Search Results (105)

Background/Objectives: Myotonic dystrophy type 1 (DM1) is a rare neuromuscular disorder characterized by respiratory dysfunction that significantly impacts quality of life and longevity. This study aimed to explore the outcomes of pulmonary function tests and sleep-disordered breathing (SDB) workups in children with DM1 and to identify the factors contributing to SDB. Methods: A retrospective study examined patients’ medical records, including genetic analyses, clinical characteristics, and noninvasive pulmonary function testing (PFT), when possible. The Pediatric Sleep Questionnaire (PSQ), arterial blood gases, polygraphy, and overnight transcutaneous capnometry (PtcCO₂) were used to assess SDB. Results: The size of CTG expansion in the DMPK gene directly correlated with the severity of respiratory complications and the need for early tracheostomy tube insertion in 7/20 (35%) patients. A total of 13/20 (65%) children were available for respiratory evaluation during spontaneous breathing. While moderate/severe obstructive sleep apnea syndrome (OSAS) and hypoventilation were confirmed in 4/13 (31%) children, none of the patients had mixed or dominantly central sleep apnea syndrome. There was no correlation between apnea–hypopnea index (AHI) or PtcCO₂ and the presence of SDB-related symptoms or the PSQ score. Although a significant correlation between AHI and PtcCO₂ was not confirmed (p = 0.447), the oxygen desaturation index directly correlated with PtcCO₂ (p = 0.014). Conclusions: While SDB symptoms in children with DM1 may not fully correlate with observed respiratory events or impaired gas exchange during sleep, a comprehensive screening for SDB should be considered for all patients with DM1. Further research into disease-specific recommendations encompassing the standardization of PFT, as well as overnight polygraphic and capnometry recordings, could help to guide timely, personalized treatment. Full article

Introduction: Optimal control of acute postoperative pain after major surgery accelerates the recovery process, shortens hospital stays, and minimizes healthcare costs. Intrathecal morphine is a simple, safe, and reliable regional technique that provides prolonged analgesia, useful in a wide variety of procedures. Materials and Methods: A retrospective observational study was conducted on patients who underwent various major abdominal or thoracic surgical procedures and were administered intrathecal morphine between January 2018 and December 2021. The primary objective was to establish the safety of the technique in terms of the incidence of early and late respiratory depression, atelectasis, the need for respiratory support, and the possible association of these complications with the presence of respiratory pathologies such as chronic obstructive pulmonary disease (COPD) or sleep apnea–hypopnea syndrome (SAHS) and obesity or smoking habit. Secondary objectives included recording the consumption of rescue intravenous (IV) morphine in the first postoperative 24 h, the incidence of PONV, and the incidence of late postoperative complications (at 90 days) such as pneumonia, readmission rates, and reoperation rates. Hospital stay and mortality were also recorded. Results: A total of 484 patients were included in the study. No patient experienced respiratory depression. Atelectasis occurred in 2.07% of patients. Respiratory support with non-invasive mechanical ventilation (NIMV) or high-flow oxygen therapy (HFOT) was required by 1.86% of patients. In total, 51% of patients required rescue IV morphine (average 6.98 mg), with a rate significantly higher in the thoracic and general surgery groups compared to urological surgery. The incidence of postoperative nausea and vomiting (PONV) was 30.37%. Regarding other secondary objectives, readmissions, reoperations, and mortality rates were significantly higher in patients undergoing urological and thoracic surgery compared to those undergoing general surgery. Conclusions: The administration of intrathecal morphine for the control of acute postoperative pain after major surgery can be considered as a safe technique that fits perfectly within the set of measures for a multimodal approach to pain management in major abdominal and thoracic surgery. Full article

Although most research has concentrated on the link between sleep apnea and atrial fibrillation, obstructive sleep apnea (OSA) is also associated with ventricular arrhythmias. These cardiac arrhythmias can be triggered by repeated episodes of hypoxemia, hypercapnia, acidosis, intrathoracic pressure fluctuations, reoxygenation, and other mechanisms that occur during apnea and hypopnea. Studies show that OSA reduces the effectiveness of arrhythmia treatments, such as antiarrhythmic medications and radiofrequency current ablation. Several non-randomized studies indicate that treating sleep apnea syndrome with continuous positive airway pressure (CPAP) may help maintain sinus rhythm following electrical cardioversion and increase the success rates of catheter ablation. This review aims to thoroughly examine the role of OSA in the development of cardiac arrhythmias. Screening for OSA and arrhythmias in patients with OSA provides vital information on the need for additional interventions, such as CPAP therapy, anticoagulation, antiarrhythmic drug therapy, catheter ablation for specific arrhythmias, or device therapy. New therapies for OSA treatment have the potential to significantly influence arrhythmia development in patients with sleep-disordered breathing. However, further research is required to validate these findings and formulate comprehensive treatment protocols. Full article

Background: Obstructive sleep apnea is a sleep-related breathing disorder associated with craniofacial morphology and dental arches. The aim of this study was to evaluate the correlation between obstructive sleep apnea and the morphometry of dental arches and upper airways. Methods: Forty patients were enrolled in the study, and the polysomnographic parameters evaluated were the apnea hypopnea index (AHI) and the oxygen desaturation index (ODI). Dental measurements taken from the 3D models included anterior arch widths, posterior arch widths, maxillary and mandibular arch lengths, and palatal surface area. A cone beam computed tomography (CBCT) evaluation was also performed. Results: In patients with moderate OSA, posterior maxillary width was significantly correlated with both minimal airway area (rho = 0.65, p < 0.01) and its transverse diameter (rho = 0.68, p < 0.01). Similarly, in patients with severe OSA, posterior maxillary width showed a significant correlation with total airway volume (rho = 1, p < 0.01), minimal airway area (rho = 1, p < 0.01), and its transverse diameter (rho = 1, p < 0.01). Conclusions: Craniofacial morphology and malocclusion can contribute to obstructive sleep apnea syndrome. Full article

This study involved 72 volunteers divided into two groups according to the apnea–hypopnea index (AHI): $\mathrm{AHI}>15$ episodes per hour ($\mathrm{e}\mathrm{p}/\mathrm{h}$) (main group, $n=39$, including 28 men, median AHI 44.15, median age 47), $0\le \mathrm{AHI}\le 15\mathrm{e}\mathrm{p}/\mathrm{h}$ (control group, $n=33$, including 12 men, median AHI 2, median age 28). Each participant underwent polysomnography with a recording of 19 EEG channels. Based on wavelet bicoherence (WB), the magnitude of connectivity between all pairs of EEG channels in six bands was estimated: $D{f}_1$ $\left[0.25;1\right]$, $D{f}_2$ $\left[1;4\right]$, $D{f}_3$ $\left[4;8\right]$, $D{f}_4$ $\left[8;12\right]$, $D{f}_5$ $\left[12;20\right]$, $D{f}_6$ $\left[20;30\right]$ Hz. In all six bands considered, we noted a significant decrease in symmetrical interhemispheric connections in OSA patients. Also, in the main group for slow oscillatory activity $D{f}_1$ and $D{f}_2$, we observe a decrease in connection values in the EEG channels associated with the central interhemispheric sulcus. In addition, patients with $\mathrm{AHI}>15$ show an increase in intrahemispheric connectivity, in particular, forming a left hemisphere high-degree synchronization node (connections PzT3, PzF3, PzFp1) in the $D{f}_2$ band. When considering high-frequency EEG oscillations, connectivity in OSA patients again shows a significant increase within the cerebral hemispheres. The revealed differences in functional connectivity in patients with different levels of AHI are quite stable, remaining when averaging the full nocturnal EEG recording, including both the entire sleep duration and night awakenings. The increase in the number of hypoxia episodes correlates with the violation of the symmetry of interhemispheric functional connections. Maximum absolute values of correlation between the apnea–hypopnea index, AHI, and the WB synchronization strength are observed for the $D{f}_2$ band in symmetrical EEG channels C3C4 ($-0.81$) and P3P4 ($-0.77$). The conducted studies demonstrate the possibility of developing diagnostic systems for obstructive sleep apnea syndrome without using signals from the cardiovascular system and respiratory activity. Full article

Introduction: There are many aspects in the relationship between smoking and sleep that have not been investigated thoroughly yet, especially in regards to obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: In this cross-sectional study, 2359 participants, who have visited the sleep clinic of our hospital during a 13-year period and were former or current smokers, were included. Their smoking history, measured in packyears of smoking, and their nicotine dependence, measured with the Fagerström scale, were correlated with various epidemiological and sleep-related variables. Results: Patients with respiratory, cardiovascular and metabolic comorbidities were older, more obese and presented a significantly greater history in packyears of smoking. Packyears were positively correlated with the Epworth sleepiness scale (ESS) (r = 0.06, p = 0.007), with %REM sleep time (r = 0.19, p = 0.042), apnea-hypopnea index (AHI) (r = 0.10, p < 0.001), oxygen desaturation index (ODI) (r = 0.10, p < 0.001), mean and maximum apnea duration (r = 0.10, p < 0.001 and r = 0.11, p < 0.001, respectively), while they were negatively correlated with mean and minimum SaO₂ (r = −0.18, p < 0.001 and r = −0.13, p < 0.001, respectively). Furthermore, smoking history exhibited a significantly increasing trend with increasing OSA diagnosis and severity (p < 0.001). Patients with abnormal movements during sleep and those with restless sleep showed a significantly higher nicotine dependence, measured with the Fagerström scale, compared to those without abnormal movements or restless sleep (5.4 ± 2.8 vs. 4.7 ± 2.8, p = 0.002 and 5.1 ± 2.9 vs. 4.7 ± 2.7, p = 0.043). Conclusions: Smoking history in packyears probably affects OSAHS characteristics, while nicotine dependence seems to be related more with abnormal sleep behaviors. Full article

Sleep apnea-hypopnea syndrome (SAHS) is a respiratory disorder characterized by cessation of breathing during sleep, resulting in daytime somnolence and various comorbidities. SAHS encompasses obstructive sleep apnea (OSA), caused by upper airway obstruction, and central sleep apnea (CSA), resulting from lack of brainstem signaling for respiration. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for SAHS, reducing apnea and hypopnea episodes by providing continuous airflow. CPAP enhances sleep quality and improves overall health by reducing the risk of comorbidities such as hypertension, type 2 diabetes mellitus, cardiovascular disease and stroke. CPAP nonadherence leads to health deterioration and occurs due to mask discomfort, unsupportive partners, upper respiratory dryness, and claustrophobia. Technological advancements such as auto-titrating positive airway pressure (APAP) systems, smart fit mask interface systems, and telemonitoring devices offer patients greater comfort and enhance adherence. Future research should focus on new technological developments, such as artificial intelligence, which may detect treatment failure and alert providers to intervene accordingly. Full article

Obstructive sleep apnea syndrome (OSAS) is a frequently underdiagnosed sleep disorder marked by recurrent episodes of apnea and/or hypopnea during sleep, primarily resulting from the partial or complete collapse of the upper airway. OSAS significantly affects patients’ health and quality of life. Additionally, it is a recognized risk factor for inducing microsleep episodes during daily activities, particularly in occupations such as professional driving, where sustained attention is critical. The aim of our study was to identify an effective screening test for use in outpatient settings, capable of distinguishing patients with a severe form of OSAS. Patients who test positive with this screening tool would subsequently be prioritized for polysomnographic evaluation in a sleep laboratory. A total of 64 patients who underwent polysomnography (PSG) or polygraphy (PG) examination at our clinic were subsequently examined by USG of the tongue with measurements of tongue base thickness (TBT) and the distance between lingual arteries (DLA) during wakefulness and in a relaxed tongue position. The measurements of TBT and DLA were subsequently correlated with the apnea–hypopnea index (AHI) obtained from PSG or PG. In our cohort of patients diagnosed with severe OSAS, a TBT threshold of ≥65 mm served as an effective cutoff value. A TBT value of ≥65 mm reached an AUC value of 78.1%, sensitivity of 74.4%, specificity of 61.9%, positive predictive value of 80%, negative predictive value of 54.2% and overall accuracy of 70.3%. A DLA value of ≥30 mm in our sample of patients with severe OSAS showed an AUC of 76.5%, sensitivity of 69.8%, specificity of 71.1%, positive predictive value of 83.3%, negative predictive value of 53.6%, and overall accuracy of 70.3%. Tongue USG markers, particularly TBT and DLA measurements during wakefulness and in a relaxed tongue position, show potential as effective screening tools for identifying severe OSAS in European populations. These markers demonstrate improved accuracy over traditional screening questionnaires by reducing the likelihood of false-negative results. Patients with a positive screening should preferably be referred for polysomnography. In this way, patients with a serious illness could receive adequate therapy sooner. Full article

Background: Obstructive sleep apnea syndrome (OSA) is a chronic inflammatory disease characterized by endothelial dysfunction and cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard treatment, hence poor adherence has prompted interest in mandibular advancement devices (MAD) as an alternative. This comprehensive review aimed to explore the effects of MAD therapy on oxidative stress, inflammation, endothelial function, and its impact on the cardiovascular risk in OSA patients. Results: MAD therapy significantly reduces the apnea-hypopnea index (AHI), improves serum nitric oxide (NOx) concentrations, reduces oxidative stress markers, and enhances endothelial function. Animal studies indicated that MAD reduces myocardial fibrosis and attenuates inflammatory markers. While both CPAP and MADs improve endothelial function and heart rate variability, CPAP is more effective in reducing OSA severity. Nevertheless, MAD has higher compliance, contributing to its positive impact on cardiovascular function. Moreover, CPAP and MADs have similar effectiveness in reducing cardiovascular risk. Conclusions: MAD therapy is an effective alternative to CPAP, particularly for patients with mild to moderate OSA as well as those intolerant to CPAP. It offers significant improvements in endothelial function and oxidative stress. Further studies are needed to assess MAD therapy in comprehensive OSA management. Full article

Background/Objectives: This study evaluated the impact of continuous positive airway pressure (C-PAP) therapy combined with a rigorous diet regimen on obese patients with obstructive sleep apnea syndrome (OSAS). Methods: Sixty obese patients (BMI ≥ 30) diagnosed with severe OSAS were recruited in order to establish the evaluation of CPAP therapy with different extents of adherence to a rigorous diet regimen. After one year, significant improvements were observed. Results: BMI reduced by 12.32%, apnea–hypopnea index (AHI) by 22.04%, oxygen desaturation index (ODI) by 15.87%, total sleep time with oxygen saturation below 90% (TST90%) by 25.2%, and Epworth Sleepiness Scale (ESS) scores by 21.74%. Patients were, then, divided into three groups, based on adherence to the restricted diet, as well as to the correct use of the nocturnal C-PAP, showing different reductions in BMI, AHI, ODI, TST90%, and ESS, according to their adherence, based on the sum of % reduction in BMI + AHI into three groups. Conclusions: These findings underscore the effectiveness of combining C-PAP therapy with a strict diet in improving OSAS symptoms and overall health in obese patients. Future studies with larger cohorts and longer follow-up periods are needed to confirm these results and explore the long-term benefits of this integrated approach. Full article

Smoking a cigarette before bed or first thing in the morning is a common habit. In this review, the relationship between smoking and sleep is investigated based on the existing literature. Out of 6504 unique items that were identified via a PubMed search related to smoking and sleep, 151 were included in this review. Tobacco smoking disrupts sleep architecture by reducing slow wave and rapid eye movement (REM) sleep and undermining sleep quality. Furthermore, smoking affects sleep-related co-morbidities, such as obstructive sleep apnea–hypopnea syndrome (OSAHS), insomnia, parasomnias, arousals, bruxism, and restless legs, as well as non-sleep-related conditions such as cardiovascular, metabolic, respiratory, neurologic, psychiatric, inflammatory, gynecologic and pediatric issues, while poor sleep quality also seems to worsen the chances of successful smoking cessation. In conclusion, the existing literature suggests that there is a wicked relation between smoking and sleep. Full article

The Berlin questionnaire (BQ), with its ten questions, stands out as one of the simplest and most widely implemented non-invasive screening tools for detecting individuals at a high risk of Obstructive Sleep Apnea (OSA), a still underdiagnosed syndrome characterized by the partial or complete obstruction of the upper airways during sleep. The main aim of this study was to enhance the diagnostic accuracy of the BQ through Machine Learning (ML) techniques. A ML classifier (hereafter, ML-10) was trained using the ten questions of the standard BQ. Another ML model (ML-2) was trained using a simplified variant of the BQ, BQ-2, which comprises only two questions out of the total ten. A 10-fold cross validation scheme was employed. Ground truth was provided by the Apnea–Hypopnea Index (AHI) measured by Home Sleep Apnea Testing. The model performance was determined by comparing ML-10 and ML-2 with the standard BQ in the Receiver Operating Characteristic (ROC) space and using metrics such as the Area Under the Curve (AUC), sensitivity, specificity, and accuracy. Both ML-10 and ML-2 demonstrated superior performance in predicting the risk of OSA compared to the standard BQ and were also capable of classifying OSA with two different AHI thresholds (AHI ≥ 15, AHI ≥ 30) that are typically used in clinical practice. This study underscores the importance of integrating ML techniques for early OSA detection, suggesting a direction for future research to improve diagnostic processes and patient outcomes in sleep medicine with minimal effort. Full article

Sleep disorders are steadily increasing in the population and can significantly affect daily life. Low-cost and noninvasive systems that can assist the diagnostic process will become increasingly widespread in the coming years. This work aims to investigate and compare the performance of machine learning-based classifiers for the identification of obstructive sleep apnea–hypopnea (OSAH) events, including apnea/non-apnea status classification, apnea–hypopnea index (AHI) prediction, and AHI severity classification. The dataset considered contains recordings from 192 patients. It is derived from a recently released dataset which contains, amongst others, audio signals recorded with an ambient microphone placed ∼1 m above the studied subjects and apnea/hypopnea accurate events annotations performed by specialized medical doctors. We employ mel spectrogram images extracted from the environmental audio signals as input of a machine-learning-based classifier for apnea/hypopnea events classification. The proposed approach involves a stacked model which utilizes a combination of a pretrained VGG-like audio classification (VGGish) network and a bidirectional long short-term memory (bi-LSTM) network. Performance analysis was conducted using a 5-fold cross-validation approach, leaving out patients used for training and validation of the models in the testing step. Comparative evaluations with recently presented methods from the literature demonstrate the advantages of the proposed approach. The proposed architecture can be considered a useful tool for supporting OSAHS diagnoses by means of low-cost devices such as smartphones. Full article

Introduction: Children born prematurely (<37 weeks’ gestation) are at increased risk of perinatal complications, comorbidities, and iron deficiency. Iron deficiency is associated with restless legs syndrome and periodic limb movement disorder. In this study, we assessed the prevalence of restless sleep disorder (RSD) and elevated periodic limb movements during sleep (PLMS) in children born prematurely who underwent polysomnography. Methods: A retrospective chart review of sleep studies was conducted in children aged 1–18 years (median age 4 years) with a history of premature birth. Children with genetic syndrome, airway surgery, or tracheostomy were excluded. Three groups were compared: children with PLMS index >5, children with RSD, and children with neither elevated PLMS index nor RSD. Results: During the study, 2577 sleep studies were reviewed. Ninety-two studies fit our criteria and were included in the analysis. The median age at birth was 31 weeks, and the interquartile range (IQR) was 27–34 weeks. A total of 32 (34.8%) children were referred for restless sleep and 55 (59.8%) for snoring. After polysomnography, 18% were found to have a PLMS index >5/h, and 14% fit the criteria for restless sleep disorder (RSD). There were no statistically significant differences in PSG parameters among the children with RSD, PLMS, and the remaining group, except for lower obstructive apnea/hypopnea index (Kruskal–Wallis ANOVA 8.621, p = 0.0135) in the RSD group (median 0.7, IQR 0.3–0.9) than in the PLMS (median 1.7, IQR 0.7–3.5) or the non-RSD/non-PLMS (median 2.0, IQR 0.8–4.5) groups. Conclusions: There was an elevated frequency of RSD and elevated PLMS in our cohort of children born prematurely. Children born prematurely are at higher risk of iron deficiency which can be a contributor factor to sleep -related movement disorders. These results add new knowledge regarding the prevalence of RSD and PLMS in these children. Full article

Children with Down syndrome (DS) are at high risk of sleep-disordered breathing (SDB). The American Academy of Pediatrics recommends a polysomnogram (PSG) in children with DS prior to the age of 4. This retrospective study examined the frequency of SDB, gas exchange abnormalities, co-morbidities, and surgical management in children with DS aged 2–4 years old at Seattle Children’s Hospital from 2015–2021. A total of 153 children underwent PSG, with 75 meeting the inclusion criteria. The mean age was 3.03 years (SD 0.805), 56% were male, and 54.7% were Caucasian. Comorbidities included (n, %): cardiac (43, 57.3%), dysphagia or aspiration (24, 32.0%), prematurity (17, 22.7%), pulmonary (16, 21.3%), immune dysfunction (2, 2.7%), and hypothyroidism (23, 30.7%). PSG parameter data collected included (mean, SD): obstructive AHI (7.9, 9.4) and central AHI (2.4, 2.4). In total, 94.7% met the criteria for pediatric OSA, 9.5% met the criteria for central apnea, and 9.5% met the criteria for hypoventilation. Only one child met the criteria for hypoxemia. Overall, 60% had surgical intervention, with 88.9% of these being adenotonsillectomy. There was no statistically significant difference in the frequency of OSA at different ages. Children aged 2–4 years with DS have a high frequency of OSA. The most commonly encountered co-morbidities were cardiac and swallowing dysfunction. Among those with OSA, more than half underwent surgical intervention, with improvements in their obstructive apnea hypopnea index, total apnea hypopnea index, oxygen saturation nadir, oxygen desaturation index, total arousal index, and total sleep duration. This highlights the importance of early diagnosis and appropriate treatment. Our study also suggests that adenotonsillar hypertrophy is still a large contributor to upper airway obstruction in this age group. Full article