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Richards DP, Miller DL, MacDonald ED, Stewart QF, Miller SD. Rotator Cuff Tears Are Related to the Side Sleeping Position. Arthrosc Sports Med Rehabil 2024; 6:100886. [PMID: 38328528 PMCID: PMC10847686 DOI: 10.1016/j.asmr.2024.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To determine whether there was a relationship between sleep position and symptomatic partial- and full-thickness rotator cuff tears. Methods A consecutive series of patients that met the inclusion/exclusion criteria (n = 58) were in seen in clinic between July 2019 and December 2019. All of these individuals had a significant partial-thickness (> 50%) or full-thickness rotator cuff tear determined by either ultrasound, magnetic resonance imaging, or both. All patients in this series either had an insidious onset of shoulder pain or their symptoms were related to the basic wear and tear of daily activities. Traumatic rotator cuff tears (those associated with a significant traumatic event such as shoulder instability, motor vehicle accidents, sports related injuries, etc.) were excluded. Previous shoulder surgery, recurrent rotator cuff tears, and worker's compensation cases also were excluded from this series. As part of the history-taking process, the patients were asked what was their preferred sleeping position-side sleeper, back sleeper, or stomach sleeper. A χ2 test was conducted to determine the relationship between rotator cuff pathology and sleep position. Results Of the 58 subjects, 52 of the patients were side sleepers, 4 were stomach sleepers, 1 was a back sleeper, and 1 preferred all 3 positions. Statistical analysis, using the χ2 test (P < .0001), demonstrated that rotator cuff tears were most often seen in side sleepers. Conclusions In our study, there appeared to be a relationship between the preference of being a side sleeper and the presence of a rotator cuff tear. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- David P. Richards
- West Virginia University – Eastern Division – Charles Town, West Virginia, U.S.A
- Rocky Mountain Health – Calgary, Alberta, Canada
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2
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Kummer RL, Marini JJ. The Respiratory Mechanics of COVID-19 Acute Respiratory Distress Syndrome-Lessons Learned? J Clin Med 2024; 13:1833. [PMID: 38610598 PMCID: PMC11012401 DOI: 10.3390/jcm13071833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a well-defined clinical entity characterized by the acute onset of diffuse pulmonary injury and hypoxemia not explained by fluid overload. The COVID-19 pandemic brought about an unprecedented volume of patients with ARDS and challenged our understanding and clinical approach to treatment of this clinical syndrome. Unique to COVID-19 ARDS is the disruption and dysregulation of the pulmonary vascular compartment caused by the SARS-CoV-2 virus, which is a significant cause of hypoxemia in these patients. As a result, gas exchange does not necessarily correlate with respiratory system compliance and mechanics in COVID-19 ARDS as it does with other etiologies. The purpose of this review is to relate the mechanics of COVID-19 ARDS to its underlying pathophysiologic mechanisms and outline the lessons we have learned in the management of this clinic syndrome.
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Affiliation(s)
- Rebecca L. Kummer
- Department of Pulmonary and Critical Care Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - John J. Marini
- Department of Pulmonary and Critical Care Medicine, Regions Hospital, St. Paul, MN 55101, USA
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3
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Katz J, Sanapo L, Bublitz MH, Guillen M, Avalos A, Aldana A, Wilson D, Bourjeily G. Longitudinally assessed maternal sleep position, measures of breathing during sleep, and fetal growth in high-risk pregnancies. Sleep 2024; 47:zsad315. [PMID: 38108687 PMCID: PMC10851852 DOI: 10.1093/sleep/zsad315] [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: 08/16/2023] [Revised: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
STUDY OBJECTIVES Subjective recall of supine sleep during pregnancy has been linked to increased risk of stillbirth, but longitudinal, objective data are lacking. We aimed to examine how sleep position and breathing parameters change throughout pregnancy, and investigated associations between maternal supine sleep, assessed objectively in early and late gestation, and fetal growth velocity in high-risk women. METHODS Women with singleton pregnancies and body mass index (BMI) ≥27 kg/m2 underwent level-III sleep apnea testing. Sleep position was assessed by accelerometry. We derived percentiles of estimated fetal weight and birthweight using FetalGPSR software, then calculated growth velocity as change in percentile/week between the second-trimester anatomy scan and birth. RESULTS In total, 446 women were included, with N = 126 in the longitudinal sleep pattern analysis and N = 83 in the fetal growth analysis. Sleep-onset position and predominant sleep position were significantly correlated in both early (p = 0.001) and late (p < 0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. Between early and late pregnancy there was a reduction in predominant supine sleepers (51.6% to 30.2%). Percent of sleep spent supine and oxygen desaturation index, in the third trimester, were significantly associated after BMI adjustment (B = 0.018, p = 0.04). Models did not suggest significant effects of early or late pregnancy supine sleep on growth velocity (p > 0.05). CONCLUSIONS Going-to-bed position predicts predominant supine sleep in less than half of women with overweight and obesity. Time spent supine throughout pregnancy correlates with measures of sleep-disordered breathing. Maternal sleep position patterns did not affect fetal growth velocity in this high-risk population, but the study was not powered to detect differences.
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Affiliation(s)
- Juliana Katz
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Departments of Medicine and Psychiatry and Human Behavior
| | - Laura Sanapo
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Departments of Medicine and Psychiatry and Human Behavior
- Department of Medicine and Psychiatry and Human Behavior, The Miriam Hospital, Women’s Medicine Collaborative, Providence, RI, USA
| | - Margaret H Bublitz
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Departments of Medicine and Psychiatry and Human Behavior
- Department of Medicine and Psychiatry and Human Behavior, The Miriam Hospital, Women’s Medicine Collaborative, Providence, RI, USA
| | - Melissa Guillen
- Department of Medicine and Psychiatry and Human Behavior, The Miriam Hospital, Women’s Medicine Collaborative, Providence, RI, USA
| | - Ashanti Avalos
- Department of Medicine and Psychiatry and Human Behavior, The Miriam Hospital, Women’s Medicine Collaborative, Providence, RI, USA
| | - Annaly Aldana
- Department of Medicine and Psychiatry and Human Behavior, The Miriam Hospital, Women’s Medicine Collaborative, Providence, RI, USA
| | - Danielle Wilson
- School of Engineering and Computer Science, Institute for Breathing and Sleep, Austin Health, VIC, Brisbane Qld, Australia
| | - Ghada Bourjeily
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Departments of Medicine and Psychiatry and Human Behavior
- Department of Medicine and Psychiatry and Human Behavior, The Miriam Hospital, Women’s Medicine Collaborative, Providence, RI, USA
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Sayed RKA, Hibbert JE, Jorgenson KW, Hornberger TA. The Structural Adaptations That Mediate Disuse-Induced Atrophy of Skeletal Muscle. Cells 2023; 12:2811. [PMID: 38132132 PMCID: PMC10741885 DOI: 10.3390/cells12242811] [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: 11/11/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
The maintenance of skeletal muscle mass plays a fundamental role in health and issues associated with quality of life. Mechanical signals are one of the most potent regulators of muscle mass, with a decrease in mechanical loading leading to a decrease in muscle mass. This concept has been supported by a plethora of human- and animal-based studies over the past 100 years and has resulted in the commonly used term of 'disuse atrophy'. These same studies have also provided a great deal of insight into the structural adaptations that mediate disuse-induced atrophy. For instance, disuse results in radial atrophy of fascicles, and this is driven, at least in part, by radial atrophy of the muscle fibers. However, the ultrastructural adaptations that mediate these changes remain far from defined. Indeed, even the most basic questions, such as whether the radial atrophy of muscle fibers is driven by the radial atrophy of myofibrils and/or myofibril hypoplasia, have yet to be answered. In this review, we thoroughly summarize what is known about the macroscopic, microscopic, and ultrastructural adaptations that mediated disuse-induced atrophy and highlight some of the major gaps in knowledge that need to be filled.
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Affiliation(s)
- Ramy K. A. Sayed
- Department of Comparative Biosciences, University of Wisconsin—Madison, Madison, WI 53706, USA; (R.K.A.S.); (J.E.H.); (K.W.J.)
- School of Veterinary Medicine, University of Wisconsin—Madison, Madison, WI 53706, USA
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, Sohag University, Sohag 82524, Egypt
| | - Jamie E. Hibbert
- Department of Comparative Biosciences, University of Wisconsin—Madison, Madison, WI 53706, USA; (R.K.A.S.); (J.E.H.); (K.W.J.)
- School of Veterinary Medicine, University of Wisconsin—Madison, Madison, WI 53706, USA
| | - Kent W. Jorgenson
- Department of Comparative Biosciences, University of Wisconsin—Madison, Madison, WI 53706, USA; (R.K.A.S.); (J.E.H.); (K.W.J.)
- School of Veterinary Medicine, University of Wisconsin—Madison, Madison, WI 53706, USA
| | - Troy A. Hornberger
- Department of Comparative Biosciences, University of Wisconsin—Madison, Madison, WI 53706, USA; (R.K.A.S.); (J.E.H.); (K.W.J.)
- School of Veterinary Medicine, University of Wisconsin—Madison, Madison, WI 53706, USA
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Kember AJ, Selvarajan R, Park E, Huang H, Zia H, Rahman F, Akbarian S, Taati B, Hobson SR, Dolatabadi E. Vision-based detection and quantification of maternal sleeping position in the third trimester of pregnancy in the home setting-Building the dataset and model. PLOS DIGITAL HEALTH 2023; 2:e0000353. [PMID: 37788239 PMCID: PMC10547173 DOI: 10.1371/journal.pdig.0000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/17/2023] [Indexed: 10/05/2023]
Abstract
In 2021, the National Guideline Alliance for the Royal College of Obstetricians and Gynaecologists reviewed the body of evidence, including two meta-analyses, implicating supine sleeping position as a risk factor for growth restriction and stillbirth. While they concluded that pregnant people should be advised to avoid going to sleep on their back after 28 weeks' gestation, their main critique of the evidence was that, to date, all studies were retrospective and sleeping position was not objectively measured. As such, the Alliance noted that it would not be possible to prospectively study the associations between sleeping position and adverse pregnancy outcomes. Our aim was to demonstrate the feasibility of building a vision-based model for automated and accurate detection and quantification of sleeping position throughout the third trimester-a model with the eventual goal to be developed further and used by researchers as a tool to enable them to either confirm or disprove the aforementioned associations. We completed a Canada-wide, cross-sectional study in 24 participants in the third trimester. Infrared videos of eleven simulated sleeping positions unique to pregnancy and a sitting position both with and without bed sheets covering the body were prospectively collected. We extracted 152,618 images from 48 videos, semi-randomly down-sampled and annotated 5,970 of them, and fed them into a deep learning algorithm, which trained and validated six models via six-fold cross-validation. The performance of the models was evaluated using an unseen testing set. The models detected the twelve positions, with and without bed sheets covering the body, achieving an average precision of 0.72 and 0.83, respectively, and an average recall ("sensitivity") of 0.67 and 0.76, respectively. For the supine class with and without bed sheets covering the body, the models achieved an average precision of 0.61 and 0.75, respectively, and an average recall of 0.74 and 0.81, respectively.
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Affiliation(s)
- Allan J. Kember
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Shiphrah Biomedical Inc., Toronto, Canada
| | - Rahavi Selvarajan
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | - Emma Park
- Shiphrah Biomedical Inc., Toronto, Canada
| | - Henry Huang
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Hafsa Zia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Farhan Rahman
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | | | - Babak Taati
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Vector Institute, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, Canada
| | - Elham Dolatabadi
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Vector Institute, Toronto, Canada
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Gędek A, Koziorowski D, Szlufik S. Assessment of factors influencing glymphatic activity and implications for clinical medicine. Front Neurol 2023; 14:1232304. [PMID: 37767530 PMCID: PMC10520725 DOI: 10.3389/fneur.2023.1232304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The glymphatic system is a highly specialized fluid transport system in the central nervous system. It enables the exchange of the intercellular fluid of the brain, regulation of the movement of this fluid, clearance of unnecessary metabolic products, and, potentially, brain immunity. In this review, based on the latest scientific reports, we present the mechanism of action and function of the glymphatic system and look at the role of factors influencing its activity. Sleep habits, eating patterns, coexisting stress or hypertension, and physical activity can significantly affect glymphatic activity. Modifying them can help to change lives for the better. In the next section of the review, we discuss the connection between the glymphatic system and neurological disorders. Its association with many disease entities suggests that it plays a major role in the physiology of the whole brain, linking many pathophysiological pathways of individual diseases.
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Affiliation(s)
- Adam Gędek
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
- Praski Hospital, Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Szlufik
- Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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7
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Gnarra O, Breuss A, Rossi L, Fujs M, Knobel SEJ, Warncke JD, Gerber SM, Bassetti CLA, Riener R, Nef T, Schmidt MH. Transferability of a Sensing Mattress for Posture Classification from Research into Clinics. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941201 DOI: 10.1109/icorr58425.2023.10304684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Sleep is crucial in rehabilitation processes, promoting neural plasticity and immune functions. Nocturnal body postures can indicate sleep quality and frequent repositioning is required to prevent bedsores for bedridden patients after a stroke or spinal cord injury. Polysomnography (PSG) is considered the gold standard for sleep assessment. Unobtrusive methods for classifying sleep body postures have been presented with similar accuracy to PSG, but most evaluations have been done in research lab environments. To investigate the challenges in the usability of a previously validated device in a clinical setting, we recorded the sleep posture of 17 patients with a sensorized mattress. Ground-truth labels were collected automatically from a PSG device. In addition, we manually labeled the body postures using video data. This allowed us also to evaluate the quality of the PSG labels. We trained neural networks based on the VGG-3 architecture to classify lying postures and used a self-label correction method to account for noisy labels in the training data. The models trained with the video labels achieved a higher classification accuracy than those trained with the PSG labels (0.79 vs. 0.68). The self-label correction could further increase the models' scores based on video and PSG labels to 0.80 and 0.70, respectively. Unobtrusive sensors validated in clinics can, therefore, potentially improve the quality of care for bedridden patients and advance the field of rehabilitation.
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Castillo-Escario Y, Blanco-Almazan D, Ferrer-Lluis I, Jane R. Measuring High-Resolution Sleep Position in Adolescents over 4 Nights with Smartphone Accelerometers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082890 DOI: 10.1109/embc40787.2023.10341202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Sleep position affects sleep quality and the severity of different diseases. Classical methods to measure sleep position are complex, expensive, and difficult to use outside the laboratory. Wearables and smartphones can help to address these issues to track sleep position at home over several nights. In this study, we monitor high-resolution sleep position in 13 adolescents over 4 nights using smartphone accelerometer data. We aim to investigate the distribution of sleep positions and position changes in adolescents, study their variability across nights, and propose new measures related to nocturnal body movements. We developed a new index, the mean sleep angle change per hour, and calculated three other measures: position shifts per hour, mean time at each position, and periods of immobility. Our results indicate that participants spent 56% of the time on the side (32% right and 24% left), 32% in supine, and 12% in prone position, similar to what happens in adults. However, adolescents moved more than adults during sleep according to all measures. There was some variability between nights, but lower than the inter-subject variability. In conclusion, this work systematically analyzes sleep position over several nights in adolescents, a largely unstudied population, and offers innovative solutions and measures for high-resolution sleep position monitoring in a simple and cost-effective way.Clinical Relevance- Our study characterizes sleep position in adolescents and provides novel unobtrusive methods and quantitative indices to monitor high-resolution sleep position at home during multiple nights.
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9
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Fong SL, Dy Closas AMF, Lim TT, Lean PL, Loh EC, Lim SY, Tan AH. From parasomnia to agrypnia excitata - An illustrative case on diagnostic approach. Parkinsonism Relat Disord 2023; 109:105332. [PMID: 36948111 DOI: 10.1016/j.parkreldis.2023.105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
The diagnostic approach to sleep-related movements disorders is seldom discussed. We report a case of fatal familial insomnia who initially presented with persistent limb movements in sleep, which later progressed to a state of agrypnia excitata. Here, the evaluation of abnormal movements in sleep is discussed using a step-by-step diagnostic approach. Although no cure is available for fatal familial insomnia, prompt recognition of this condition is important to facilitate proper management, including the involvement of interdisciplinary neuropalliative care.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Alfand Marl F Dy Closas
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Phooi Leng Lean
- Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia
| | - Ee Chin Loh
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Kerkamm F, Dengler D, Eichler M, Materzok-Köppen D, Belz L, Neumann FA, Zyriax BC, Harth V, Oldenburg M. Sleep Architecture and Sleep-Related Breathing Disorders of Seafarers on Board Merchant Ships: A Polysomnographic Pilot Field Study on the High Seas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3168. [PMID: 36833863 PMCID: PMC9962439 DOI: 10.3390/ijerph20043168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
As seafarers are assumed to have an increased risk profile for sleep-related breathing disorders, this cross-sectional observational study measured (a) the feasibility and quality of polysomnography (PSG) on board merchant ships, (b) sleep macro- and microarchitecture, (c) sleep-related breathing disorders, such as obstructive sleep apnea (OSA), using the apnea-hypopnea index (AHI), and (d) subjective and objective sleepiness using the Epworth Sleepiness Scale (ESS) and pupillometry. Measurements were carried out on two container ships and a bulk carrier. A total of 19 out of 73 male seafarers participated. The PSG's signal qualities and impedances were comparable to those in a sleep laboratory without unusual artifacts. Compared to the normal population, seafarers had a lower total sleep time, a shift of deep sleep phases in favor of light sleep phases as well as an increased arousal index. Additionally, 73.7% of the seafarers were diagnosed with at least mild OSA (AHI ≥ 5) and 15.8% with severe OSA (AHI ≥ 30). In general, seafarers slept in the supine position with a remarkable frequency of breathing cessations. A total of 61.1% of the seafarers had increased subjective daytime sleepiness (ESS > 5). Pupillometry results for objective sleepiness revealed a mean relative pupillary unrest index (rPUI) of 1.2 (SD 0.7) in both occupational groups. In addition, significantly poorer objective sleep quality was found among the watchkeepers. A need for action with regard to poor sleep quality and daytime sleepiness of seafarers on board is indicated. A slightly increased prevalence of OSA among seafarers is likely.
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Affiliation(s)
- Fiona Kerkamm
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Dorothee Dengler
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Matthias Eichler
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Danuta Materzok-Köppen
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Lukas Belz
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Felix Alexander Neumann
- Preventive Medicine and Nutrition, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Preventive Medicine and Nutrition, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
| | - Marcus Oldenburg
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Thapa-Chhetry B, Jose Arguello D, John D, Intille S. Detecting Sleep and Nonwear in 24-h Wrist Accelerometer Data from the National Health and Nutrition Examination Survey. Med Sci Sports Exerc 2022; 54:1936-1946. [PMID: 36007161 PMCID: PMC9615811 DOI: 10.1249/mss.0000000000002973] [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] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Estimating physical activity, sedentary behavior, and sleep from wrist-worn accelerometer data requires reliable detection of sensor nonwear and sensor wear during both sleep and wake. PURPOSE This study aimed to develop an algorithm that simultaneously identifies sensor wake-wear, sleep-wear, and nonwear in 24-h wrist accelerometer data collected with or without filtering. METHODS Using sensor data labeled with polysomnography ( n = 21) and directly observed wake-wear data ( n = 31) from healthy adults, and nonwear data from sensors left at various locations in a home ( n = 20), we developed an algorithm to detect nonwear, sleep-wear, and wake-wear for "idle sleep mode" (ISM) filtered data collected in the 2011-2014 National Health and Nutrition Examination Survey. The algorithm was then extended to process original raw data collected from devices without ISM filtering. Both algorithms were further validated using a polysomnography-based sleep and wake-wear data set ( n = 22) and diary-based wake-wear and nonwear labels from healthy adults ( n = 23). Classification performance (F1 scores) was compared with four alternative approaches. RESULTS The F1 score of the ISM-based algorithm on the training data set using leave-one-subject-out cross-validation was 0.95 ± 0.13. Validation on the two independent data sets yielded F1 scores of 0.84 ± 0.60 for the data set with sleep-wear and wake-wear and 0.94 ± 0.04 for the data set with wake-wear and nonwear. The F1 score when using original, raw data was 0.96 ± 0.08 for the training data sets and 0.86 ± 0.18 and 0.97 ± 0.04 for the two independent validation data sets. The algorithm performed comparably or better than the alternative approaches on the data sets. CONCLUSIONS A novel machine-learning algorithm was designed to recognize wake-wear, sleep-wear, and nonwear in 24-h wrist-worn accelerometer data that are applicable for ISM-filtered data or original raw data.
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Affiliation(s)
- Binod Thapa-Chhetry
- Bouvé College of Health Sciences, Northeastern University, Boston, MA
- Khoury College of Computer Sciences, Northeastern University, Boston, MA
| | | | - Dinesh John
- Khoury College of Computer Sciences, Northeastern University, Boston, MA
| | - Stephen Intille
- Bouvé College of Health Sciences, Northeastern University, Boston, MA
- Khoury College of Computer Sciences, Northeastern University, Boston, MA
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Wieczorek T, Michałek-Zrąbkowska M, Więckiewicz M, Mazur G, Rymaszewska J, Smardz J, Wojakowska A, Martynowicz H. Sleep Bruxism Contributes to Motor Activity Increase during Sleep in Apneic and Nonapneic Patients-A Polysomnographic Study. Biomedicines 2022; 10:biomedicines10102666. [PMID: 36289928 PMCID: PMC9599859 DOI: 10.3390/biomedicines10102666] [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: 09/30/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Jaw motor activity (MA) in sleep bruxism (SB) has been demonstrated to accompany lower limb movements. However, it remains unknown whether SB activity coexists with other types of movements and what the possible underlying mechanisms of such temporal coexistence are. In obstructive sleep apnea (OSA), increased movement activity is also reported, including SB activity; however, no studies have compared MA in apneic and nonapneic SB patients. Aim: This cross-sectional study focused on the phenomenon of “big body movements” in patients with either SB or OSA (or both) and intended to identify the primary factors contributing to their appearance, using polysomnography (PSG) recording. Methods: A whole-night videoPSG was carried out in 287 participants, and 124 apneic and 146 nonapneic participants were selected for the study. In both groups, participants were further divided into no SB, moderate SB, and severe SB (SSB) subgroups based on their bruxism episode index (BEI). MA was recorded using a built-in sensor of the central PSG unit located on the participant’s chest during the examination. Results: The presence of SB was related to the higher intensity of MA in both apneic and nonapneic participants, though in general the MA level was higher in apneic participants, with the highest level observed in SSB apneic participants. Conclusions: SB might contribute to MA. The prevalence of SB might be higher in nonapneic patients due to phasic and mixed SB activity, whereas the SB phenotype seems to be less relevant in apneic patients. SB activity is likely to increase MA in non-REM 1 sleep.
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Affiliation(s)
- Tomasz Wieczorek
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence:
| | - Monika Michałek-Zrąbkowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mieszko Więckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Joanna Rymaszewska
- Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Wojakowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
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15
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Influence of the device used for obstructive sleep apnea diagnosis on body position: a comparison between polysomnography and portable monitor. Sleep Breath 2022; 27:887-891. [DOI: 10.1007/s11325-022-02674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
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An Enhanced Posture Prediction-Bayesian Network Algorithm for Sleep Posture Recognition in Wireless Body Area Networks. Int J Telemed Appl 2022; 2022:3102545. [PMID: 35642188 PMCID: PMC9148412 DOI: 10.1155/2022/3102545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Wireless body area networks have taken their unique recognition in providing consistent facilities in health monitoring. Several studies influence physiological signal monitoring through a centralized approach using star topology in regular activities like standing, walking, sitting, and running which are considered active postures. Unlike regular activities like walking, standing, sitting, and running, the in-bed sleep posture monitoring of a subject is highly necessary for those who have undergone surgery, victims of breathing problems, and victims of COVID-19 for whom oxygen imbalance is a major issue as the mortality rate in sleep is high due to unattended patients. Suggestions from the medical field state that the patients with the above-mentioned issues are highly suggested to follow the prone sleep posture that enables them to maintain the oxygen level in the human body. A distributed model of communication is used where mesh topology is used for the data packets to be carried in a relay fashion to the sink. Heartbeat rate (HBR) and image monitoring of the subject during sleep are closely monitored and taken as input to the proposed posture prediction-Bayesian network (PP-BN) to predict the consecutive postures to increase the accuracy rate of posture recognition. The accuracy rate of the model outperforms the existing classification and prediction algorithms which take the cleaned dataset as input for better prediction results.
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Fransson AMC, Isacsson G, Nohlert E. The outcome of oral appliance therapy on position-dependent obstructive sleep apnea: A multicenter randomized controlled trial. Am J Orthod Dentofacial Orthop 2022; 162:386-393. [PMID: 35562290 DOI: 10.1016/j.ajodo.2021.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This multicenter trial on patients with obstructive sleep apnea (OSA) treated with an oral appliance aimed to determine the effect of sleeping positions. METHODS A cohort of 314 patients with OSA were enrolled and evaluated at 8 weeks and 1 year, focusing on treatment effects. At baseline and the 2 follow-ups, new polygraphic registration comparing the proportion of treatment responders without position-dependent OSA (non-position-dependent OSA [non-POSA]) and with POSA was used. RESULTS At the 8-week and 1-year follow-up, 205 and 139 patients were included, respectively. The proportion of responders (apnea-hypopnea index [AHI] <10 and/or ≥50% reduction in AHI) was 56% for the non-POSA group and 69% for the POSA group (not significant [NS]). The responders increased at the 1-year follow-up: 68% and 77% for the non-POSA and POSA groups (NS), respectively. The absolute change in AHI in all sleeping positions at 8 weeks was -12.9 (interquartile range, -25.0 to -0.5) in the non-POSA group and -10.5 (interquartile range, -19.9 to -5.3; NS) in the POSA group. However, the decrease in supine AHI was significantly greater among subjects with POSA. In contrast, the decrease in nonsupine AHI was significantly greater in the non-POSA group, an effect that remained at the 1-year follow-up. CONCLUSIONS Our hypothesis that subjects with POSA at baseline would have a higher treatment response rate after oral appliance treatment compared with subjects without POSA was rejected. However, those with POSA had a significantly higher supine AHI decrease, and those without POSA had significantly less nonsupine AHI.
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Affiliation(s)
- Anette M C Fransson
- Department of Dental Research, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Göran Isacsson
- Department of Orofacial Pain and Jaw function, Västmanland County Hospital, Västerås, Sweden
| | - Eva Nohlert
- Region Vastmanland - Uppsala University Centre for Clinical Research, Vastmanland Hospital, Västerås, Sweden
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Bolton R, Hulshof H, Daanen HAM, van Dieën JH. Effects of mattress support on sleeping position and low-back pain. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To determine the efficacy of decreasing spinal curvature – when sleeping laterally – in reducing low-back pain (LBP) and improving sleep quality in people with chronic LBP. Secondly, to investigate whether sleeping positions, nocturnal movements, and skin temperature are related to pain in people with chronic LBP.
Methods
Sixteen subjects with chronic LBP (50% female, mean age 45.6 ± 13.1 years) slept for one night on their own mattress, followed by three nights on an experimental mattress – designed to reduce spinal curvature in lateral sleeping positions – and then a final night again on their own mattress. Sleep positions, nocturnal movements, skin temperature, and room temperature were measured throughout the five nights. Numerical pain ratings for pain while lying, pain on rising, stiffness on rising, sleep quality, and mattress comfort were recorded for both mattresses.
Results
The experimental mattress was associated with 18% (p<.05) lower pain scores while lying and a 25% (p<.01) higher comfort rating. Pain on rising, stiffness on rising, and sleep quality were not different between own and experimental mattress. The relationship between sleep positions and pain scores was non-significant, but pain when rising was positively correlated with nocturnal movement (p<.05) and skin temperature was negatively correlated with pain while lying (p<0.05).
Conclusion
Pain while lying in bed decreased and comfort was higher for the experimental mattress compared to the participants’ own mattresses.
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Cerritelli L, Caranti A, Migliorelli A, Bianchi G, Stringa LM, Bonsembiante A, Cammaroto G, Pelucchi S, Vicini C. Sleep position and obstructive sleep apnea (OSA): Do we know how we sleep? A new explorative sleeping questionnaire. Sleep Breath 2022; 26:1973-1981. [DOI: 10.1007/s11325-022-02576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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Smits EJ, Salomoni S, Costa N, Rodríguez-Romero B, Hodges PW. How reliable is measurement of posture during sleep: real-world measurement of body posture and movement during sleep using accelerometers. Physiol Meas 2022; 43. [PMID: 34986463 DOI: 10.1088/1361-6579/ac482f] [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: 08/10/2021] [Accepted: 01/05/2022] [Indexed: 11/12/2022]
Abstract
Objective Understanding sleeping behaviours could improve prevention and treatment of sleep problems and associated health conditions. This study aimed to evaluate a method to assess body posture and movement during sleep using trunk-worn accelerometers for 28 days. Approach Participants (50 adults with low back pain (66% female); aged 32(±9) years) wore two activPAL-micro sensors (thigh, trunk) during their normal daily life for 28 consecutive days. Parameters related to body posture (e.g., time spent lying supine or prone) and movement (e.g., number of turns) during sleep were calculated for each night. Average values for each parameter were identified for different periods, the Spearman-Brown Prophecy Formula was used to estimate the minimum number of nights required to obtain a reliable estimate of each parameter, and repeatability of measures between different weeks was calculated. Main Results Participants spent 8.1(±0.8) hours asleep and most time (44%) was spent in a supine posture. The minimum number of nights required for reliable estimates varied between sleep parameters, range 4-21 nights. The most stable parameters (i.e., requiring less than seven nights) were "average activity", "no. of turns", "time spent prone", and "posture changes in the first hour". Some measures differed substantially between weeks. Significance Most sleep parameters related to body posture and movement require a week or more of monitoring to provide reliable estimates of behaviour over one month. Notably, one week may not reflect behaviour in another week, and the time varying nature of sleep needs to be considered.
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Affiliation(s)
- Esther Josefina Smits
- School of Health and Rehabilitation Sciences, The University of Queensland, 84A Services Road, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Sauro Salomoni
- School of Health and Rehabilitation Sciences, The University of Queensland, 84A services Road, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Nathalia Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, 84A services road, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Beatriz Rodríguez-Romero
- Department of Physiotherapy, Medicine and Biomedical Sciences, University of A Coruna, Campus de Oza, A Coruna, A Coruna, 15001, SPAIN
| | - Paul W Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, 84A Services Rd, Saint Lucia, Queensland, 4072, AUSTRALIA
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Cary D, Jacques A, Briffa K. Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study. PLoS One 2021; 16:e0260582. [PMID: 34847195 PMCID: PMC8631621 DOI: 10.1371/journal.pone.0260582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/14/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Research with a focus on sleep posture has been conducted in association with sleep pathologies such as insomnia and positional obstructive sleep apnoea. Research examining the potential role sleep posture may have on waking spinal symptoms and quality of sleep is however limited. The aims of this research were to compare sleep posture and sleep quality in participants with and without waking spinal symptoms. METHODS Fifty-three participants (36 female) were, based on symptoms, allocated to one of three groups; Control (n = 20, 16 female), Cervical (n = 13, 10 female) and Lumbar (n = 20, 10 female). Participants completed an online survey to collect general information and patient reported outcomes and were videoed over two consecutive nights to determine sleep posture using a validated classification system including intermediate sleep postures. RESULTS Participants in the symptomatic groups also reported a lower sleep quality than the Control group. Compared to Control group participants, those in the Cervical group had more frequent posture changes (mean (SD); 18.3(6.5) versus 23.6(6.6)), spent more time in undesirable/provocative sleep postures (median IQR; 83.8(16.4,105.2) versus 185.1(118.0,251.8)) minutes and had more long periods of immobility in a provocative posture, (median IQR: 0.5(0.0,1.5) versus 2.0 (1.5,4.0)). There were no significant differences between the Control and Lumbar groups in the number of posture changes (18.3(6.5) versus 22.9(9.1)) or the time spent in provocative sleep postures (0.5(0.0,1.5) versus 1.5(1.5,3.4)) minutes. DISCUSSION This is the first study using a validated objective measure of sleep posture to compare symptomatic and Control group participants sleeping in their home environment. In general, participants with waking spinal symptoms spent more time in provocative sleep postures, and experienced poorer sleep quality.
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Affiliation(s)
- Doug Cary
- School of Allied Health, Faculty of Health Science, Curtin University, Bentley, Western Australia, Australia
- Esperance Physiotherapy, Esperance, Western Australia, Australia
| | - Angela Jacques
- School of Allied Health, Faculty of Health Science, Curtin University, Bentley, Western Australia, Australia
| | - Kathy Briffa
- School of Allied Health, Faculty of Health Science, Curtin University, Bentley, Western Australia, Australia
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22
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The Effect of Sleep Position Preference on Eyelid and Eyebrow Symmetry. Ophthalmic Plast Reconstr Surg 2021; 38:266-269. [PMID: 34652313 DOI: 10.1097/iop.0000000000002066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between sleep position preference and eyebrow and eyelid position and degree of upper eyelid dermatochalasis. METHODS A prospective study evaluating the impact of sleep position on facial asymmetry was conducted at an academic ophthalmology department. Eligibility criteria included the absence of periocular-altering trauma or surgery, contact lens use, or other periorbital disease processes. Patients reported their sleep position preference on a questionnaire. Standardized digital photographs of patients were obtained, and Image J software was used for measurements and converted into millimeters based on a standard corneal limbus-to-limbus ratio. Upper and lower eyelid position, upper eyelid dermatochalasis, and eyebrow position were assessed by the following image-derived measurements: marginal reflex distance 1 (iMRD1), marginal reflex distance 2 (iMRD2), tarsal platform show (iTPS), and central brow position (iBP). These results were compared with the patient reported sleep position preference to determine correlation. RESULTS Seventy-one patients were enrolled and reported the following sleep position preferences: 28 (right), 24 (left), 13 (both), and 6 (supine). Patients with a right- or left-sided preference demonstrated lower iMRD1 measurements for the preferred sleep side (p < 0.0004) with no other significant difference in periorbital measurements. A larger degree of upper eyelid height (iMRD1) asymmetry was observed among patients with a sleep side preference. CONCLUSION Patients with a predominant sleep side preference demonstrate a significant increase in ipsilateral upper eyelid asymmetry and an inferior upper eyelid position on the sleep side. There were no differences noted in lower eyelid position, central eyebrow position, or amount of upper eyelid dermatochalasis.
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Millen RN, Thomas KN, Versteeg MPT, van Rij AM. Popliteal Vein Compression, Obesity, and Chronic Venous Disease. J Vasc Surg Venous Lymphat Disord 2021; 10:200-208.e2. [PMID: 34343719 DOI: 10.1016/j.jvsv.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is a known risk factor for the development of chronic venous disease (CVD). However, some obese patients with lower limb skin changes suggestive of venous disease do not demonstrate venous reflux or obstruction. Popliteal vein compression (PVC) caused by knee hyper-extension during standing has been postulated by others to be more common in the obese due to the increased adipose content of the popliteal fossa. This compression may contribute to the development of venous disease. OBJECTIVE To examine the prevalence of PVC in obese and non-obese subjects, with and without venous disease. METHODS Participants were recruited across the range of clinical CEAP classifications and body mass. Those referred for venous studies had full venous ultrasound assessments. To assess for PVC, the popliteal vein was assessed via B-mode ultrasound whilst the subject stood and performed two manoeuvres: knee hyper-extension and a bilateral toe stand. Video clips of each manoeuvre were analysed offline. RESULTS There were 309 limbs (158 subjects), of which 131 were non-obese (BMI 26±3 kg/m2) and 178 obese (BMI 43±8 kg/m2). PVC with toe stand was more common in obese limbs (89% vs. 64%, P<0.001). It occurred mainly in the distal popliteal vein, associated with contraction of the gastrocnemius muscles. PVC with knee hyper-extension was also more frequent in obese limbs (39% vs. 10%, P<0.0001), and was distinct as it occurred more proximally in the popliteal vein. PVC with knee hyper-extension was significantly more frequent in all obese C classes of obese patients, most notably in the obese with C4-6 CVD (41% vs. 4%, P<0.0001) and was associated with more severe VCSS (median 8 (range: 0-19) vs. 5 (0-21), P = 0.034). There were 19 limbs with skin changes (C4-6) with no venous reflux or obstruction on ultrasound; exclusively obese limbs. These limbs, designated CEAP Pn limbs, were in older, shorter participants with a higher BMI than their counterparts demonstrating reflux, and they also had more frequent PVC with knee hyper-extension (63% vs. 37%, P=0.036). CONCLUSIONS PVC with toe stand and knee hyper-extension are both functional effects and more common in obese limbs. PVC(toe stand) is likely associated with normal functioning of the calf muscle pump. While PVC(lock) may contribute to CVD in some obese limbs, the demonstration of PVC(lock) alone is insufficient evidence for direct intervention.
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Affiliation(s)
- Rebecca N Millen
- Department of Surgical Sciences, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Kate N Thomas
- Department of Surgical Sciences, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Matthew P T Versteeg
- Department of Surgical Sciences, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand; Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Andre M van Rij
- Department of Surgical Sciences, Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.
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Ferrer-Lluis I, Castillo-Escario Y, Montserrat JM, Jané R. SleepPos App: An Automated Smartphone Application for Angle Based High Resolution Sleep Position Monitoring and Treatment. SENSORS 2021; 21:s21134531. [PMID: 34282793 PMCID: PMC8271412 DOI: 10.3390/s21134531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
Poor sleep quality or disturbed sleep is associated with multiple health conditions. Sleep position affects the severity and occurrence of these complications, and positional therapy is one of the less invasive treatments to deal with them. Sleep positions can be self-reported, which is unreliable, or determined by using specific devices, such as polysomnography, polygraphy or cameras, that can be expensive and difficult to employ at home. The aim of this study is to determine how smartphones could be used to monitor and treat sleep position at home. We divided our research into three tasks: (1) develop an Android smartphone application (‘SleepPos’ app) which monitors angle-based high-resolution sleep position and allows to simultaneously apply positional treatment; (2) test the smartphone application at home coupled with a pulse oximeter; and (3) explore the potential of this tool to detect the positional occurrence of desaturation events. The results show how the ‘SleepPos’ app successfully determined the sleep position and revealed positional patterns of occurrence of desaturation events. The ‘SleepPos’ app also succeeded in applying positional therapy and preventing the subjects from sleeping in the supine sleep position. This study demonstrates how smartphones are capable of reliably monitoring high-resolution sleep position and provide useful clinical information about the positional occurrence of desaturation events.
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Affiliation(s)
- Ignasi Ferrer-Lluis
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Correspondence: (I.F.-L.); (R.J.)
| | - Yolanda Castillo-Escario
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
| | - Josep Maria Montserrat
- Sleep Lab, Pneumology Service, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Raimon Jané
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Correspondence: (I.F.-L.); (R.J.)
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Ferrer-Lluis I, Castillo-Escario Y, Montserrat JM, Jané R. Enhanced Monitoring of Sleep Position in Sleep Apnea Patients: Smartphone Triaxial Accelerometry Compared with Video-Validated Position from Polysomnography. SENSORS 2021; 21:s21113689. [PMID: 34073215 PMCID: PMC8198328 DOI: 10.3390/s21113689] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 12/11/2022]
Abstract
Poor sleep quality is a risk factor for multiple mental, cardiovascular, and cerebrovascular diseases. Certain sleep positions or excessive position changes can be related to some diseases and poor sleep quality. Nevertheless, sleep position is usually classified into four discrete values: supine, prone, left and right. An increase in sleep position resolution is necessary to better assess sleep position dynamics and to interpret more accurately intermediate sleep positions. This research aims to study the feasibility of smartphones as sleep position monitors by (1) developing algorithms to retrieve the sleep position angle from smartphone accelerometry; (2) monitoring the sleep position angle in patients with obstructive sleep apnea (OSA); (3) comparing the discretized sleep angle versus the four classic sleep positions obtained by the video-validated polysomnography (PSG); and (4) analyzing the presence of positional OSA (pOSA) related to its sleep angle of occurrence. Results from 19 OSA patients reveal that a higher resolution sleep position would help to better diagnose and treat patients with position-dependent diseases such as pOSA. They also show that smartphones are promising mHealth tools for enhanced position monitoring at hospitals and home, as they can provide sleep position with higher resolution than the gold-standard video-validated PSG.
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Affiliation(s)
- Ignasi Ferrer-Lluis
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (Y.C.-E.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Correspondence: (I.F.-L.); (R.J.)
| | - Yolanda Castillo-Escario
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (Y.C.-E.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
| | - Josep Maria Montserrat
- Sleep Lab, Pneumology Service, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (J.M.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Raimon Jané
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028 Barcelona, Spain; (Y.C.-E.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), 28029 Madrid, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya-Barcelona Tech (UPC), 08028 Barcelona, Spain
- Correspondence: (I.F.-L.); (R.J.)
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Alinia P, Samadani A, Milosevic M, Ghasemzadeh H, Parvaneh S. Pervasive Lying Posture Tracking. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5953. [PMID: 33096769 PMCID: PMC7589361 DOI: 10.3390/s20205953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022]
Abstract
Automated lying-posture tracking is important in preventing bed-related disorders, such as pressure injuries, sleep apnea, and lower-back pain. Prior research studied in-bed lying posture tracking using sensors of different modalities (e.g., accelerometer and pressure sensors). However, there remain significant gaps in research regarding how to design efficient in-bed lying posture tracking systems. These gaps can be articulated through several research questions, as follows. First, can we design a single-sensor, pervasive, and inexpensive system that can accurately detect lying postures? Second, what computational models are most effective in the accurate detection of lying postures? Finally, what physical configuration of the sensor system is most effective for lying posture tracking? To answer these important research questions, in this article we propose a comprehensive approach for designing a sensor system that uses a single accelerometer along with machine learning algorithms for in-bed lying posture classification. We design two categories of machine learning algorithms based on deep learning and traditional classification with handcrafted features to detect lying postures. We also investigate what wearing sites are the most effective in the accurate detection of lying postures. We extensively evaluate the performance of the proposed algorithms on nine different body locations and four human lying postures using two datasets. Our results show that a system with a single accelerometer can be used with either deep learning or traditional classifiers to accurately detect lying postures. The best models in our approach achieve an F1 score that ranges from 95.2% to 97.8% with a coefficient of variation from 0.03 to 0.05. The results also identify the thighs and chest as the most salient body sites for lying posture tracking. Our findings in this article suggest that, because accelerometers are ubiquitous and inexpensive sensors, they can be a viable source of information for pervasive monitoring of in-bed postures.
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Affiliation(s)
- Parastoo Alinia
- Philips Research North America, Cambridge, MA 02141, USA; (P.A.); (A.S.); (M.M.)
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA;
| | - Ali Samadani
- Philips Research North America, Cambridge, MA 02141, USA; (P.A.); (A.S.); (M.M.)
| | - Mladen Milosevic
- Philips Research North America, Cambridge, MA 02141, USA; (P.A.); (A.S.); (M.M.)
| | - Hassan Ghasemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA;
| | - Saman Parvaneh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA 99164, USA;
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Shedding Light on Nocturnal Movements in Parkinson's Disease: Evidence from Wearable Technologies. SENSORS 2020; 20:s20185171. [PMID: 32927816 PMCID: PMC7571235 DOI: 10.3390/s20185171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
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Pucci G, D’Abbondanza M, Camilli M, Bisogni V, Anastasio F, Gandolfo V, Alcidi R, Mojovic N, Ministrini S, Lupattelli G, Vaudo G. Assessment of nocturnal hypertension by ambulatory blood pressure monitoring at the forearm in people with morbid obesity. J Clin Hypertens (Greenwich) 2020; 22:1538-1545. [DOI: 10.1111/jch.13983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/24/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Giacomo Pucci
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria" University Hospital Terni Italy
| | - Marco D’Abbondanza
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Matteo Camilli
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Valeria Bisogni
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria" University Hospital Terni Italy
| | - Fabio Anastasio
- Unit of Cardiology ASST‐VAL Hospital of Sondrio Sondrio Italy
| | - Vito Gandolfo
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Natasa Mojovic
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Stefano Ministrini
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Graziana Lupattelli
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria della Misericordia" University Hospital Perugia Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery University of Perugia, Unit of Internal Medicine, "Santa Maria" University Hospital Terni Italy
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The effect of in-lab polysomnography and home sleep polygraphy on sleep position. Sleep Breath 2020; 25:251-255. [PMID: 32418018 PMCID: PMC7987683 DOI: 10.1007/s11325-020-02099-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Little is known regarding the influence of in-laboratory polysomnography (PSG) equipment on sleep position, especially on the prevalence of supine positioning, which in many cases may lead to a more severe sleep apnea diagnosis. The aim of this study was to assess the percentage of supine sleep during an in-laboratory PSG compared to that seen during a home sleep apnea test (HSAT). METHODS This was a retrospective cohort study comparing in-laboratory PSG and HSAT using a peripheral arterial tone (PAT) technology device. RESULTS Of 445 PSG and 416 HSAT studies analyzed, there was no significant difference in the proportion of supine sleep time between PSG (44%) and HSAT (45%, p = 0.53). Analysis of the differences in sleep position (supine versus non-supine), analyzed by sex, BMI (≥ 30 kg/m2 versus < 30 kg/m2), and age (≥ 60 years versus < 60 years), was significant only for women, who had more supine sleep during HSAT at 61 ± 24% than during PSG at 45 ± 26% (p < 0.001). CONCLUSION Overall there was no difference in the percentage of supine sleep when comparing in-laboratory PSG to HSAT. However, women had more supine sleep with HSAT than with PSG.
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Boentert M. Sleep disturbances in patients with amyotrophic lateral sclerosis: current perspectives. Nat Sci Sleep 2019; 11:97-111. [PMID: 31496852 PMCID: PMC6701267 DOI: 10.2147/nss.s183504] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 01/08/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease inevitably leading to generalized muscle weakness and premature death. Sleep disturbances are extremely common in patients with ALS and substantially add to the burden of disease for both patients and caregivers. Disruption of sleep can be caused by physical symptoms, such as muscle cramps, pain, reduced mobility, spasticity, mucus retention, and restless legs syndrome. In addition, depression and anxiety may lead to significant insomnia. In a small subset of patients, rapid eye movement (REM) sleep behavioral disorder may be present, reflecting neurodegeneration of central nervous system pathways which are involved in REM sleep regulation. With regard to overall prognosis, sleep-disordered breathing (SDB) and nocturnal hypoventilation (NH) are of utmost importance, particularly because NH precedes respiratory failure. Timely mechanical ventilation is one of the most significant therapeutic measures to prolong life span in ALS, and transcutaneous capnometry is superior to pulse oxymetry to detect NH early. In addition, it has been shown that in patients on home ventilatory support, survival time depends on whether normocapnia, normoxia, and elimination of apneic events during sleep can be reliably achieved. Several studies have investigated sleep patterns and clinical determinants of sleep disruption in ALS, but exact prevalence numbers are unknown. Thus, constant awareness for sleep-related symptoms is appropriate. Since no curative treatment can be offered to affected patients, sleep complaints should be thoroughly investigated in order to identify any treatable etiology and improve or stabilize quality of life as much as possible. The use of hypnotics should be confined to palliation during the terminal phase and refractory insomnia in earlier stages of the disease, taking into account that most compounds potentially aggravate SDB.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology, University Hospital Muenster, Muenster, Germany
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31
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Evaluation of Sleep Position for Possible Nightly Aggravation and Delay of Healing in Tennis Elbow. J Am Acad Orthop Surg Glob Res Rev 2019; 3:e082. [PMID: 31592507 PMCID: PMC6754212 DOI: 10.5435/jaaosglobal-d-19-00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Tennis elbow symptoms are reportedly most severe in the morning, which prompted a search for a pathological process while asleep. A “pathological sleep position” was hypothesized that repetitively aggravates an elbow lesion if the arm is overhead and pressure is on the lateral elbow. This hypothesis was tested by using a restraint to keep the arm down while asleep.
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32
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Intraocular Pressure Elevation during Lateral Body Posture in Side-sleeping Glaucoma Patients. Optom Vis Sci 2019; 96:62-70. [DOI: 10.1097/opx.0000000000001322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Veauthier C, Piper SK, Gaede G, Penzel T, Paul F. The first night effect in multiple sclerosis patients undergoing home-based polysomnography. Nat Sci Sleep 2018; 10:337-344. [PMID: 30498381 PMCID: PMC6207396 DOI: 10.2147/nss.s176201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The first night effect (FNE) is a polysomnography (PSG) habituation effect in the first of several consecutive in-laboratory PSGs (I-PSGs). The FNE is caused by the discomfort provoked by electrodes and cables and the exposure to an unfamiliar environment. A reverse FNE (RFNE) with an improved sleep in the first night is characteristic of insomnia, presumably because the video PSG in the sleep laboratory leads to a decrease in the negatively toned cognitive activity. Therefore, two or more I-PSGs are required for an accurate diagnosis. Although the FNE is well documented in I-PSG, little is known about the FNE and the RFNE in home-based PSGs (H-PSGs). METHODS This is a retrospective analysis of a recently published cross-sectional study using H-PSG. Sixty-three consecutive patients suffering from multiple sclerosis (MS) were investigated by two consecutive H-PSGs without video. The differences between the first and second H-PSGs were analyzed. The patients were classified into four subgroups: no sleep disorder, insomnia, sleep-related breathing disorders (SRBDs), and periodic limb movement disorder or restless legs syndrome (PLMD/RLS). RESULTS MS patients suffering from insomnia showed no RFNE. MS patients with SRBD or PLMD/RLS showed no reduced sleep efficiency but significantly less slow wave sleep. Furthermore, SRBD patients showed significantly less non-rapid eye movement (NREM) sleep, and PLMD/RLS patients were significantly awake longer in the first night after sleep onset (increased wake-after-sleep-onset time) and showed a higher rapid eye movement (REM) latency. CONCLUSION SRBD and PLMD/RLS patients showed a significant FNE. Two consecutive H-PSGs are required in these patients to obtain a precise hypnogram even in the ambulatory field. In MS patients suffering from insomnia, no RFNE was found, and in insomnia patients one H-PSG seems to be sufficient.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| | - Sophie K Piper
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Gunnar Gaede
- Department of Neurology, St. Joseph Krankenhaus Berlin-Weissensee, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, .,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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