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Summary: Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk factor for cardiovascular disease in patients with obstructive sleep apnea. The aim of the study was to determine whether the presence of periodic limb movements during sleep affects serum lipid levels in obstructive sleep apnea. Total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, non‐ high‐density lipoprotein cholesterol and triglyceride levels were investigated in 4138 patients with obstructive sleep apnea in the European Sleep Apnea Database (ESADA) cohort, divided into those with periodic limb movements during sleep index ≥ 15 per hr (n = 628) and controls (n = 3510). ANCOVA adjusted for age, sex, body mass index, apnea–hypopnea index, alcohol intake, smoking status, diabetes, insomnia and study site was used to assess differences in lipids between periodic limb movements during sleep and controls. Patients with periodic limb movements during sleep (24% female, 54.4 ± 12.1 years, body mass index 31.9 ± 5.8 kg m−2, apnea–hypopnea index 36.7 ± 25.4 per hr) had higher triglyceride (1.81 ± 1.04 versus 1.69 ± 0.90 mmol L−1, p = 0.002) and lower high‐density lipoprotein cholesterol (1.19 ± 0.34 versus 1.24 ± 0.37 mmol L−1, p = 0.002) levels, whilst there was no difference in either total cholesterol (4.98 ± 1.10 versus 4.94 ± 1.07 mmol L−1), low‐density lipoprotein cholesterol (3.04 ± 0.96 versus 2.98 ± 0.98 mmol L−1) or non‐ high‐density lipoprotein cholesterol (3.78 ± 1.10 versus 3.70 ± 1.05 mmol L−1) concentrations (all p > 0.05). The results remained unchanged after most sensitivity analyses. Patients with obstructive sleep apnea with periodic limb movements during sleep had more prevalent cardiovascular disease (11% versus 6%, p < 0.01). Periodic limb movements during sleep in obstructive sleep apnea is associated with dyslipidaemia independently of important confounders. Our results highlight periodic limb movements during sleep as an additional risk factor for cardiovascular disease in obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Introduction: Environmental noise is recognized by the World Health Organization as a significant public health concern, negatively impacting human health and well-being. To address and better understand these effects, the "De Oorzaak" citizen science project was initiated in Flanders, Belgium. Objective: This study aims to assess the effects of environmental noise on health, stress, and sleep among the Flemish population. It also seeks to explore the relationship between sound sensitivity and sociodemographic factors. Material and methods: A comprehensive population-level questionnaire was administered to thousands of Flemish residents over a one-month period. This survey included questions on quality of life, health status, stress levels, sleep quality, and detailed sociodemographic information. Additionally, a subset of 100 participants from Antwerp underwent an extensive audiological test battery. This included self-report questionnaires, audiometry, and a newly developed diagnostic test for hyperacusis utilizing natural sounds. Participants were categorized into two groups based on their scores from the Hyperacusis Questionnaire (HQ): with or without hyperacusis. Results: Data collection is ongoing, and preliminary analysis focuses on the correlation between various measures of sound sensitivity and other demographic variables. Conclusions: The "De Oorzaak" project leverages citizen science to generate a rich dataset that will enhance our understanding of the public health implications of environmental noise. [ABSTRACT FROM AUTHOR]

Background and objective: To personalize OSA management, several studies have attempted to better capture disease heterogeneity by clustering methods. The aim of this study was to conduct a cluster analysis of 23 000 OSA patients at diagnosis using the multinational ESADA. Methods: Data from 34 centres contributing to ESADA were used. An LCA was applied to identify OSA phenotypes in this European population representing broad geographical variations. Many variables, including symptoms, comorbidities and polysomnographic data, were included. Prescribed medications were classified according to the ATC classification and this information was used for comorbidity confirmation. Results: Eight clusters were identified. Four clusters were gender‐based corresponding to 54% of patients, with two clusters consisting only of men and two clusters only of women. The remaining four clusters were mainly men with various combinations of age range, BMI, AHI and comorbidities. The preferred type of OSA treatment (PAP or mandibular advancement) varied between clusters. Conclusion: Eight distinct clinical OSA phenotypes were identified in a large pan‐European database highlighting the importance of gender‐based phenotypes and the impact of these subtypes on treatment prescription. The impact of cluster on long‐term treatment adherence and prognosis remains to be studied using the ESADA follow‐up data set. A cluster analysis of a pan‐European database of over 23 000 OSA patients found eight distinct clinical phenotypes, with clear gender‐based differences and implications for more personalized treatment prescriptions. See relatedEditorial [ABSTRACT FROM AUTHOR]

Summary: In obstructive sleep apnea, patients' sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 209), moderate (n = 222) and severe (n = 272) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two‐step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two‐step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep‐states for power‐laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake‐state durations followed a power‐law distribution, while sleep‐state durations were characterized by an exponential distribution. Sleep‐stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort (n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea‐related clinical outcomes like arterial hypertension and daytime sleepiness. [ABSTRACT FROM AUTHOR]

Background and objective: Obstructive sleep apnoea (OSA) and hyperlipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidaemia in patients of the European Sleep Apnea Database (ESADA) cohort. Methods: The cross‐sectional analysis included 11 892 patients (age 51.9 ± 12.5 years, 70% male, body mass index (BMI) 31.3 ± 6.6 kg/m2, mean oxygen desaturation index (ODI) 23.7 ± 25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidaemia in relation to measures of OSA (ODI, apnoea‐hypopnoea index, mean and lowest oxygen saturation) was determined by means of general linear model analysis with adjustment for important confounders such as age, BMI, comorbidities and study site. Results: Hyperlipidaemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, P < 0.001. Corresponding numbers in patients with diabetes were 8.5% and 41.5%, P < 0.001. Compared with ODI quartile I, patients in ODI quartiles II‐IV had an adjusted OR (95% CI) of 1.33 (1.15–1.55), 1.37 (1.17–1.61) and 1.33 (1.12–1.58) (P < 0.001), respectively, for hyperlipidaemia. Obesity was defined as a significant risk factor for hyperlipidaemia. Subgroups of OSA patients with cardio‐metabolic comorbidities demonstrated higher prevalence of HL. In addition, differences in hyperlipidaemia prevalence were reported in European geographical regions with the highest prevalence in Central Europe. Conclusion: Obstructive sleep apnoea, in particular intermittent hypoxia, was independently associated with the prevalence of hyperlipidaemia diagnosis. [ABSTRACT FROM AUTHOR]

Polysomnography (PSG) is considered the gold standard to assess sleep accurately, but it can be expensive, time-consuming, and uncomfortable, specifically in long-term sleep studies. Actigraphy, on the other hand, is both cheap and user-friendly, but depending on the application lacks detail and accuracy. Our aim was to evaluate cardiorespiratory and movement signals in discriminating between wake, rapid-eye-movement (REM), light (N1N2), and deep (N3) sleep. The dataset comprised 85 nights of PSG from a healthy population. Starting from a total of 750 characteristic variables (features), problem-specific subsets of 40 features were forwardly selected using the combination of a wrapper method (Cohen's kappa statistic on radial basis function (RBF)-kernel support vector machine (SVM) classifier) and filter method (minimum redundancy maximum relevance criterion on mutual information). Final classification was performed using an RBF-kernel SVM. Non-subject-specific wake versus sleep classification resulted in a Cohen's kappa value of 0.695, while REM versus NREM resulted in 0.558 and N3 versus N1N2 in 0.553. The broad pool of initial features gave insight in which features discriminated best between the different classes. The classification results demonstrate the possibility of making long-term sleep monitoring more widely available. [ABSTRACT FROM PUBLISHER]

Proper body support plays an import role in the recuperation of our body during sleep. Therefore, this study uses an automatically adapting bedding system that optimises spinal alignment throughout the night by altering the stiffness of eight comfort zones. The aim is to investigate the influence of such a dynamic sleep environment on objective and subjective sleep parameters. The bedding system contains 165 sensors that measure mattress indentation. It also includes eight actuators that control the comfort zones. Based on the measured mattress indentation, body movements and posture changes are detected. Control of spinal alignment is established by fitting personalized human models in the measured indentation. A total of 11 normal sleepers participated in this study. Sleep experiments were performed in a sleep laboratory where subjects slept three nights: a first night for adaptation, a reference night and an active support night (in counterbalanced order). Polysomnographic measurements were recorded during the nights, combined with questionnaires aiming at assessing subjective information. Subjective information on sleep quality, daytime quality and perceived number of awakenings shows significant improvements during the active support (ACS) night. Objective results showed a trend towards increased slow wave sleep. On the other hand, it was noticed that % N1-sleep was significantly increased during ACS night, while % N2-sleep was significantly decreased. No prolonged N1 periods were found during or immediately after steering. [ABSTRACT FROM AUTHOR]

Although daytime emotional stressful events are often presumed to cause sleep disturbances, the few studies of stressful life events on sleep physiology have resulted in various and contradictory findings. As research has focused in particular on stress in itself, the present study is the first to investigate the effect using polysomnography (PSG). Results indicate a significant increase in sleep fragmentation, as expressed by decreased sleep efficiency, total sleep time, percentage of rapid eye movement (REM) sleep, and an increased wake after sleep onset latency, total time awake, latency to SWS, number of awakenings and number of awakenings from REM sleep. The results demonstrate that negative emotion correlates with enhanced sleep fragmentation helping us to understand why sleep patterns change and how sleep disturbances may develop. [ABSTRACT FROM AUTHOR]

FACE collected real life clinical data and long-term follow-up (FU) in a CHF population with SDB eligible for ASV. We previously identified 6 clinically meaningful clusters using Latent class analysis. We investigate herein whether these clusters may have different morbi-mortality outcomes. Reduced (HFrEF), middle range (HFmrEF) and preserved (HFpEF) CHF classes were included. Eligible SDB were central sleep apnea (CSA), coexistent obstructive central SA not controlled under CPAP and CPAP emergent CSA. ASV was offered to all. Controls were patients who refused ASV at inclusion. Morbi-mortality events were collected for 2 years. Primary endpoint in the time-to event analysis was the first event of death, unplanned hospitalization for worsening HF or cardiac transplant. 503 patients were included in the ITT analysis at 2-year FU. ASV was protective for primary outcome (P = 0.01, Fig. 1 A). Cluster behavior regarding primary outcome was different, the worst prognosis was for HFrEF with CSA (Fig. 1 B). ASV did not benefit in the HFrEF with CSA or OSA clusters (Fig. 1 C) but was protective for 2 clusters: obese HFpEF with CSA and severe hypoxemic patients with OSA (Fig. 1 D). These results align with recent studies that showed no impact on morbi-mortality of ASV in HFrEF but a protective effect in two HFpEF clusters. [ABSTRACT FROM AUTHOR]

Adaptive servo-ventilation (ASV) is a non-invasive ventilation mode for suppressing CSA-CSR. FACE is an observational prospective multicentre cohort study designed to assess the effects of adding ASV (PaceWave™, AutosetCS™; ResMed) to standard care on morbidity and mortality in symptomatic chronic HF patients who have CSA or co-existing central and obstructive sleep-disordered breathing (SDB). To collect real life clinical data and long-term follow-up of all CHF patients grade of severity (reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF)) with SDB requesting ASV. Medical history, medications, clinical presentation, sleep study, cardiac function and quality of life were assessed at inclusion. Patients are followed up to 2 years. Inclusion data are presented in median with interquartile range or in % of the sample. 509 CHF pts were included, 72 [64; 79] year old, men (88%) and with a BMI of 28 [25; 32] kg/m2. Patients were HFrEF, HFmrEF and HFpEF, in 31, 20, and 50% respectively and 27% had a cardiac implant. Current or former tobacco and alcohol users were 46 and 14% respectively. Main comorbidities were hypertension (72%), diabetes (37%), COPD (12%), atrial fibrillation (40%). ASV indications were predominant CSA (69%), emergent CSA (6.4%) and coexistent OSA-CSA not controlled on CPAP (25%). Although, SDB was severe with a mean AHI per hour of 41 [31; 55] and a sleep time with SpO2 < 90% (T90) of 33 min [5;101] patients were not sleepy with an ESS of 7 [4; 11]. HF symptoms were highly present with a Minnesota Living With Heart Failure Questionnaire (MLHFQ) score of 29 [16; 48] and pts distribution of 19, 43, 33 and 5% in NYHA class I, II, III and IV respectively. SDB were widespread distributed in a heterogeneous population of CHF patients with different etiologies, comorbidities and HF severity classes. A cluster analysis has been conducted to identify different phenogroups. [ABSTRACT FROM AUTHOR]

Adaptive servo-ventilation (ASV) is a non-invasive ventilation mode for suppressing CSA-CSR. FACE is an observational prospective multicentre cohort study designed to assess the effects of adding ASV (PaceWave™, AutosetCS™; ResMed) to standard care on morbidity and mortality in symptomatic chronic HF patients who have CSA or co-existing central and obstructive sleep-disordered breathing (SDB). FACE cohort study was collecting real life clinical data and long-term follow-up in a heterogeneous CHF population with SDB eligible for ASV. Latent class analysis (LCA) was proposed to cluster homogeneous phenogroups that may behaved differently. Clinical presentation, sleep study, cardiac function and quality of life were assessed at inclusion. Patients were on CHF therapy and were offered to be treated by ASV. Morbidity and mortality were collected at 3-month follow-up. The primary end point in the time-to event analysis was the first event of death from any cause, unplanned hospitalization for worsening heart failure or cardiac transplant. 509 CHF pts were included in the ITT analysis, LCA identified 6 well defined phenogroups. At 3-month follow-up, there was significant difference between clusters for primary outcome incidence P < 0.01, and death from any cause or hospitalization for all causes (P < 0.01) and hospitalizations for all causes (P < 0.02). The worse prognosis occurred in the cluster 1 low LVEF < 35%, male (96%), predominant CSA (90%), stroke (38%), Afib (44%), ASV acceptance (53%) (Fig. 1). A phenogroup analysis including cardiac functions, SDB and ASV acceptance is promising in predicting outcomes of CHF patients. [ABSTRACT FROM AUTHOR]