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Intermittent hypoxia (IH) is a central characteristic of sleep apnea syndrome (SAS), and it subjects cells in the body to repetitive apnea, chronic hypoxia, oxygen desaturation, and hypercapnia. Since SAS is linked to various serious cardiovascular complications, especially hypertension, many studies have been conducted to elucidate the mechanism of hypertension induced by SAS/IH. Hypertension in SAS is associated with numerous cardiovascular disorders. As hypertension is the most common complication of SAS, cell and animal models to study SAS/IH have developed and provided lots of hints for elucidating the molecular mechanisms of hypertension induced by IH. However, the detailed mechanisms are obscure and under investigation. This review outlines the molecular mechanisms of hypertension in IH, which include the regulation systems of reactive oxygen species (ROS) that activate the renin–angiotensin system (RAS) and catecholamine biosynthesis in the sympathetic nervous system, resulting in hypertension. And hypoxia-inducible factors (HIFs), Endotheline 1 (ET-1), and inflammatory factors are also mentioned. In addition, we will discuss the influences of SAS/IH in cardiovascular dysfunction and the relationship of microRNA (miRNA)s to regulate the key molecules in each mechanism, which has become more apparent in recent years. These findings provide insight into the pathogenesis of SAS and help in the development of future treatments.

Abstract Background Patients suffering from aortic dissection (AD) often experience sleep apnea syndrome (SAS), which aggravates their respiratory function and aortic false lumen expansion. Methods We analyzed the peri-operative data of Stanford A AD patients, with or without SAS, between January 2017 and June 2019. Subjects were separated into SAS positive (SAS+) and SAS negative (SAS−) cohorts, based on the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). We next analyzed variables between the SAS+ and SAS− groups. Results 155, out of 198 AAD patients, were enlisted for this study. SAS+ patients exhibited higher rates of pneumonia (p

Sergio Tufik,1 Monica Levy Andersen,1 Daniela Santoro Rosa,2 Sergio Brasil Tufik,1 Gabriel Natan Pires1 1Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; 2Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, BrazilCorrespondence: Gabriel Natan Pires, Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, CEP: 04024-002, Brazil, Email gnspires@gmail.com; Gabriel.Pires@sono.org.brIntroduction: Previous studies have linked sleep disturbances (including sleep deprivation and obstructive sleep apnea) to an impairment in immune response after vaccination for several diseases, although it has not yet been tested for COVID-19. This study sought to evaluate the effects of obstructive sleep apnea on anti-SARS-CoV-2 IgG levels after vaccination against COVID-19 among older adults.Methods: The study was based on a convenience sample of inpatients who underwent full night type-I polysomnography. Inclusion criteria included being ≥ 60 years with full COVID-19 vaccination schedule. Exclusion criteria included previous COVID-19 diagnosis (assessed via self-report), less than 15 days between last dose and IgG testing, self-report of continuous positive air pressure (CPAP) use in the last three months, having undergone CPAP or split-night polysomnography, or incomplete/invalid data.Results: Out of 122 included patients (no/mild OSA: 35; moderate: 31; severe: 56), 9.8% were considered seronegative for the IgG anti-SARS-CoV-2 test (IgG count< 50.0 AU/mL), and the median IgG levels for the whole sample was 273 AU/mL (IQR: 744), with no statistically significant differences among OSA severity groups. There was neither association between OSA severity and IgG serostatus nor correlation between IgG levels and apnea-hypopnea index. A linear regression model to predict IgG levels was built, produced an R2 value of 0.066 and the only significant predictor was time from vaccination to testing; while OSA severity was considered non-significant.Discussion: Our results demonstrate that the severity of OSA is not correlated with a decrease in anti-SARS-CoV-2 IgG levels among older adults, and that the efficiency of COVID-19 vaccinations are not reduced from mild to severe OSA.Keywords: sleep, sleep apnea syndrome, COVID-19, SARS-CoV-2, vaccination

Sleep-disordered breathing (SDB) is a risk factor for recurrent adverse events in patients with coronary artery disease (CAD). However, the prognosis of continuous positive alveolar pressure (CPAP) treatment for SDB with CAD remains unknown. A total of 281 consecutive patients with stable CAD requiring percutaneous coronary intervention (PCI) were included and classified into three groups according to the concomitance of SDB and CPAP treatment (untreated SDB group, n = 61; CPAP-SDB group, n = 24; and non-SDB group, n = 138). The incidence of major adverse cardiac and cerebrovascular events (MACCEs) within a year after PCI was compared between the three groups. The characteristics of the culprit plaques, including macrophage accumulation, were further assessed using optical coherence tomography. The incidence of MACCEs was significantly different among the three groups (p = 0.037), with the highest incidence in the untreated-SDB group (22.9%) and 8.3% and 10.1% in the CPAP-SDB and non-SDB groups, respectively. The incidence of MACCEs at 1 year was significantly lower in patients with appropriate CPAP use than that in inadequately treated patients with SDB (0.0 vs. 22.5%, p = 0.048). Macrophage accumulation differed significantly among the three groups, with the highest accumulation in the untreated SDB group. CPAP treatment for SDB may be associated with a lower incidence of MACCEs following PCI and a lower prevalence of macrophages in the culprit plaques. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy of uvulopalatopharyngoplasty and the corresponding postoperative airflow. Eleven patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Computational fluid dynamics (CFD) was implemented. CFD could be accomplished in nine cases. Airflow analysis was not possible in cases with a high respiratory event index (REI) score. Before surgery, stenosis was identified in the oropharynx and epiglottic area. And the airflow velocity and pressure were found to have significantly decreased in the oropharynx postoperatively, while in the epiglottic area, those data had increased postoperatively in some cases. The velocity and pressure of the oropharynx are related to REI score. From the CFD analysis, airflow analysis is important for evaluating the apnea state. It is suggested that the postoperative function can now be predicted preoperatively. [ABSTRACT FROM AUTHOR]

It is essential to estimate the sleep quality and diagnose the clinical stages in time and at home, because they are closely related to and important causes of chronic diseases and daily life dysfunctions. However, the existing "gold-standard" sensing machine for diagnosis (Polysomnography (PSG) with Electroencephalogram (EEG) measurements) is almost infeasible to deploy at home in a "ubiquitous" manner. In addition, it is costly to train clinicians for the diagnosis of sleep conditions. In this paper, we proposed a novel technical and systematic attempt to tackle the previous barriers: first, we proposed to monitor and sense the sleep conditions using the infrared (IR) camera videos synchronized with the EEG signal; second, we proposed a novel cross-modal retrieval system termed as Cross-modal Contrastive Hashing Retrieval (CCHR) to build the relationship between EEG and IR videos, retrieving the most relevant EEG signal given an infrared video. Specifically, the CCHR is novel in the following two perspectives. Firstly, to eliminate the large cross-modal semantic gap between EEG and IR data, we designed a novel joint cross-modal representation learning strategy using a memory-enhanced hard-negative mining design under the framework of contrastive learning. Secondly, as the sleep monitoring data are large-scale (8 h long for each subject), a novel contrastive hashing module is proposed to transform the joint cross-modal features to the discriminative binary hash codes, enabling the efficient storage and inference. Extensive experiments on our collected cross-modal sleep condition dataset validated that the proposed CCHR achieves superior performances compared with existing cross-modal hashing methods. [ABSTRACT FROM AUTHOR]

Children with medical complexity (CMCs) represent a subgroup of children who may have congenital or acquired multisystemic disease. CMCs are frequently predisposed to respiratory problems and often require long-term mechanical ventilation (LTMV). The indications for LTMV in CMCs are increasing, but gathering evidence about indications, titration, and monitoring is currently the most difficult challenge due to the absence of validated data. The aim of this review was to examine the clinical indications and ethical considerations for the initiation, continuation, or withdrawal of LTMV among CMCs. The decision to initiate long-term ventilation should always be based on clinical and ethical considerations and should be shared with the parents. [ABSTRACT FROM AUTHOR]

This paper proposes a robust method to screen patients with sleep apnea syndrome (SAS) using a single-lead electrocardiogram (ECG). This method consists of minute-by-minute abnormal breathing detection and apnea-hypopnea index (AHI) estimation. Heartbeat interval and ECG-derived respiration (EDR) are calculated using the single-lead ECG and used to train the models, including ResNet18, ResNet34, and ResNet50. The proposed method, using data from 1232 subjects, was developed with two open datasets and experimental data and evaluated using two additional open datasets and data acquired from an abdomen-attached wearable device (in total, data from 189 subjects). ResNet18 showed the best results, having an average Cohen's kappa coefficient of 0.57, in the abnormal breathing detection. Moreover, SAS patient classification, with 15 as the AHI threshold, yielded an average Cohen's kappa coefficient of 0.71. The results of patient classification were biased toward data from the wearable patch-type device, which may be influenced by different ECG waveforms. The proposed method is tuned with a sample of the data from the device, and the performance result of Cohen's kappa increased from 0.54 to 0.91 for SAS patient classification. Our method, proposed in this paper, achieved equivalent performance results with data recorded using an abdomen-attached wearable device and two open datasets used in previous studies, although the method had not used those data during model training. The proposed method could reduce the development costs of commercial software, as it was developed using open datasets, has robust performance throughout all datasets. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of obstructive sleep apnea (OSA) in Japan is 9% among males and 3% among females. Up to 2.5 million patients are estimated to suffer from the disease, but limited number of facilities are capable of carrying out polysomnography (PSG), leaving more than 80% of these individuals are undiagnosed. In recent years, the development of new portable sleep monitoring (PMs) devices has been remarkable. We evaluate the correlation between the results of the LS-140 PMs device (Fukuda Denshi Tech Co. Ltd.), released in 2017, and those of PSG. Methods: We obtained contemporaneous data from the same patients by equipping 58 patients with PMs (LS-140) devices while they underwent PSG. Our primary outcome was Case 2 of the intraclass correlation coefficient (ICC), i.e., the ICC (2.1). And we used a Bland-Altman analysis to compare the apnea-hypopnea index (AHI) given by PSG and the respiratory event index (REI) given by LS-140 and examined the sensitivity and specificity of the REI relative to the AHI in the diagnosis of OSA. We also carried out the same comparison but in terms of the presence or absence of periodic limb movements (PLMs). Results: The ICC (2.1) between The REI and the AHI was 0.944, a rather high value (p

Obstructive sleep apnea syndrome (OSAS) is the most common breathing-related sleep disorder. It is characterized by recurrent episodes of partial or complete airway obstruction during sleep, resulting in a reduction in or the total cessation of airflow, despite ongoing respiratory efforts, leading to oxygen desaturation and arousal. The purpose of this literature review is to evaluate the most common characteristics of this pathology, as well as to investigate the most effective treatment options, providing an update on the management of OSA patients.

A high-fat diet (HFD) accumulates fat in the cardiovascular system, alters the metabolism, and affects cardiac function. Dyslipidemia is associated with the development of sleep apnea syndrome (SAS), which is associated with intermittent hypoxia (IH); however, it is unclear whether SAS affects cardiac function in patients with dyslipidemia. The purpose of this study was to evaluate how IH affects cardiac function in rats fed with a HFD. Male 5-week-old Sprague-Dawley rats of two groups (normal diet (SD) and HFD) were divided into IH-exposed and unexposed groups. Zinc protoporphyrin-9 (ZnPPIX) was administered as a heme oxygenase-1 (HO-1) inhibitor to the SD and IH + HFD groups, and cardiac function and blood viscosity were examined. In the IH + HFD group, echocardiography showed an increased fractional shortening (FS), which peaked on day 4. Western blot analysis revealed an increase in HO-1 after 2 weeks. This peak continued even after the HO-1 inhibitor and ZnPPIX were administered. One cause of increased FS is the stagnation of blood flow due to an increased blood viscosity. To be able to send highly viscous blood to every corner of the body, the heart must contract strongly. Therefore, HO-1 is released by the body as a biological defense reaction. HO-1 has a vasodilatory effect and suppresses hyper constriction. Thus, IH exposure to HFD causes and drives transient hyper constriction, releasing HO-1 as a biological response. This led to dilated blood vessels, after which the FS returned to normal.

BackgroundObstructive sleep apnea (OSA) is a serious disease with a high prevalence in the general population. The purpose of this study is to explore the effectiveness of the GOAL questionnaire in the clinical screening of OSA and compare it with other existing screening tools.Materials and methodsOutpatients and inpatients who underwent polysomnography (PSG) examination at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from January 2013 to November 2016 were analyzed retrospectively. The basic data such as demographic, medical history, etc., and PSG data of the patients were collected, and the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of GOAL and five other screening scales (the NoSAS score, Epworth Sleepiness Scale, the Berlin questionnaire, STOP, and STOP-Bang questionnaire) were calculated.ResultsData from 2,171 participants (1,644 male; 78%) were analyzed there were 1,507 OSA patients [Apnea Hypopnea Index (AHI) ≥ 5 events/h] among them, accounting for about 69.415%. No matter which cut-off point (AHI ≥ 5, 15 and 30 events/h), the AUC score reveals that GOAL questionnaire had comparable screening ability to the NoSAS and STOP-BANG, and performed better than the ESS, and the AUC scores of the STOP questionnaire and Epworth Sleepiness Scale (ESS) were both lower than 0.7. When the cut-off point of the AHI was 5 events/h, the AUC of GOAL was the highest at 0.799 (0.781–0.816), and its sensitivity was the highest at 89.1%. The sensitivity levels of the NoSAS score and STOP-Bang questionnaire were 67.4 and 78.8% respectively, while ESS and the Berlin questionnaire have higher specificity (70.2 and 72.3% respectively) but lower sensitivity (49.3 and 60.0% respectively).ConclusionGOAL is a free, efficient and easy to manage tool with a screening ability comparable to NoSAS and STOP-Bang, and better than that of ESS.

Sleep apnea syndrome (SAS) is characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia [IH]), and is a risk factor for cardiovascular disease (CVD) and insulin resistance/Type 2 diabetes. However, the mechanisms linking IH stress and CVD remain elusive. We exposed rat H9c2 and mouse P19.CL6 cardiomyocytes to experimental IH or normoxia for 24 h to analyze the mRNA expression of several cardiomyokines. We found that the mRNA levels of regenerating gene IV (Reg IV) and hepatocyte growth factor (Hgf) in H9c2 and P19.CL6 cardiomyocytes were significantly increased by IH, whereas the promoter activities of the genes were not increased. A target mRNA search of microRNA (miR)s revealed that rat and mouse mRNAs have a potential target sequence for miR-499. The miR-499 level of IH-treated cells was significantly decreased compared to normoxia-treated cells. MiR-499 mimic and non-specific control RNA (miR-499 mimic NC) were introduced into P19.CL6 cells, and the IH-induced upregulation of the genes was abolished by introduction of the miR-499 mimic, but not by the miR-499 mimic NC. These results indicate that IH stress downregulates the miR-499 in cardiomyocytes, resulting in increased levels of Reg IV and Hgf mRNAs, leading to the protection of cardiomyocytes in SAS patients. [ABSTRACT FROM AUTHOR]

Introduction: This study's purpose is to compare obstructive sleep apnea (OSA) patients over 65 with those under 65 using polysomnography tests. Materials and Method: The polysomnography tests performed on 108 patients (54 study and 54 control group) from January 1, 2018 to January 1, 2022 were examined retrospectively at the ear, nose and throat clinic in the Adana City Training and Research Hospital. Results: The study group and the control group shared the same body mass index (BMI) median, apnea-hypopnea index (AHI) median value, the mean oxygen saturation median value, the minimum oxygen saturation median value, the oxygen saturation < 90% (SAT90) median value, the oxygen desaturation index (ODI) median value, the average apnea duration value and the arousal index value. (p>0.01) Conclusion: In conclusion, being a male above 65 years of age may be a risk factor for obstructive sleep apnea. However, getting older does not increase obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical characteristics and related influencing factors of obstructive sleep apnea (OSA) combined with obesity-related sleep hypoventilation (ORSH) and to identify indicators that can predict the OSA combined with ORSH population. Methods A total of 185 obese patients (body mass index ≥30 kg/m2 ) who were admitted to hospital due to snoring were selected. All patients underwent daytime awake arterial blood gas analysis, pulmonary function examination, polysomnography monitoring and percutaneous carbon dioxide monitoring at least 7 hours. According to the above examination results, patients were divided into the OSA group (n=109), the OSA combined with ORSH group (n= 46) and the OSA combined with obesity hypopnea syndrome (OHS) group (n=30). The general clinical characteristics, pulmonary function, arterial blood gas and polysomnography monitoring indexes were compared and analyzed in the three groups. Multivariate Logistic regression analysis was conducted to analyze the risk factors of OSA combined with ORSH. A model was established and receiver operating characteristic (ROC) curve was drawn to analyze the prediction efficiency. Results Waist circumference, BMI and proportion of stroke patients were higher in the OSA combined with OHS group than those in the OSA group and the OSA combined with ORSH group, while the percentage of forced expiratory volume in the first second in the predicted value (FEV1%) and the percentage of forced vital capacity in the predicted value (FVC%) were significantly lower in the OSA combined with OHS group than those in the OSA group and the OSA combined with ORSH group (P＜0.05). Arterial partial pressure of oxygen [p(O2)] was significantly lower in the OSA combined with OHS group than that in the OSA group, while arterial partial pressure of carbon dioxide [p(CO2)] and bicarbonate ion (HCO3 - ) were significantly higher than those in the OSA group and the OSA combined with ORSH group (P＜0.05). P(CO2) and HCO3 - were significantly higher in the OSA combined with ORSH group than those in the OSA group (P＜0.05). Compared with the OSA group, the Epworth sleepiness scale score (ESS) was higher in the OSA combined with OHS group, and the oxygen reduction index (ODI), apnea hypopnea index (AHI), micro-arousal index (MAI), apnea index (AI), mean apnea time (MAT), longest apnea time (LAT), the percentage of time with blood oxygen saturation less than 90% of the total time (T90) and the treatment proportion of bi-level positive airway pressure (BI-PAP) ventilation mode were increased in the OSA combined with ORSH group and the OSA combined with OHS group, while the minimum oxygen saturation (minSpO2) and mean blood oxygen saturation (meanSpO2) decreased (P＜0.05). Compared with the OSA combined with ORSH group, the proportion of continuous positive airway pressure (CPAP) treatment mode was decreased in the OSA combined with OHS group, and the proportion of BI-PAP ventilator treatment was increased (P＜0.05). Multivariate Logistic regression analysis indicated that prolonged LAT and increased HCO3 -were independent risk factors for OSA combined with ORSH. The area under the curve predicted by LAT and HCO3 - was 0.784, the sensitivity was 0.913, and the specificity was 0.541. Conclusion The combined detection of LAT and HCO3 - has a certain predictive value for OSA combined with ORSH. [ABSTRACT FROM AUTHOR]

Sleep is a significant physiological activity. In 2020 the World Health Organization pointed out in the "World Sleep Day" statistical report that nearly 27% of the world's population suffers from sleep disorders. Among them sleep apnea syndrome has attracted widespread attention as it's not easy to detect and has great harm. Moreover the severe sleep apnea syndrome could induce cardiovascular and cerebrovascular diseases central nervous diseases digestive system diseases and even tumour diseases. More severely patients may even suffer sudden death at night which will seriously affect patient's quality of life. As there is a large number of patients with sleep apnea syndrome the traditional medical examination is time-consuming expensive and inconvenient to promote resulting in a low diagnosis rate of sleep apnea syndrome. Therefore only the sleep apnea syndrome is diagnosed in time can patients' health be effectively improved. In this paper smart clothing that can effectively monitor sleep apnea syndrome is designed to pave the way for patients to understand their condition at home and get an early warning of related condition. In this way the optimal opportunity for treatment is improved. Firstly 50 patients with sleep apnea syndrome were investigated by questionnaire survey and interviewed to analyze their physiological needs psychological needs and use demand and the actual needs of users were identified through the analysis of the survey result. Secondly the appearance hardware and software of intelligent clothing were designed according to the actual demand. Among them the appearance design involves the design of fabric material colour appearance and size smart clothing and the effectiveness of fusion between intelligent clothing fabric and electronic components is also taken into account. The hardware part involves design of the monitoring components of smart clothing including the Bluetooth communication module the blood oxygen monitoring module the snore recognition module and battery module mainly. Among them the Bluetooth communication module plays a role in data transmission the battery module provides a power supply the blood oxygen saturation sensor monitors blood oxygen and records the blood oxygen rate of the human body and the snore module identifies and monitors the frequency of snoring which can directly reflect the current user's physiological parameters. The collected data will be transmitted to the mobile phone terminal through Bluetooth to determine whether the user has sleep apnea syndrome symptoms and the corresponding user report will be generated. The software part involves the design of the mobile App where users can check sleep reports and get relevant warnings. Finally according to the above design of intelligent clothing the experimental verification was given. The experiment was divided into two parts. The first part is the functional test including oxygen saturation and snoring tests and the second part is a comprehensive experiment. In order to verify the accuracy of judgment of actual wearing of smart clothes a comprehensive experiment of apnea syndrome with seven hours of sleep at night was carried out. The experimental results were compared with PSG diagnostic results and the experimental results were verified by the methods of experimental data comparison and the regression equation established by Matlab software. After the experiment was finished the subjects were evaluated for their wearing to understand the actual wearing feelings of users. This paper designed intelligent clothing by incorporating electronic components into garments and the physiological data of patients were monitored to make the patients know their illness. Moreover physiological information such as snore and oxyhemoglobin saturation was monitored by intelligent clothing. Then the data were uploaded to the mobile phone APP to determine whether the users suffer from sleep apnea syndrome. The health report and relevant warnings were obtained. Featuring functionality aesthetics practicality and comfort intelligent clothing also meets the psychological needs of users. The experimental results in this paper show that the smart clothes designed can better monitor and judge whether patients suffer from sleep apnea syndrome. It carries out follow-up related warnings to achieve the best treatment opportunity of patients and it can be used as an intelligent device for monitoring sleep apnea syndrome in daily life. During the development process and application of intelligent clothing it is found that the main direction of future research lies in comfort wear-ability accuracy aesthetics and how to better meet customers' needs. The research results can provide reference for the real-time monitoring of identifying apnea syndrome for people staying at home. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS) is characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia, IH), and it is a risk factor for cardiovascular disease (CVD) and insulin resistance/type 2 diabetes. However, the mechanisms linking IH stress and CVD remain elusive. We exposed rat H9c2 and mouse P19.CL6 cardiomyocytes to experimental IH or normoxia for 24 h to analyze the mRNA expression of the components of Cd38-cyclic ADP-ribose (cADPR) signaling. We found that the mRNA levels of cluster of differentiation 38 (Cd38), type 2 ryanodine receptor (Ryr2), and FK506-binding protein 12.6 (Fkbp12.6) in H9c2 and P19.CL6 cardiomyocytes were significantly decreased by IH, whereas the promoter activities of these genes were not decreased. By contrast, the expression of phosphatase and tensin homolog deleted from chromosome 10 (Pten) was upregulated in IH-treated cells. The small interfering RNA for Pten (siPten) and a non-specific control RNA were introduced into the H9c2 cells. The IH-induced downregulation of Cd38, Ryr2, and Fkbp12.6 was abolished by the introduction of the siPten, but not by the control RNA. These results indicate that IH stress upregulated the Pten in cardiomyocytes, resulting in the decreased mRNA levels of Cd38, Ryr2, and Fkbp12.6, leading to the inhibition of cardiomyocyte functions in SAS patients. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a sleep disorder with well-known metabolic consequences. The relationship between OSA and bone health, especially osteoporosis, remains poorly understood. Given that both OSA and osteoporosis are highly prevalent chronic conditions with significant public health implications, this study aims to investigate the association of OSA with bone health and osteoporosis. A systematic search of PubMed, Embase and Cochrane Library was conducted from inception to November 22, 2022. Fifteen studies comprising 158,273 individuals were included. The presence of OSA correlated negatively with bone mineral density on meta-analysis (pooled correlation = -0.30; 95 % CI, -0.42 to -0.17; N = 8). Individuals with OSA had poorer bone mineral density scores (mean difference = -0.58, 95 % CI, -1.15 to -0.01; N = 8), and significantly higher risk of developing osteoporosis (adjusted odds ratio = 2.18; 95 % CI, 1.14 to 4.16; N = 4). Notably, both body mass index (BMI) and age were not significant effect modulators in the correlation of OSA and bone density. These findings suggest that OSA is associated with diminished bone health, and it is severity-dependent. Further studies are required to determine if treatment of OSA may have the potential to mitigate these risks., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Patients with Osteoarthritis (OA) often also suffer from Sleep Apnea Syndrome (SAS), and many scholars have started to notice this link, although the relationship between the two is still unclear. In this review, we aim to summarize the current literature on these two diseases, integrate evidence of the OA and OSA connection, explore and discuss their potential common mechanisms, and thus identify effective treatment methods for patients with both OA and SAS. Some shared characteristics of the two conditions have been identified, notably aging and obesity as mutual risk factors. Both diseases are associated with various biological processes or molecular pathways, including mitochondrial dysfunction, reactive oxygen species production, the NF-kB pathway, HIF, IL-6, and IL-8. SAS serves as a risk factor for OA, and conversely, OA may influence the progression of SAS. The effects of OA on SAS are underreported in the literature and require more investigation. To effectively manage these patients, timely intervention for SAS is necessary while treating OA, with weight reduction being a primary requirement, alongside combined treatments such as Continuous positive airway pressure (CPAP) and medications. Additionally, numerous studies in drug development are now aimed at inhibiting or clearing certain molecular pathways, including ROS, NF-KB, IL-6, and IL-8. Improving mitochondrial function might represent a viable new strategy, with further research into mitochondrial updates or transplants being essential., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Weng, Luo, Luo, Yao, Zhang, Tan and Yin.)

Léa Dormegny,1,2 Reana Velizarova,1 Carmen M Schroder,1,3 Ulker Kilic-Huck,1,3 Henri Comtet,1,3 Hélène Dollfus,4 Patrice Bourgin,1,3 Elisabeth Ruppert1,3 1Centre des Troubles du Sommeil - CIRCSom, Hôpital Civil, University of Strasbourg, Strasbourg, 67091, France; 2Department of Ophthalmology, Hôpital Civil, University of Strasbourg, Strasbourg, 67091, France; 3Institute for Cellular and Integrative Neurosciences, CNRS - UPR 3212, Strasbourg, 67000, France; 4Centre des Affections Rares en Génétique Ophtalmologique (CARGO), University of Strasbourg, Strasbourg, 67091, FranceCorrespondence: Elisabeth RuppertCentre des Troubles du Sommeil - CIRCSom - Hôpital Civil, 1, place de l’Hôpital, BP 426, Cedex, Strasbourg, 67091, FranceTel +33 3 88 11 64 30Fax +33 3 88 11 51 53Email elisabeth.ruppert@chru-strasbourg.frObjective/Background: Bardet–Biedl syndrome (BBS) is a rare but well-recognized ciliopathy with high genetic and phenotypic heterogeneity. Cardinal features include obesity, diabetes and high blood pressure (HBP), which are often associated with sleep-disordered breathing. Also, the high prevalence of blindness due to retinal dystrophy could affect circadian sleep–wake rhythms. We characterized in this cohort of adult BBS patients sleep-disordered breathing, sleep quality, daytime sleepiness and chronotype.Patients and Methods: Thirty-two patients with genetically confirmed BBS were included in this observational single center study. Overnight respiratory polygraphy was performed for sleep apnea syndrome (SAS) in 30 patients. Quality of sleep, daytime sleepiness, fatigue and chronotype were assessed in 25 patients using Pittsburgh sleep quality index (PSQI), 14-day sleep diary (SD), Epworth sleepiness scale (ESS), Pichot fatigue scale (PFS) and Horne and Ostberg morningness-eveningness questionnaire (MEQ).Results: Patients’ mean age was 32± 11 years and mean BMI 32.6± 7.7 kg/m2. Eleven (35%) patients had HBP and 7 (22%) diabetes. Moderate to severe sleep apnea syndrome (SAS) was present in 5 (17%) and was not associated with altered sleep, daytime sleepiness or fatigue. Most of the patients (63%) evaluated their sleep as of good quality (PSQI ≤ 5). Median scores of sleep quality, daytime sleepiness and fatigue were normal (PSQI of 3.0 [2.0– 6.0], ESS of 9.0 [6.0– 13.0] and PFS of 8.0 [3.0– 13.0], respectively). Predominant chronotypes according to MEQ were either “intermediate” (57%) or “moderate morning” (29%). None had a free running sleep–wake cycle. 14-day SD revealed overall few awakenings at night and low daytime napping.Conclusions: Given the cardiovascular risk factors, systematic screening for SAS should be considered in BBS patients, regardless of sleep and daytime vigilance complaints. None of these highly visually impaired patients had a circadian sleep–wake rhythm disorder. Further objective assessments are needed to better characterize sleep and circadian rhythms in BBS patients.Keywords: Bardet–Biedl syndrome, ciliopathy, sleep disordered breathing, sleep apnea syndrome, chronotype, circadian rhythm sleep wake disorder

The aim of this paper is to perform an observational descriptive study of the Obstructive Sleep Apnea Syndrome (OSAS) in a population of children by evaluating the prevalence and role of sex and age variables. The 22-item Pediatric Sleep Questionnaire (PSQ) was administered to parents of children aged 3 to 12 years. The questionnaire is a very simple tool since it allows for the indication of patients with possible OSAS diagnosis through a cut-off of 0.33. The anonymous diagnostic questionnaire, available in digital format, was administered to the population under study by a link or QR code. Only the questionnaires completed in all their parts were recorded and analyzed. Eight hundred and thirty-two questionnaires were collected. One hundred and fifty-four subjects obtained a PSQ score > 0.33 and the prevalence of OSAS was 18.51%. The Chi-square test showed a statistically significant association between the PSQ score > 0.33 and male sex. The higher prevalence of subjects with a value of PSQ > 0.33 (n = 277) are aged 3–4–5 years, followed by the 6–7–8 range in the group with PSQ score > 0.33, p < 0.05. The prevalence of OSAS was 18.51% in children aged 3 to 12 years. The variables male biological sex and the age group 3–8 year were statistically significant for subjects with OSAS diagnosis. This study underlines the use of the 22-item Pediatric Sleep Questionnaire as a first screening tool to identify children at risk of OSAS.

Background: Patients suffering from aortic dissection (AD) often experience sleep apnea syndrome (SAS), which aggravates their respiratory function and aortic false lumen expansion.Methods: We analyzed the peri-operative data of Stanford A AD patients, with or without SAS, between January 2017 and June 2019. Subjects were separated into SAS positive (SAS+) and SAS negative (SAS-) cohorts, based on the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). We next analyzed variables between the SAS+ and SAS- groups.Results: 155, out of 198 AAD patients, were enlisted for this study. SAS+ patients exhibited higher rates of pneumonia (p < 0.001), heart failure (HF, p = 0.038), acute kidney injury (AKI, p = 0.001), ventilation time (p = 0.009), and hospitalization duration (p < 0.001). According to subsequent follow-ups, the unstented aorta false lumen dilatation (FLD) rate increased markedly, with increasing degree of SAS (p < 0.001, according to AHI and ODI). The SAS+ patients exhibited worse cumulative survival rate (p = 0.025). The significant risk factors (RF) for poor survival were: severe (p = 0.002) or moderate SAS (p = 0.008), prolonged ventilation time (p = 0.018), AKI (p = 0.015), HF New York Heart Association (NYHA) IV (p = 0.005) or III (p = 0.015), pneumonia (p = 0.005), Marfan syndrome (p = 0.010), systolic blood pressure (BP) upon arrival (p = 0.009), and BMI ≥ 30 (p = 0.004).Conclusions: SAS+ Stanford A AD patients primarily exhibited higher rates of complications and low survival rates in the mid-time follow-up. Hence, the RFs associated with poor survival must be monitored carefully in SAS patients. Moreover, the FLD rate is related to the degree of SAS, thus treating SAS may mitigate FLD. [ABSTRACT FROM AUTHOR]

• Sleep apnea syndrome (SAS) screening AI-based on R-R interval data was validated with a large clinical polysomnography dataset. • AUC of 0.92, a sensitivity of 0.80 and a specificity of 0.84 were achieved. • The SAS screening algorithm is easy to implement into a smartphone app. Easily detecting patients with undiagnosed sleep apnea syndrome (SAS) requires a home-use SAS screening system. In this study, we validate a previously developed SAS screening methodology using a large clinical polysomnography (PSG) dataset (N = 938). We combined R-R interval (RRI) and long short-term memory (LSTM), a type of recurrent neural networks, and created a model to discriminate respiratory conditions using the training dataset (N = 468). Its performance was validated using the validation dataset (N = 470). Our method screened patients with severe SAS (apnea hypopnea index; AHI ≥ 30) with an area under the curve (AUC) of 0.92, a sensitivity of 0.80, and a specificity of 0.84. In addition, the model screened patients with moderate/severe SAS (AHI ≥ 15) with an AUC of 0.89, a sensitivity of 0.75, and a specificity of 0.87. Our method achieved high screening performance when applied to a large clinical dataset. Our method can help realize an easy-to-use SAS screening system because RRI data can be easily measured with a wearable heart rate sensor. It has been validated on a large dataset including subjects with various backgrounds and is expected to perform well in real-world clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To construct neural models to predict the progression of glaucoma in patients with sleep apnea. Materials and Methods: Modeling the use of neural networks was performed using the Neurosolutions commercial simulator. The built databases gather information on a group of patients with primitive open-angle glaucoma and normal-tension glaucoma, who have been associated with sleep apnea syndrome and various stages of disease severity. The data within the database were divided as follows: 65 were used in the neural network training stage and 8 were kept for the validation stage. In total, 21 parameters were selected as input parameters for neural models including: age of patients, BMI (body mass index), systolic and diastolic blood pressure, intraocular pressure, central corneal thickness, corneal biomechanical parameters (IOPcc, HC, CRF), AHI, desaturation index, nocturnal oxygen saturation, remaining AHI, type of apnea, and associated general conditions (diabetes, hypertension, obesity, COPD). The selected output parameters are: c/d ratio, modified visual field parameters (MD, PSD), ganglion cell layer thickness. Forward-propagation neural networks (multilayer perceptron) were constructed with a layer of hidden neurons. The constructed neural models generated the output values for these data. The obtained results were then compared with the experimental values. Results: The best results were obtained during the training stage with the ANN network (21:35:4). If we consider a 25% confidence interval, we find that very good results are obtained during the validation stage, except for the average GCL thickness, for which the errors are slightly higher. Conclusions: Excellent results were obtained during the validation stage, which support the results obtained in other studies in the literature that strengthen the connection between sleep apnea syndrome and glaucoma changes. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS), characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia (IH)), is a risk factor for hypertension and insulin resistance. We report a correlation between IH and insulin resistance/diabetes. However, the reason why hypertension is induced by IH is elusive. Here, we investigated the effect of IH on the expression of catecholamine-metabolizing enzymes using an in vitro IH system. Human and mouse neuroblastoma cells (NB-1 and Neuro-2a) were exposed to IH or normoxia for 24 h. Real-time RT-PCR revealed that IH significantly increased the mRNA levels of dopamine β-hydroxylase (DBH) and phenylethanolamine N-methyltransferase (PNMT) in both NB-1 and Neuro-2a. Western blot showed that the expression of DBH and PNMT in the NB-1 cells was significantly increased by IH. Reporter assays revealed that promoter activities of DBH and PNMT were not increased by IH. The miR-375 level of IH-treated cells was significantly decreased relative to that of normoxia-treated cells. The IH-induced up-regulation of DBH and PNMT was abolished by the introduction of the miR-375 mimic, but not by the control RNA. These results indicate that IH stress increases levels of DBH and PNMT via the inhibition of miR-375-mediated mRNA degradation, potentially playing a role in the emergence of hypertension in SAS patients. [ABSTRACT FROM AUTHOR]

Objective: The NoSAS score is a new tool widely used in recent years to screen for obstructive sleep apnea. A number of studies have shown that the NoSAS score is more accurate than previous tools, such as the Berlin, STOP-Bang, and STOP questionnaires. Therefore, this meta-analysis assessed the diagnostic value of the NoSAS score for sleep apnea syndrome in comparison to polysomnography. Methods: Two researchers searched the PubMed, EMBASE, Cochrane, and Web of Science databases through November 13, 2020. This paper used Endnote9.3 software to manage the literature and RevMan 5.3 and STATA12.0 software to perform the meta-analysis. Results: A total of 10 studies were included in this meta-analysis, including 14,510 patients. The meta-analysis showed that the pooled sensitivity was 0.798 (95% CI 0.757, 0.833), the pooled specificity was 0.582 (95% CI 0.510, 0.651), the positive likelihood ratio was 1.909 (95% CI 1.652, 2.206), the negative likelihood ratio was 0.347 (95% CI 0.300, 0.403), the diagnostic OR was 5.495 (95% CI 4.348, 6.945), and the area under the SROC curve was 0.77 (95% CI 0.73, 0.80). The NoSAS score has good efficacy in identifying patients likely to have obstructive sleep apnea. Conclusion: The NoSAS score can accurately identify patients likely to have obstructive sleep apnea. Therefore, in the absence of polysomnography, one should use the NoSAS score to evaluate patients with suspected sleep apnea syndrome. [ABSTRACT FROM AUTHOR]

AIM Whether obstructive sleep apnea (OSA) actually represents an independent risk factor for aortic dilation in the general population is unclear. We investigated this issue through a review and a meta-analysis of cardiac imaging studies that provided data on this vascular phenotype measured at the root or ascending tract level. DESIGN A computerized search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 30 November 2021. Studies were identified by using the following search terms: "aortic root," "ascending aorta," "vascular damage," "echocardiography," "computed tomography," "magnetic resonance imaging," "obstructive sleep apnea," "sleep disordered breathing." RESULTS Eleven studies including a total of 1,860 patients with OSA (without aortic aneurysms and connective tissue diseases) and 233 non-OSA controls were considered. Aortic diameter was significantly higher in patients with OSA than in non-OSA controls (standard means difference [SMD] = 0.73 ± 0.08, confidence interval [CI]: 0.57–0.88, P < 0.0001). This was also the case for patients with severe OSA as compared with their counterparts with mild OSA (SMD = 0.42 ± 0.07, CI: 0.28–0.56, P < 0.0001). CONCLUSIONS Our findings suggest an association between OSA and aortic enlargement and particularly in the severe OSA setting. However, this conclusion must be taken with caution in relation to 2 types of factors: (i) the paucity of available data, and (ii) the limits deriving from the methodological differences of the various studies. Larger prospective and carefully designed studies are needed to shed light on this relevant public health topic. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study is to identify sleep disorders in adults with sickle cell disease and to examine the effects of accompanying sleep disorders on the prognosis of sickle cell disease. MATERIAL AND METHODS: Twenty-eight patients followed up with a diagnosis of sickle cell disease and 22 healthy volunteers were included in our study. RESULTS: Both groups had similar characteristics in terms of age, gender, and body mass index. More obstructive sleep apnea syndrome was detected in the sickle cell group than in healthy volunteers. Statistically, the sickle cell patient group had higher apnea-hypopnea index and lower nighttime oxygen desaturation. As the degree of obstructive sleep apnea syndrome increased in the sickle cell group, it was found that there were more emergency admissions and hospitalization due to painful crises and/or acute chest syndrome in the last 1 year. Also, lower sleep efficiency was found in the sickle cell disease patient group. In the sickle cell group, it was found that the restless leg syndrome severity was statistically significantly more. CONCLUSION: As hypoxia deepens in sickle cell patients, mortality and morbidity due to the disease increase significantly. Comorbid sleep disturbances in sickle cell patients exacerbate nocturnal hypoxia and negatively affect the prognosis of the disease. Therefore, patients with sickle cell disease should be questioned in detail in terms of obstructive sleep apnea syndrome and, if necessary, polysomnographic evaluation should be performed to provide treatment for sleep disorders in the early period. [ABSTRACT FROM AUTHOR]

The high prevalence of obstructive sleep apnea syndrome (OSA) causes a steady interest in this pathology. In recent years, one of the urgent problems in modern somnology is the assessment of the main mechanisms of neuronal dysfunction during the day and at night in OSA, the ideas about which, to a large extent, remain contradictory and not fully understood. One of the modern methods for assessing neuronal dysfunction during sleep is the study of the sleep microstructure, and for its assessment, the method of analysis of cyclic alternating pattern (CAP), an EEG marker of unstable sleep, is used. The cyclic alternating pattern is found both in the sleep of adults and children with various sleep disorders and, in particular, with OSAS, therefore, it is a sensitive tool for studying sleep disorders throughout life. With the elimination of night hypoxia against the background of CPAP therapy, the sleep microstructure is restored, the spectral characteristics of the EEG change, and a decrease in the number of EEG arousals after treatment leads to the restoration of daytime functioning. Understanding the role of short-term EEG activations of the brain during sleep can provide significant data on sleep functions in health and disease. Despite the improving diagnosis of sleep disorders using machine algorithms, assessing the relationship of structures and functions of the brain during sleep, neurophysiological data are not entirely clear, which requires further research. In this review, we tried to analyze the results of the main studies of the neurophysiological sleep pattern in OSA against the background of respiratory support during sleep.

BackgroundThe incidence of sleep apnea syndrome (SAS) is reported to be markedly high in patients with chronic kidney disease (CKD). Therefore, it is extremely important to know whether SAS affects prognosis in patients with CKD. Further, it is imperative to understand the prognostic impact of home continuous positive airway pressure (CPAP) therapy, which is one of the most common treatments for SAS.Materials and MethodsWe used a clinical database to identify patients with CKD using diagnosis codes. We included patients with CKD aged 20 years or more, not on renal replacement therapy, with a known change in renal function for at least 1 year. The propensity score was used to compare event rates for patients with SAS and those without SAS. In addition, the prognostic impact of CPAP therapy was investigated. The primary outcome is a composite of death, initiation of renal replacement therapy, hospitalization for heart failure, ischemic heart disease, and cerebrovascular disease.ResultsFrom the database, 31,294 patients with CKD without SAS and 1,026 with SAS were found to be eligible. Of these, 419 (41%) patients with SAS and 10,713 (34%) patients without SAS (P < 0.01) reached the primary outcome. After adjustment with the propensity score, the SAS group was found to have a similarly poor prognosis (P < 0.01): the hazard ratio for the primary outcome was 1.26 (95% CI, 1.08–1.45, P < 0.01) in the group with SAS compared with the group without SAS. Conversely, in patients with SAS and using CPAP, the hazard ratio was lower and did not differ significantly (HR 0.96, 95% CI: 0.76–1.22, P = 0.76).ConclusionIn patients with CKD and SAS, the risk of death and cardiovascular disease is high. In addition, patients treated with CPAP may have improved life expectancy.

Objective: To compare pulse oximetry with manual analysis against all signals of respiratory polygraphy. Material and Methods: This retrospective study estimated sensitivity (S), specificity (Sp) and positive/negative likelihood ratio (LR+/-) of the oxygen desaturation index (ODI-test) and apnea-hypopnea index (AHI-reference). Results: 3854 patients (61.5% men) were included. Age, BMI, Epworth sleepiness scale and AHI were: 55 years (44-65), 30.9kg/m2 (27-36), 7 points (4-11), and 14 events/hour (6-25), respectively. 18% showed an AHI 15 and < 30, and 31% > 30. The S, Sp, and LR+/- of ODI for AHI = 5 events/hour was 93%, 92%, 12 and 0.08 with an accuracy of 93%. For AHI = 15 events/hour, the values were: S 94%, Sp 94%, LR+ 15 and LR- 0.06 and 94% accuracy (r2 Spearman: 0.92). Conclusion: In a population at a high risk for OSA, home-based pulse oximetry had a diagnostic accuracy > 90% when is compared against all respiratory signals obtained from simplified home sleep testing.

Objective: The purpose of this study was to assess the relationship between the quantity of jobs and nocturnal awakenings of Brazilians living in Massachusetts. Material and Methods: We sampled of 48 documented Brazilians around the age of 45.5 years old. 52.1% of them were women. Data gathering occurred for three weeks, using the Pittsburgh Sleep Quality Index. Participants also wore wrist actigraph and filled sleep/wake diary for a week. Results: The sleep quality of immigrants with one job (mean=8.58, SD=4.16) is better when compared to immigrants with 2-3 jobs (mean=12.7, SD=3.57) according to the PSQI scores. Immigrants with 2-3 jobs reported dissatisfaction on three components of the scale: sleep duration, sleep efficiency and sleep quality. Discussion: There is a positive relationship between the quantity of jobs and nocturnal awakenings and between nocturnal awakenings and complaints related to sleep apnea among Brazilians in Massachusetts. The assessment of systemic morbidities associated with sleep pattern changes should be considered in future research.

Sleep apnea syndrome (SAS) is a common but underdiagnosed health problem related to impaired quality of life and increased cardiovascular risk. In order to solve the problem of complicated and expensive operation procedures for clinical diagnosis of sleep apnea, here we propose a small and low-cost wearable apnea diagnostic system. The system uses a photoplethysmography (PPG) optical sensor to collect human pulse wave signals and blood oxygen saturation synchronously. Then multiscale entropy and random forest algorithms are used to process the PPG signal for analysis and diagnosis of sleep apnea. The SAS determination is based on the comprehensive diagnosis of the PPG signal and blood oxygen saturation signal, and the blood oxygen is used to exclude the error induced by non-pathological factors. The performance of the system is compared with the Compumedics Grael PSG (Polysomnography) sleep monitoring system. This simple diagnostic system provides a feasible technical solution for portable and low-cost screening and diagnosis of SAS patients with a high accuracy of over 85%.

Summary: The aims of the present prospective clinical study were to determine objective, sensor‐measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner‐specific adherence‐related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non‐adherent to continuous positive airway pressure (mean age 56.2 years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow‐up was 8.3 (3.4–16.5) months. The mean apnea–hypopnea index (AHI) was 26.6 events/hr at baseline and 12.5 events/hr at the 8‐month follow‐up (both p < 0.001). The mean sensor‐measured adherence at the 8‐month follow‐up was 60.1% for ≥4 hr/night of appliance use for ≥5 days/week. Average usage was 6.4 hr/night, when worn. The mean reduction in the AHI was significantly greater in the "good adherence" (Δ 17.4) than the "poor adherence" group (Δ11.0; p < 0.05). From the partner's perspective, the appliance had a positive effect on sharing a bedroom in the good‐ (55%) compared to the poor‐adherence group (25%; p < 0.05) and on their relationship (51.7% versus 17.9%, respectively; p < 0.05). Regression analyses identified the partner's snoring and apneas to be the most significant factor predicting good adherence to MAD (odds ratio 4.4, 95% confidence interval 1.4–14.0). In conclusion, social factors, like partner perceptions, were positively associated with adherence, which indicate that partner's attitudes and support may be a resource that can be utilised to improve adherence in oral appliance treatment of OSA. [ABSTRACT FROM AUTHOR]

Sleep medicine is a cross-disciplinary subject with high relevance for psychiatry and psychotherapy. The three most common sleep disorders (insomnia, sleep apnea syndrome and restless legs syndrome) are presented here with practical relevance. Cognitive behavioral therapy is the treatment of choice for insomnia, whereas symptomatic drug treatment (especially with GABA receptor agonists) should be used with caution. Sleep-related breathing disorders have a high prevalence of around 24% among psychiatric inpatients in Germany. Typical symptoms of obstructive sleep apnea syndrome should lead to a staged diagnostic process and, if necessary, cardiorespiratory polysomnography. It is not unusual for restless legs syndrome to be caused by psychopharmacological treatment. The primary form was usually treated with dopamine or dopamine agonists but due to the risk of augmentation, alternatives should be considered more often. [ABSTRACT FROM AUTHOR]

Introduction: We previously identified UDP‐N‐acetylglucosamine 2‐epimerase (GNE) myopathy patients with sleep apnea and a past history of thrombocytopenia, but without disease‐specific cardiac involvement. This study aimed to clarify the occurrence, severity, and serial changes of these complications. Methods: Thirty‐three genetically confirmed GNE myopathy patients who participated in a 5‐y longitudinal observational history study underwent platelet count and platelet‐associated immunoglobulin G (PA‐IgG) measurements, a sleep study, and electrocardiography (ECG), Holter ECG, and echocardiogram examinations. Results: Among the 33 patients, three had low platelet counts and 17 out of 26 were PA‐IgG positive. No patient exhibited bleeding tendencies, and 3 out of 28 had low platelet counts. Muscle weakness was more pronounced, and summed MMT and grip power significantly lower, in PA‐IgG‐positive patients than in PA‐IgG‐negative patients. Of 19 patients, 7, 4, and 3 who underwent a sleep study had mild, moderate, and severe sleep apnea, respectively, and three started continuous positive airway pressure (CPAP). The respiratory disturbance index was not significantly correlated with physical evaluation items or forced vital capacity. All patients underwent ECG, 32 underwent cardiac ultrasound, and 25 underwent Holter ECG. No disease‐specific cardiac involvement was noted, no serial changes during the follow‐up period were observed for ECG and echocardiography, and none of the patients required therapy for cardiac abnormalities. Discussion: PA‐IgG is a potential disease biomarker in GNE myopathy patients, although its significance needs to be clarified. While none of the patients in this study experienced cardiomyopathy or arrythmia due to myopathy, sleep apnea was identified as a frequent complication. See editorial on pages 263–265 in this issue. [ABSTRACT FROM AUTHOR]

Introduction The occurrence of chronic obstructive airway disease and obstructive sleep apnea (OSA) is a popular syndrome called overlap syndrome. Aim To evaluate the prevalence of OSA in chronic obstructive pulmonary disease (COPD). Patients and methods A total of 86 patients with COPD (54.65% men, with a mean age of 62.065 years) were included in our study. Clinical criteria and biochemical tests were registered, and polysomnography was done. Results Overall, 38 patients with an apnea–hypopnea index more than 5 events/h were defined as having overlap syndrome (44.19%). Conclusion The results showed an OSA prevalence of 44.19% in patients with COPD. A sleep study should be considered in overweight patients with COPD, even in patients without symptoms of sleep apnea.

Introduction-Sleep and epilepsy are closely linked. Some late-onset adult epilepsies can be triggered by sleep deprivation in connection with many sleep disorders, and among them obstructive sleep apnea syndrome (OSAS) which causes hypoxemia and sleep fragmentation that can be the cause of epileptic seizures and complicate their treatment. Observation-We report the cases of two patients who presented late epileptic seizures of unknown etiology. Faced with clinical features leading to OSA, ventilatory polygraphy-type sleep recordings were performed and demonstrated moderate OSA in the first patient and severe OSA associated with obesity / hypoventilation syndrome (SOH) in the second patient.

Objectives: To evaluate symptoms related to Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in patients with cardiovascular disease (CVD) and its relation with personal characteristics and medication use. Methods: The Pittsburgh sleep quality index (PSQI), Berlin questionnaire (BQ) and Epworth sleepiness scale (ESS) were used, including variables such as gender, body mass index, systemic arterial hypertension, cardiopathy and amount of medicines used, from January to October/2017, and performed data analysis. Results: A total of 231 patients participated, 66.23% presented poor sleep quality; 24.68% high risk of OSAHS and 31.7% excessive daytime sleepiness (EDS). The BQ showed a higher chance of a high risk for OSAHS in pre-obese and obese I-degree. The ESS showed an increase in EDS with the reduction of 1 medication for cardiopathy. The PSQI showed a higher chance of poor sleep quality in females than not male. Discussion: Other than this study, the literature shows that EDS can result from the use of drugs for heart disease and hypertension. The literature shows that overweight and obesity increase the chance of systemic arterial hypertension, moreover, this research showed that weight also had a greater influence on the high risk of OSAHS. This shows that overweight and obesity are risk factors for systemic arterial hypertension, OSAHS and CVD. This study evidenced, as well as the literature, poorer sleep quality in females.

Obstructive sleep apnea syndrome (OSAS) is characterized with interruption of sleep with apnea attacks and is associated with various diseases such as metabolic syndrome. GDF-15 (Growth differentiation factor 15) is a cytokine belonging to the transforming growth factor - β superfamily and it has been found to be associated with chronic heart failure, acute pulmonary embolism, and acute attacks of chronic obstructive pulmonary disease (COPD). It was aimed to evaluate the relationship between disease severity and mean GDF-15 in patients diagnosed with OSAS. Our study was carried out with 75 patients with OSAS. GDF-15 levels were checked by in the morning fasting blood test. Among the 75 patients, 27 constituted the mild, 22 constituted the moderate and 26 constituted the severe OSAS groups. The mean ages of the patients were not significantly different between groups (53.17±10, 54.61±10.2 and 53.5±11.6 respectively; p>0,05). GDF-15 levels were not significantly different between groups separately (p>0.05). There was only a weak positive relationship between GDF-15 and NREM and REM (p<0.05). In our study, it was revealed that there was no significant relationship between the OSAS severity groups and GDF-15. Our determination of a positive relationship with NREM and REM may have been related to reduction of minute ventilation experienced in OSAS-diagnosed patients, tachycardic fluctuations, their more severe nature and increased right ventricular pressure. Consequently, our current knowledge indicates that GDF-15 is not much guiding in the prediction and monitoring of OSAS severity. [ABSTRACT FROM AUTHOR]

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Purpose: Sleep apnea syndrome (SAS) is a prevalent sleep disorder in which apnea and hypopnea occur frequently during sleep and result in increase of the risk of lifestyle-related disease development as well as daytime sleepiness. Although SAS is a common sleep disorder, most patients remain undiagnosed because the gold standard test polysomnography (PSG), is high-cost and unavailable in many hospitals. Thus, an SAS screening system that can be used easily at home is needed. Methods: Apnea during sleep affects changes in the autonomic nervous function, which causes fluctuation of the heart rate. In this study, we propose a new SAS screening method that combines heart rate measurement and long short-term memory (LSTM) which is a type of recurrent neural network (RNN). We analyzed the data of intervals between adjacent R waves (R-R interval; RRI) on the electrocardiogram (ECG) records, and used an LSTM model whose inputs are the RRI data is trained to discriminate the respiratory condition during sleep. Results: The application of the proposed method to clinical data showed that it distinguished between patients with moderate-to-severe SAS with a sensitivity of 100% and specificity of 100%, results which are superior to any other existing SAS screening methods. Conclusion: Since the RRI data can be easily measured by means of wearable heart rate sensors, our method may prove to be useful as an SAS screening system at home. [ABSTRACT FROM AUTHOR]

Background: Cyclic variation of heart rate (CVHR) associated with sleep‐disordered breathing reflects cardiac autonomic responses to apneic/hypoxic stress. However, the association of CVHR with cardiac function is unclear. Methods: We investigated a total of 181 patients who underwent both 24‐hour Holter electrocardiography (ECG) and quantitative gated single‐photon emission computed tomography (SPECT) myocardial functional imaging, excluding patients with atrial fibrillation, myocardial infarction, structural heart disease, and implantable devices, from January 2017 to July 2018. The number of CVHR per hour (CVHR index) in sleeping‐time Holter ECG was compared with the parameters of left ventricular (LV) systolic and diastolic functions assessed by cardiac SPECT functional imaging, peak filling rate (PFR), first‐third mean filling rate (1/3 MFR), and time to peak filling rate (TTPF). Results: In all patients, the CVHR index was not associated with any parameters of cardiac functions. However, in a propensity score–matched subgroup of patients without ischemia (N = 39), the CVHR index was negatively correlated with PFR (r = −0.35, P < .05) and 1/3 MFR (r = −0.37, P < .05) but positively correlated with TTPF (r = 0.43, P < .01) and was not correlated with LV ejection fraction. Multivariate linear regression analysis revealed that high CVHR index was independently associated with LV diastolic dysfunction, even after adjusting for the relative wall thickness and LV mass index assessed by echocardiography. Conclusion: These results indicate that the high frequency of CVHR in sleeping time is associated with LV diastolic dysfunction in nonischemic patients, irrespective of LV geometry. [ABSTRACT FROM AUTHOR]

Objective: To study the serum levels of fibrinogen and d-dimer in patients with obstructive sleep apnea (OSA) and its correlation with apnea hypopnea index (AHI), oxygen desaturation index (ODI), minimal oxygen saturation and arousal index. Methods: It was a case control study in which 23 cases of OSA and 23 controls were enrolled. Morning fasting serum fibrinogen and d-dimer were measured in cases of OSA and controls. Results: Serum fibrinogen levels among OSA patients (268.47±53.11mg/dl) were elevated as compared to the levels in controls (221.52±65.84mg/ dl) (p

Fetal alcohol syndrome is the result of prenatal effect of alcohol on the fetus and manifests as disorders of neural and mental development and various congenital developmental disorders leading to comorbid diseases. Among congenital developmental disorders for the pathology, adenotonsillar pathology was described. Narrowing of the nasopharyngeal opening, faciomaxillary dysmorphias and muscle hypotony can lead to sleep apnea syndrome. The article presents a clinical case of fetal alcohol syndrome and sleep apnea in a 7‑year-old girl with multiple developmental disorders born form alcohol-abusing mother. Breathing abnormalities during sleep must be differentiated per character and cause. Cardiorespiratory monitoring is used to diagnose respiratory abnormalities, the results determine patient management tactics. Interdisciplinary approach to observation and treatment of a child with fetal alcohol syndrome is necessary to increase the effectiveness of rehabilitation measures and patient’s quality of life.

Excessive daytime sleepiness is a common clinical application of Obstructive Sleep Apnea syndrome and narcolepsy patients. Although both medical conditions can be different in extensive daytime sleepiness features and accompanying symptomatology, distinctive features may be masked in some cases. In our four reported cases, there were obstructive sleep apnea syndrome and narcolepsy type 1 coexistence. We aimed to discuss the possibility of this condition being comorbidity, the possibility of masking the type clinics in their association or the possibility of causing each other’s risk factors. In two of the reported cases, although excessive daytime sleepiness was not restful and typical cataplexy attacks were not described in the beginning, cataplexy attacks started to be defined even when excessive daytime sleepiness persisted when they were treated with Sleep Apnea syndrome. As a result of repeated diagnostic tests, they were diagnosed with narcolepsy in addition to Sleep Apnea syndrome. In the other two cases, excessive daytime sleepiness and cataplexy attacks, and diagnostic tests indicated type 1 narcolepsy, but it was observed that the Body Mass indexes were increased in the clinical follow-up and sleep apnea syndrome was diagnosed with repeated test. By presenting the approach to these four cases, we aimed to identify the causes and possible mechanisms about coexistence between narcolepsy and sleep apnea syndrome.

Charcot-Marie-Tooth disease (CMT) is a hereditary peripheral neuropathy characterized by progressive atrophy of distal muscles. Respiratory complications are rare. We present a case of a 49-year-old male with childhood-onset CMT bearing a genetic mutation of MFN2. He had difficulty breathing when he was 46. Imaging examination revealed complications of phrenic nerve paralysis and pneumothorax with a funnel chest. Respiratory function test demonstrated severe restrictive ventilatory impairment. Polysomnography supported the diagnosis of mild sleep apnea syndrome. Noninvasive positive pressure ventilation successfully reduced respiratory symptoms. To our knowledge, this is the first demonstration of multiple respiratory complications in a CMT patient.