies used physical positioning like specially designed pillows or semirigid backpacks.Positional therapy versus CPAPThe three studies included for this comparison were randomised cross-over trials. Two studies found that there was no difference in Epworth Sleepiness Scale (ESS) scores between CPAP and positional therapy. Two studies showed that CPAP produced a greater reduction in Apnoea-Hypopnoea Index (AHI) with a mean difference (MD) of 6.4 events per hour (95% CI 3.00 to 9.79; low-certainty evidence) compared to positional therapy. Subjective adherence, evaluated in one study, was found to be significantly greater with positional therapy (MD 2.5 hours per night, 95% CI 1.41 to 3.59; moderate-certainty evidence).In terms of secondary outcomes, one study each reported quality-of-life indices and quality-of-sleep indices with no significant difference between the two groups. One study reported cognitive outcomes using multiple parameters and found no difference between the groups. There were insufficient data to comment on other secondary outcomes like respiratory disturbance index (RDI), and frequency and duration of nocturnal desaturation. None of the studies clearly reported adverse effects.Positional therapy versus inactive controlThree studies of positional therapy versus no intervention were randomised cross-over trials, while two studies were parallel-arm studies. Data from two studies showed that positional therapy significantly improved ESS scores (MD -1.58, 95% CI -2.89 to -0.29; moderate-certainty evidence). Positional therapy showed a reduction in AHI compared with control (MD -7.38 events per hour, 95% CI -10.06 to -4.7; low-certainty evidence). One study reported adherence. The number of participants who continued to use the device at two months was no different between the two groups (odds ratio (OR) 0.80, 95% CI 0.33 to 1.94; low-certainty evidence). The same study reported adverse effects, the most common being pain in the back and chest, and sleep disturbance but there was no significant difference between the two groups in terms of device discontinuation (OR 1.25, 95% CI 0.5 to 3.03; low-certainty evidence). One study each reported quality-of-life indices and quality-of-sleep indices, with no significant difference between the two groups. One study reported cognitive outcome, and found no difference between the groups. There was insufficient evidence to comment on other secondary outcomes (RDI, frequency and duration of nocturnal desaturation). AUTHORS' CONCLUSIONS The review found that CPAP has a greater effect on improving AHI compared with positional therapy in positional OSA, while positional therapy was better than inactive control for improving ESS and AHI. Positional therapy may have better adherence than CPAP. There were no significant differences for other clinically relevant outcomes such as quality of life or cognitive function. All the studies were of short duration. We are unable to comment on the long-term effects of the therapies. This is important, as most of the quality-of-life outcomes will be evident only when the therapies are given over a longer period of time. The certainty of evidence was low to moderate.
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Affiliation(s)
- P R Srijithesh
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, India
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27
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Carneiro-Barrera A, Díaz-Román A, Guillén-Riquelme A, Buela-Casal G. Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta-analysis. Obes Rev 2019; 20:750-762. [PMID: 30609450 DOI: 10.1111/obr.12824] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Lifestyle interventions addressing diet, exercise-training, sleep hygiene, and/or tobacco/alcohol cessation are recommended in the management of obstructive sleep apnoea (OSA). Yet their effectiveness on this condition still requires further research. This systematic review and meta-analysis was aimed at establishing (a) the effectiveness of lifestyle interventions on apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), excessive daytime sleepiness (EDS), and secondary OSA measures among adults, and (b) which intervention characteristics may drive the greatest improvements. A systematic search of studies was conducted using CINAHL, ProQuest, Psicodoc, Scopus, and Web of Science, from inception to April 2018. Standardized mean differences were calculated using the inverse variance method and random-effects models. The meta-analyses of 13 randomized controlled trials and 22 uncontrolled before-and-after studies (1420 participants) revealed significant reductions on AHI (d = -0.61 and -0.46, respectively), ODI (d = -0.61 and -0.46) and EDS (d = -0.41 and -0.49). Secondary OSA outcomes were also improved after interventions. However, effectiveness of interventions differed depending on their components, OSA severity, and gender. Thus, until future research further supports the differential effectiveness among lifestyle interventions on OSA, those addressing weight loss through diet and exercise-training may be the most effective treatments for male patients with moderate-severe OSA.
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Affiliation(s)
| | - Amparo Díaz-Román
- Mind, Brain, and Behaviour Research Centre, CIMCYC, University of Granada, Granada, Spain
| | | | - Gualberto Buela-Casal
- Mind, Brain, and Behaviour Research Centre, CIMCYC, University of Granada, Granada, Spain
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28
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Shinoda M, Yamakawa T, Takahashi K, Nagakura J, Suzuki J, Sakamoto R, Kadonosono K, Terauchi Y. PREVALENCE OF OBSTRUCTIVE SLEEP APNEA DETERMINED BY THE WATCHPAT IN NONOBESE JAPANESE PATIENTS WITH POOR GLUCOSE CONTROL AND TYPE 2 DIABETES. Endocr Pract 2019; 25:170-177. [PMID: 30817196 DOI: 10.4158/ep-2018-0200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Diagnosing obstructive sleep apnea (OSA) usually involves high cost, patient inconvenience, and the need for examination at a specialized center. This study employed a portable, wearable, diagnostic device (WatchPAT) to investigate the prevalence of OSA in nonobese Japanese patients with type 2 diabetes. METHODS Patients with type 2 diabetes were tested for OSA over one night using the WatchPAT. Logistic regression analysis was used to estimate the odds ratios (ORs) of risk factors for OSA in nonobese subjects. RESULTS A total of 200 eligible patients with type 2 diabetes were studied (64.5% men; aged 60.1 ± 13.6 years; body mass index [BMI], 26.3 ± 5.2 kg/m2). When OSA was defined as apnea-hypopnea index ≥5/hour, its prevalence was 80.5%. The prevalence of OSA in subjects with a BMI <20 kg/m2, ≥20 and <25 kg/m2, ≥25 and <30 kg/m2, and ≥30 kg/m2 was 38.9%, 73.5%, 86.5%, and 97.5%, respectively. The severity of OSA increased in proportion to BMI, especially when the BMI was >25 kg/m2. The prevalence of OSA was also high (66.3%) in normal-weight subjects (BMI <25 kg/m2). Furthermore, the serum triglyceride level (OR, 1.01; 95% confidence interval, 1.00 to 1.02; P = .042) was significantly related to OSA. CONCLUSION A high prevalence of OSA was observed in this nonobese population of Japanese patients with type 2 diabetes. The triglyceride level was associated with OSA among nonobese patients. ABBREVIATIONS AHI = apnea-hypopnea Index; BMI = body mass index; CI = confidence interval; ESS = Epworth Sleepiness Scale; HbA1c = glycated hemoglobin; OR = odds ratio; OSA = obstructive sleep apnea; PAT = peripheral arterial tone; T2D = type 2 diabetes; TG = triglyceride.
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29
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Avis KT, Gamble KL, Schwebel DC. Effect of positive airway pressure therapy in children with obstructive sleep apnea syndrome: does positive airway pressure use reduce pedestrian injury risk? Sleep Health 2019; 5:161-165. [PMID: 30928116 PMCID: PMC6443098 DOI: 10.1016/j.sleh.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/16/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Treatment with positive airway pressure (PAP) therapy reduces injury risk among adults with obstructive sleep apnea syndrome (OSAS), but the effect of PAP therapy on children's injury risk is unknown. This study investigated whether treatment of OSAS with PAP reduces children's pedestrian injury risk in a virtual reality pedestrian environment. METHODS Forty-two children ages 8-16 years with OSAS were enrolled upon diagnosis by polysomnography. Children crossed a simulated street several times upon enrollment, prior to PAP treatment, and again after 3 months of PAP therapy. Children underwent sleep studies at all time points. RESULTS Children adherent with PAP had a significant reduction in hits by a virtual vehicle (P < .01) and less time to contact with oncoming vehicles (P < .01) following treatment. Those who were nonadherent did not show improved safety. There was no change in attention to oncoming traffic. CONCLUSIONS OSAS may have significant consequences on children's daytime functioning in a critical domain of personal safety: pedestrian skills. In pedestrian simulation, children with OSAS adherent to PAP therapy showed improvement in pedestrian safety and had fewer collisions with a virtual vehicle following treatment. Results highlight need for heightened awareness of the real-world benefits of treatment for pediatric sleep disorders. LEVEL OF EVIDENCE Level II Therapeutic Study.
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Affiliation(s)
- Kristin T Avis
- University of Alabama at Birmingham, Department of Pediatrics, Birmingham, AL
| | - Karen L Gamble
- University of Alabama at Birmingham, Department of Psychiatry, Birmingham, AL
| | - David C Schwebel
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL.
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30
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Botokeky E, Freymond N, Gormand F, Le Cam P, Chatte G, Kuntz J, Liegeon MN, Gaillot-Drevon M, Massardier-Pilonchery A, Fiquemont A, Fort E, Marcu M, Petitjean T, Charbotel B. Benefit of continuous positive airway pressure on work quality in patients with severe obstructive sleep apnea. Sleep Breath 2019; 23:753-759. [PMID: 30685849 DOI: 10.1007/s11325-018-01773-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of this prospective study was to assess the effect of CPAP therapy on job productivity and work quality for patients with severe obstructive sleep apnea (OSA). METHODS A convenience sample of patients diagnosed with severe OSA using polysomnography or polygraphy and with a therapeutic indication for CPAP was enrolled in our study. Patients completed two self-administered questionnaires: the first before CPAP therapy and the second during the first 6 months after CPAP treatment. OSA symptoms were evaluated through self-administered questionnaires assessing potential effects on occupational activity: excessive daytime sleepiness was rated by the Epworth Sleepiness Scale (ESS), emotional status was rated by the Hospital Anxiety and Depression (HAD) scale, work quality was rated by the Work Role Functioning Questionnaire (WRFQ). RESULTS Forty patients (30 men, mean age 47.3 ± 8.3, mean BMI 31.6 ± 7.4, mean apnea-hypopnea index 51.8 ± 16.3) showed a beneficial effect of CPAP therapy on ESS score (mean 11.6 to 8.2, p < 0.0001), the anxiety dimension (mean 57.5% to 20%, p = 0.0002), and the overall anxiety-depressive score (mean 50% to 22.5%, p = 0.0006). Mean WRFQ scores were significantly improved in the second questionnaire for the dimensions of timetable requirements (69.3% to 83.5%, p < 0.0001), productivity requirements (71.4% to 82.2%, p < 0.0001), mental requirements (72.0% to 84.3%, p < 0.0001), and social requirements (82.6% to 91.4%, p < 0.003). CONCLUSIONS We observed that adherence to CPAP therapy for patients with severe OSA mitigates the impact of symptoms on work including excessive daytime sleepiness, impairment of work ability, and anxiety and depressive disorders.
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Affiliation(s)
- Elsa Botokeky
- Department of Occupational Diseases, CHU Lyon, Pierre-Bénite, France. .,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMRESTTE, UMR T_9405, 8 avenue Rockefeller, 69373, Lyon, France.
| | - N Freymond
- Department of Respiratory Medicine, Centre Hospitalier Lyon Sud, CHU Lyon, Pierre-Bénite, France
| | - F Gormand
- Department of Sleep Disorders, Centre Hospitalier Croix Rousse, CHU Lyon, Lyon, France
| | - P Le Cam
- Department of Sleep Disorders, Centre Hospitalier Croix Rousse, CHU Lyon, Lyon, France
| | - G Chatte
- Private Practice Pneumology, 42 Rue Jean Moulin, 69300, Caluire-et-Cuire, France
| | - J Kuntz
- Private Practice Pneumology, 42 Rue Jean Moulin, 69300, Caluire-et-Cuire, France
| | - M N Liegeon
- Private Practice Pneumology, 42 Rue Jean Moulin, 69300, Caluire-et-Cuire, France
| | - M Gaillot-Drevon
- Department of Respiratory Medicine, Centre Hospitalier Lyon Sud, CHU Lyon, Pierre-Bénite, France
| | - A Massardier-Pilonchery
- Department of Occupational Diseases, CHU Lyon, Pierre-Bénite, France.,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMRESTTE, UMR T_9405, 8 avenue Rockefeller, 69373, Lyon, France
| | - A Fiquemont
- University Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008, Lyon, France
| | - E Fort
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMRESTTE, UMR T_9405, 8 avenue Rockefeller, 69373, Lyon, France
| | - M Marcu
- Department of Respiratory Medicine, Centre Hospitalier Lyon Sud, CHU Lyon, Pierre-Bénite, France
| | - T Petitjean
- Department of Sleep Disorders, Centre Hospitalier Croix Rousse, CHU Lyon, Lyon, France
| | - B Charbotel
- Department of Occupational Diseases, CHU Lyon, Pierre-Bénite, France.,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMRESTTE, UMR T_9405, 8 avenue Rockefeller, 69373, Lyon, France
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D'Rozario AL, Field CJ, Hoyos CM, Naismith SL, Dungan GC, Wong KKH, Grunstein RR, Bartlett DJ. Impaired Neurobehavioural Performance in Untreated Obstructive Sleep Apnea Patients Using a Novel Standardised Test Battery. Front Surg 2018; 5:35. [PMID: 29868603 PMCID: PMC5968192 DOI: 10.3389/fsurg.2018.00035] [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] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Objective/Background Although polysomnography (PSG) is the gold-standard measure for assessing disease severity in obstructive sleep apnea (OSA), it has limited value in identifying individuals experiencing significant neurobehavioural dysfunction. This study used a brief and novel computerised test battery to examine neurobehavioural function in adults with and without OSA. Patients/Methods 204 patients with untreated OSA [age 49.3 (12.5) years; body mass index, [BMI] 33.6 (8.0) kg/m2; Epworth sleepiness scale 12 (4.9)/24; apnea hypopnea index 33.6 (25.8)/h] and 50 non-OSA participants [age 39.2 (14.0) years; BMI 25.8 (4.2) kg/m2, ESS 3.6 (2.3)/24]. All participants completed a computerised neurobehavioural battery during the daytime in the sleep clinic. The OSA group subsequently underwent an overnight PSG. The 30 min test battery assessed cognitive domains of visual spatial scanning and selective attention (Letter Cancellation Test), executive function (Stroop task) and working memory (2- and 3-Back tasks), and a validated sustained attention task (psychomotor vigilance task, PVT). Group differences in performance were compared. Associations between disease severity and performance were examined in the OSA group. Results After controlling for age, gender and education, OSA patients demonstrated impaired performance on the Stroop-Text, 2 and 3-Back tasks, and the PVT compared with the non-OSA group. OSA patients had worse performance on the LCT with fewer average hits albeit with better accuracy. Some OSA polysomnographic disease severity measures were weakly correlated with performance. Conclusions This brief test battery may provide a sensitive, standardised method of assessing daytime dysfunction in OSA.
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Affiliation(s)
- Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Clarice J Field
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Camilla M Hoyos
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - George C Dungan
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital and Sydney Local Health District, Camperdown, NSW, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital and Sydney Local Health District, Camperdown, NSW, Australia
| | - Delwyn J Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Hoshino T, Sasanabe R, Tanigawa T, Murotani K, Arimoto M, Ueda H, Shiomi T. Effect of rapid eye movement-related obstructive sleep apnea on adherence to continuous positive airway pressure. J Int Med Res 2018; 46:2238-2248. [PMID: 29614906 PMCID: PMC6023053 DOI: 10.1177/0300060518758583] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by respiratory events such as apnea and hypopnea predominately or exclusively during REM sleep. Several studies have revealed clinical predictors of adherence to the use of continuous positive airway pressure (CPAP). However, the effect of REM-related OSA on adherence to CPAP use remains unclear. Therefore, we investigated the effects of REM-related OSA on adherence to CPAP use 6 months after treatment initiation. Methods We enrolled 161 patients in this study and divided them into 3 groups: the good adherence, poor adherence, and dropout groups. We compared polysomnographic data and clinical findings, including those regarding morbidity of REM-related OSA, among the three groups to identify predictors of adherence to CPAP use. Results None of the 43 patients in the good adherence group had REM-related OSA. Multivariate logistic regression analysis of the good adherence and dropout groups indicated that REM-related OSA was the only factor associated with adherence to CPAP use (odds ratio, 41.984; 95% confidence interval, 2.257–781.007). Conclusions REM-related OSA is a reliable risk factor for dropout from CPAP therapy.
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Affiliation(s)
- Tetsuro Hoshino
- 1 Department of Otorhinolaryngology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ryujiro Sasanabe
- 2 Department of Sleep Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Tohru Tanigawa
- 1 Department of Otorhinolaryngology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kenta Murotani
- 3 Center for Clinical Research, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mariko Arimoto
- 1 Department of Otorhinolaryngology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiromi Ueda
- 1 Department of Otorhinolaryngology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Toshiaki Shiomi
- 2 Department of Sleep Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Rizzo D, Libman E, Creti L, Baltzan M, Bailes S, Fichten C, Lavigne G. Determinants of policy decisions for non-commercial drivers with OSA: An integrative review. Sleep Med Rev 2018; 37:130-137. [DOI: 10.1016/j.smrv.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
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Jackson ML, McEvoy RD, Banks S, Barnes M. Neurobehavioral Impairment and CPAP Treatment Response in Mild-Moderate Obstructive Sleep Apneas. J Clin Sleep Med 2018; 14:47-56. [PMID: 29198304 DOI: 10.5664/jcsm.6878] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 09/29/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The degree of neurobehavioral impairment and treatment response in mild-moderate obstructive sleep apnea (OSA) compared to that of an appropriate control group are unclear. This study compared neurobehavioral function and response to continuous positive airway pressure (CPAP) treatment in patients with mild to moderate OSA with those of a non-sleep apneic community sample of similar demography. METHODS One hundred ten patients with OSA and 31 asymptomatic community dwellers underwent overnight polysomnography and neurobehavioral testing. Participants with OSA (n = 88) were treated with CPAP for 3 months, and repeat evaluations were performed at the end of the treatment period. RESULTS Compared to the community sample, participants with OSA were significantly sleepier, had impaired mood and quality of life, and showed decrements in neuropsychological function, specifically psychomotor function, working memory and vigilance. Some neuropsychological and mood outcomes were normalized with CPAP, but significant decrements persisted in most outcomes even in those participants with adequate device usage. CONCLUSIONS Patients with mild to moderate OSA have significant neurobehavioral morbidity. During "gold standard" treatment, normal function was not achieved, even with adequate device usage. CPAP efficacy for improving sleepiness and neuropsychological function in this milder end of the OSA spectrum may be poor, which may affect CPAP adherence. These findings suggest that there may be neurological changes related to OSA that do not respond to CPAP treatment, the etiology of which requires further investigation.
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Affiliation(s)
- Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health: Flinders Centre of Research Excellence Flinders University, Bedford Park, South Australia, Australia
| | - Siobhan Banks
- Centre for Sleep Research, University of South Australia, Adelaide, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, The University of Melbourne, Victoria, Australia
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Lee MC, Shen YC, Wang JH, Li YY, Li TH, Chang ET, Wang HM. Effects of continuous positive airway pressure on anxiety, depression, and major cardiac and cerebro-vascular events in obstructive sleep apnea patients with and without coronary artery disease. Tzu Chi Med J 2018; 29:218-222. [PMID: 29296051 PMCID: PMC5740695 DOI: 10.4103/tcmj.tcmj_128_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Obstructive sleep apnea (OSA) is associated with bad cardiovascular outcomes and a high prevalence of anxiety and depression. This study investigated the effects of continuous positive airway pressure (CPAP) on the severity of anxiety and depression in OSA patients with or without coronary artery disease (CAD) and on the rate of cardio- and cerebro-vascular events in those with OSA and CAD. Materials and Methods: This prospective study included patients with moderate-to-severe OSA, with or without a recent diagnosis of CAD; all were started on CPAP therapy. Patients completed the Chinese versions of the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline and after 6-month follow-up. The occurrence of major adverse cardiac and cerebrovascular events (MACCE) was assessed every 3 months up to 1 year. Results: BAI scores decreased from 8.5 ± 8.4 at baseline to 5.4 ± 6.9 at 6 months in CPAP-compliant OSA patients without CAD (P < 0.05). BAI scores also decreased from 20.7 ± 14.9 to 16.1 ± 14.5 in CPAP-compliant OSA patients with CAD. BDI-II scores decreased in CPAP-compliant OSA patients without CAD (from 11.1 ± 10.7 at baseline to 6.6 ± 9.5 at 6 months) and in CPAP-compliant OSA patients with CAD (from 20.4 ± 14.3 to 15.9 ± 7.3). In addition, there was a large effect size (ES) of BAI and BDI in 6-month CPAP treatment of OSA patients with CAD and a large ES in those with OSA under CPAP treatment. In OSA patients with CAD, the occurrence of MACCE was significantly lower in CPAP-compliant patients than that in CPAP noncompliant patients (11% in CPAP compliant and 50% in noncompliant; P < 0.05). Conclusions: CPAP improved anxiety and depression in OSA patients regardless of CAD. In OSA patients with CAD, CPAP-compliant patients had a lower 1-year rate of MACCE than CPAP-noncompliant patients.
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Affiliation(s)
- Ming-Chung Lee
- Department of Human Development and Psychology, College of Humanities and Social Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Cardiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yu-Ying Li
- Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tzu-Hsien Li
- Department of Human Development and Psychology, College of Humanities and Social Sciences, Tzu Chi University, Hualien, Taiwan.,Department of Psychiatry, Pingtung Branch of Kaohsiung Armed Forces General Hospital, Pingtung, Taiwan
| | - En-Ting Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Chest, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hsiu-Mei Wang
- Department of Chest, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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36
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Devita M, Zangrossi A, Marvisi M, Merlo P, Rusconi ML, Mondini S. Global cognitive profile and different components of reaction times in obstructive sleep apnea syndrome: Effects of continuous positive airway pressure over time. Int J Psychophysiol 2018; 123:121-126. [DOI: 10.1016/j.ijpsycho.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/12/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022]
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The effectiveness of two types of MADS for OSA therapy. Clin Oral Investig 2017; 22:1995-2003. [PMID: 29214378 PMCID: PMC5945916 DOI: 10.1007/s00784-017-2290-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 11/21/2017] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to determine differences in effectiveness between two types of mandibular advancement device (MAD). MATERIAL AND METHODS In this retrospective, cohort study, the two devices used were MAD type "Somnodent-Flex" (MAD 1) and MAD type "Herbst" (MAD 2). One hundred thirty-seven patients participated in this study, 67 patients were treated with MAD 1, and 70 patients with MAD 2. The indication MAD with obstructive sleep apnea (OSA) is based on a polysomnography test, in accordance with the CBO guidelines. The effectiveness of MAD therapy can be determined by a second polysomnography test (with the MAD in situ). The apnea-hypopnea index (AHI) is registered during the first and the second polysomnography test. Changes in these values determine the effectiveness. RESULTS A significant decrease in AHI was found regarding T1 and T2 for both the MADs: F (1, 134) = 140,850, p < 0,001. The mean differences of both the MADs turned out to correlate to T1. After correcting for this covariance, there was no significant difference between the two MAD devices regarding the AHI value: F (1, 134) = 1160, p = 0,283. CONCLUSIONS The results of the present study show no significant difference in effectiveness between MAD 1 and MAD 2 in respect to the AHI value. CLINICAL RELEVANCE Since 2012, healthcare insurance companies in the Netherlands refunds MAD type "Somnodent" used for treatment of sleep apnea. It is important to investigate if this type of MAD is as more effective or less effective as other types of MADs. If research points out that other MADs are more effective in reducing the sleep apnea, refund policies have to be adapted.
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Zhu Z, Zhang F, Liu Y, Yang S, Li C, Niu Q, Niu J. Relationship of Obstructive Sleep Apnoea with Diabetic Retinopathy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4737064. [PMID: 29230409 PMCID: PMC5694589 DOI: 10.1155/2017/4737064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/04/2017] [Indexed: 12/27/2022]
Abstract
Until now, the relationship of obstructive sleep apnoea (OSA) with diabetic retinopathy (DR) was controversial. This meta-analysis was performed to obtain definitive conclusion on this topic. Relevant articles were searched on databases of Pubmed, Google Scholar, and Chinese National Knowledge Infrastructure (CNKI). The articles were selected according to inclusion and exclusion criteria. Odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the relationship of OSA with risk of DR. I2 and P value were used to assess the presence of heterogeneity. I2 ≥ 50% or P < 0.05 indicated significant heterogeneity. Sensitivity analysis was performed to evaluate the robustness of pooled results. Begg's funnel plot and Egger's regression analysis were adopted to assess publication bias. 6 eligible studies were selected in the present meta-analysis. The pooled results indicated that OSA was significantly associated with increased risk of DR (OR = 2.01, 95% CI = 1.49-2.72). Subgroup analysis based on type of diabetes mellitus suggested that OSA was related to DR in both Type 1 and Type 2 diabetes mellitus. Sensitivity analysis demonstrated that pooled results were robust. No significant publication bias was observed (P = 0.128). The results indicate that OSA is related to increased risk of DR.
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Affiliation(s)
- Zhenliu Zhu
- Ophthalmology Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Fengying Zhang
- Otorhinolaryngological Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Yunxia Liu
- Outpatient Operating Room, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Shuqin Yang
- Otorhinolaryngological Department, Weifang People's Hospital, 151 Guangwen Street, Kuiwen District, Weifang 261000, China
| | - Chunting Li
- Yantai KangAi Eye Hospital, 26 Zhichu Road, Zhifu District, Yantai 264000, China
| | - Qingliang Niu
- Imaging Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
| | - Jinming Niu
- Otorhinolaryngological Department, Weifang Traditional Chinese Hospital, 1055 Weizhou Road, Kuiwen District, Weifang 261000, China
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Effect of continuous positive airway pressure on regional cerebral blood flow in patients with severe obstructive sleep apnea syndrome. Sleep Med 2017; 32:122-128. [DOI: 10.1016/j.sleep.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/19/2022]
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40
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CPAP Treatment Partly Normalizes Sleep Spindle Features in Obstructive Sleep Apnea. SLEEP DISORDERS 2017; 2017:2962479. [PMID: 28261503 PMCID: PMC5312446 DOI: 10.1155/2017/2962479] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/26/2016] [Accepted: 01/15/2017] [Indexed: 11/24/2022]
Abstract
Objective. Obstructive sleep apnea (OSA) decreases sleep spindle density and frequency. We evaluated the effects of continuous positive airway pressure (CPAP) treatment on different features of sleep spindles. Methods. Twenty OSA patients underwent two night polysomnographies in a diagnostic phase and one night polysomnography after 6 months of CPAP treatment. The control group comprised 20 healthy controls. Sleep spindles were analyzed by a previously developed automated method. Unilateral and bilateral spindles were identified in central and frontopolar brain locations. Spindle density and frequency were determined for the first and last half of the NREM time. Results. The density of bilateral central spindles, which did not change in the untreated OSA patients, increased towards the morning hours during CPAP treatment and in the controls. Central spindles did not become faster with sleep in OSA patients and the central spindles remained slow in the left hemisphere even with CPAP. Conclusion. CPAP treatment normalized spindle features only partially. The changes may be associated with deficits in thalamocortical spindle generating loops. Significance. This study shows that some sleep spindle changes persist after CPAP treatment in OSA patients. The association of these changes to daytime symptoms in OSA patients needs to be further evaluated.
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Rehling T, Banghøj AM, Kristiansen MH, Tarnow L, Molsted S. Reduced Inspiratory Muscle Strength in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnoea. J Diabetes Res 2017; 2017:4121794. [PMID: 29147664 PMCID: PMC5632871 DOI: 10.1155/2017/4121794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/05/2017] [Accepted: 08/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. METHODS Patients with T2DM with OSA (n = 33) and without OSA (n = 28) were included. The maximum IMS was tested using the POWERbreathe KH2 device. Reference IMS values were data calculated using an algorithm based on general populations and adjusted for age and gender. RESULTS There was no difference in IMS between the OSA group (median (range) 77 (35-124) cmH2O) and the non-OSA group (84 (33-122) cmH2O) (p = 0.97). The IMS values were reduced in the OSA group compared with the reference values (92.9 (62.3-100.0) cmH2O) (p = 0.030), whereas the non-OSA group did not have reduced IMS. When the IMS values of all T2DM patients were compared with reference values, the IMS values were 79 (33-124) cmH2O and 93.8 (62.3-102.4) cmH2O, respectively (p = 0.017). CONCLUSION No difference in IMS between patients with T2DM with or without OSA was found. However, patients with T2DM and OSA had reduced IMS compared with age- and gender-matched references whereas the non-OSA group did not have reduced IMS.
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Affiliation(s)
- Thomas Rehling
- University College (UCC) Department of Physiotherapy, Hillerød, Denmark
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Anne Margareta Banghøj
- Department of Cardiology, Nephrology & Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Lise Tarnow
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
- Health, Aarhus University, Aarhus, Denmark
| | - Stig Molsted
- Department of Cardiology, Nephrology & Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
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42
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Banghoej AM, Nerild HH, Kristensen PL, Pedersen-Bjergaard U, Fleischer J, Jensen AEK, Laub M, Thorsteinsson B, Tarnow L. Obstructive sleep apnoea is frequent in patients with type 1 diabetes. J Diabetes Complications 2017; 31:156-161. [PMID: 28029582 DOI: 10.1016/j.jdiacomp.2016.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 01/03/2023]
Abstract
AIM Obstructive Sleep Apnoea (OSA) is frequent in patients with type 2 diabetes. The aim of this study is to evaluate prevalence of OSA in patients with type 1 diabetes. METHODS In a cross-sectional design, all patients with type 1 diabetes attending the outpatient clinic were offered screening for OSA for one night with the ApneaLink+ home-monitoring device. OSA was classified by the Apnoea-Hypopnea index (AHI; apnoeas/hypopneas per hour sleep). Symptoms of OSA were scored using the Epworth Sleepiness Score. Presence of autonomic neuropathy was evaluated by the Vagus® device. RESULTS A total of 200 of 518 eligible patients with type 1 diabetes (39%) participated (68% men; age 52±15years (mean±SD), diabetes duration 24±14years and BMI 25.3±3.3kg/m2). OSA was diagnosed in 92 patients (46% (95% CI: 40-53)). Five patients had known OSA, and OSA was newly diagnosed in 87 patients, predominantly mild OSA (60 patients (69%)). OSA was present in 32% of the patients with normal BMI, in 60% of overweight patients, and in 61% of obese patients. Patients with type 1 diabetes and OSA were largely asymptomatic and did not report more sleepiness than patients without OSA. At multivariate analysis, age, BMI and presence of nephropathy were positively associated with risk of OSA. CONCLUSIONS The prevalence of asymptomatic OSA is high in a cohort of patients with type 1 diabetes. Older age, overweight, and presence of nephropathy are associated with OSA.
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Affiliation(s)
- Anne Margareta Banghoej
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød.
| | - Henriette Holst Nerild
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød
| | - Peter Lommer Kristensen
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød
| | - Ulrik Pedersen-Bjergaard
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | | | | | - Birger Thorsteinsson
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lise Tarnow
- Nordsjællands University Hospital, Department of Cardiology, Nephrology and Endocrinology, Hillerød; Aarhus University Hospital, Medical Research Laboratory, Aarhus
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Avellar AB, Carvalho LB, Prado GF, Prado LB. Pharmacotherapy for residual excessive sleepiness and cognition in CPAP-treated patients with obstructive sleep apnea syndrome: A systematic review and meta-analysis. Sleep Med Rev 2016; 30:97-107. [DOI: 10.1016/j.smrv.2015.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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44
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Werli KS, Otuyama LJ, Bertolucci PH, Rizzi CF, Guilleminault C, Tufik S, Poyares D. Neurocognitive function in patients with residual excessive sleepiness from obstructive sleep apnea: a prospective, controlled study. Sleep Med 2016; 26:6-11. [PMID: 28007359 DOI: 10.1016/j.sleep.2016.06.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate neurocognitive function in adult patients with residual excessive sleepiness (RES) after appropriate treatment of obstructive sleep apnea (OSA) with CPAP and good adherence to treatment. METHODS This was a prospective controlled study. We included patients of both sexes, aged 35-60 years with OSA and an apnea-hypopnea index >20 ev/h, effectively treated with CPAP, but with a residual Epworth Sleepiness Scale score ≥11. The control group consisted of OSA patients adequately treated with CPAP who did not present with excessive sleepiness after treatment. Both groups underwent the following evaluations: polysomnography, multiple sleep latency testing, depression symptoms, and cognitive assessment. RESULTS Regarding baseline characteristics, the data were matched for age, years of study, and body mass index. Long-term memory result did not show a significant difference between the two groups (RES group 4.7 ± 2.0; control group 6.5 ± 1.9; p = 0.08). The executive functions were the most affected, with alterations in Wisconsin test, number of categories (RES group: 1.6 ± 1.4; control group: 3.0 ± 1.4; p = 0.01), and semantic verbal fluency test (RES group: 13.6 ± 3.3; control group: 16.9 ± 4.3; p = 0.04). CONCLUSION In summary, the mean depression scale score in the group with residual excessive sleepiness was significantly higher than that in the control group. Patients with residual excessive sleepiness showed impairment of executive functions but no impairments in other cognitive domains.
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Affiliation(s)
- Ksdy S Werli
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Leonardo J Otuyama
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo H Bertolucci
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila F Rizzi
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
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Joyeux-Faure M, Naegelé B, Pépin JL, Tamisier R, Lévy P, Launois SH. Continuous positive airway pressure treatment impact on memory processes in obstructive sleep apnea patients: a randomized sham-controlled trial. Sleep Med 2016; 24:44-50. [PMID: 27810185 DOI: 10.1016/j.sleep.2016.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/20/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the changes in a large panel of memory processes after six weeks of continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. This randomized controlled trial compared the influence of effective CPAP to sham CPAP over six weeks on different memory processes in OSA patients. METHODS The study took place in a sleep laboratory and outpatient sleep clinic in a French tertiary-care university hospital. A total of 36 patients with OSA were randomized to receive either CPAP (n = 18) or sham CPAP (n = 18) for six weeks. Interventions were either effective CPAP or non-effective sham CPAP, for six weeks. All patients underwent an extensive battery of tasks evaluating three separate memory systems, before and after treatment. Verbal episodic memory was tested after forced encoding, procedural memory was tested using simplified versions of mirror drawing and reading tests, and working memory was examined with validated paradigms based on a theoretical model. RESULTS The study subjects were 55 ± 11 years of age and 72.2% were male. The mean body mass index was 29.5 ± 4.1 kg/m2 and the apnea-hypopnea index was 37.1 ± 16.3/h. Prior to treatment, memory performances of OSA patients were altered. In an intention-to-treat analysis, memory deficits were not significantly improved after six weeks of effective CPAP compared to sham CPAP treatment. Verbal episodic, procedural, and working memory scores were comparable between both groups. CONCLUSION Using cautious methodology in comparing effective CPAP to sham CPAP and a well-defined set of memory assessments, we did not find improvement in memory performance after six weeks of treatment.
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Affiliation(s)
- Marie Joyeux-Faure
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France.
| | - Bernadette Naegelé
- Neuro-Vascular Department, Grenoble University Hospital, Grenoble, France; Inserm U836, Grenoble Neurosciences Institut, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
| | - Patrick Lévy
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
| | - Sandrine H Launois
- HP2 Unit, Inserm U1042, Grenoble Alpes University, Grenoble, France; Department of Physiology and Sleep, Grenoble University Hospital, Grenoble, France
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Garbarino S, Lanteri P, Durando P, Magnavita N, Sannita WG. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E831. [PMID: 27548196 PMCID: PMC4997517 DOI: 10.3390/ijerph13080831] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/15/2022]
Abstract
Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.
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Affiliation(s)
- Sergio Garbarino
- Center of Sleep Medicine, Genoa 16132, Italy.
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy.
| | - Paola Lanteri
- Child Neurology and Psychiatry Unit, Istituto Giannina Gaslini, Genoa 16148, Italy.
| | - Paolo Durando
- Department of Health Sciences, Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino IST, Genoa 16132, Italy.
| | - Nicola Magnavita
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
| | - Walter G Sannita
- Center of Sleep Medicine, Genoa 16132, Italy.
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy.
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Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study. Sleep Breath 2016; 21:243-253. [PMID: 27495797 DOI: 10.1007/s11325-016-1389-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/07/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea. METHODS This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea. RESULTS Of 5415, 154 patients with sleep apnea (2.84 %) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13 %) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24). CONCLUSIONS There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.
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Li YY, Mazarakis T, Shen YC, Yang MC, Chang ET, Wang HM. Anxiety and depression are improved by continuous positive airway pressure treatments in obstructive sleep apnea. Int J Psychiatry Med 2016. [PMID: 28629298 DOI: 10.1177/0091217417696737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Obstructive sleep apnea involves repeated nocturnal desaturation and sleep fragmentation that leads to poor sleep quality, anxiety, and depression. This study aimed to investigate short- and long-term improvements in the anxiety and depression of patients with different obstructive sleep apnea treatments. Methods This is a prospective, non-randomized hospital-based study evaluated 55 patients (46 male, 9 female) with obstructive sleep apnea. The patients were divided into three groups based on different treatment: uvulopalatopharyngoplasty group, continuous positive airway pressure group, and no treatment group (by their own decision). They completed the Beck Depression Inventory II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index before treatment and at one and six months after treatment. Results Compared to the no treatment group, the surgery and continuous positive airway pressure groups had higher body mass index, AHI, and Epworth sleepiness scale, but no difference in Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory. The continuous positive airway pressure and surgery groups still had no improvements in Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory scores one month after treatment. At six months after treatment, the continuous positive airway pressure group had significantly decreased Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory, whereas the surgery group had significant difference in Beck Anxiety Inventory only and the no treatment group still had no significant difference in any of the parameters. Conclusions Continuous positive airway pressure can improve the sleep quality, quality of life, depression, and anxiety of obstructive sleep apnea patients after six months of treatment. However, surgery can significantly improve anxiety only in the same period.
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Affiliation(s)
- Yu-Ying Li
- 1 Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Thodoris Mazarakis
- 1 Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Yu-Chih Shen
- 2 Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,3 School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Miao-Chun Yang
- 4 Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - En-Ting Chang
- 3 School of Medicine, Tzu Chi University, Hualien, Taiwan.,5 Division of Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hsiu-Mei Wang
- 5 Division of Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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The effect of treating obstructive sleep apnea with positive airway pressure on depression and other subjective symptoms: A systematic review and meta-analysis. Sleep Med Rev 2016; 28:55-68. [DOI: 10.1016/j.smrv.2015.07.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/26/2015] [Accepted: 07/13/2015] [Indexed: 01/18/2023]
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50
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Jurádo-Gámez B, Guglielmi O, Gude F, Buela-Casal G. Effects of continuous positive airway pressure treatment on cognitive functions in patients with severe obstructive sleep apnoea. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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