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  • Age and sex differences in the association between sleep duration and general and abdominal obesity at 6-year follow-up: The Rural Chinese Cohort Study
    Sleep Med. (IF 3.360) Pub Date : 2020-01-16
    Qionggui Zhou; Xiaoyan Wu; Dongdong Zhang; Leilei Liu; Jian Wang; Ruirong Cheng; Jinchun Lin; Yu Liu; Xizhuo Sun; Zhaoxia Yin; Honghui Li; Yang Zhao; Yongcheng Ren; Dechen Liu; Xu Chen; Feiyan Liu; Cheng Cheng; Chunmei Guo; Fulan Hu

    Objective The association between sleep duration and general and abdominal obesity in adults, especially in the rural Chinese population, remain unclear. Therefore, we conducted this study to evaluate the association between sleep duration and general and abdominal obesity in rural Chinese adults. Methods We included 12,446 adults aged 18-75 years old who completed a baseline examination during 2007-2008 and follow-up during 2013-2014. We prospectively investigated the sleep–obesity association over a 6-year follow-up, on average. Multivariable logistic regression was performed to assess the probability of new-onset general and abdominal obesity, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results As compared with sleep duration 6.5-7.5 h, short sleep duration (<6.5 h) was significantly associated with increased probability of abdominal obesity in men (OR=1.60, 95% CI: 1.05-2.45) after controlling for multiple covariates. A similar association was found in men aged >60 years but not in women or in men ≤60 years. We found no significant association between sleep duration and general obesity. The results were consistent when restricting the analysis to participants without cardiovascular disease, type 2 diabetes mellitus or cancer at baseline. Conclusions Short sleep duration was significantly associated with abdominal obesity in rural Chinese adults, and the association varied by sex and age.

    更新日期:2020-01-17
  • Effect of exercise training on subjective parameters in patients with obstructive sleep apnea: a systematic review and meta-analysis
    Sleep Med. (IF 3.360) Pub Date : 2020-01-14
    Ozeas L. Lins-Filho; Rodrigo Pinto Pedrosa; Jessica M.L. Gomes; Sandra L. Dantas Moraes; Belmiro Cavalcanti Egito Vasconcelos; Cleidiel Aparecido Araujo Lemos; Eduardo Piza Pellizzer

    Obstructive sleep apnea (OSA) has many effects on subjective parameters of the disease, such as reduction in quality of life (QoL), sleep quality (SQ), and increases in daytime sleepiness. Studies have reported the beneficial effect of exercise training on OSA severity; however, whether it improves subjective parameters remains unclear. The purpose of the present review was to investigate the effect of exercise training on QoL, daytime sleepiness, and SQ in adults with OSA by summarizing the results of clinical trials. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO. A systematic review of the PubMed, Scopus, and Cochrane (CENTRAL) databases was conducted. Risk of bias analysis was performed using the Cochrane tool, and Review Manager version 5.2 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform the meta-analysis. Of the 1573 studies initially retrieved, 8 relevant studies with 228 participants were included in the analysis. The studies presented moderate risk of bias. Exercise training significantly improved QoL (mean difference, 12.9 [95% confidence interval (CI) 6.4 to 19.5]) and SQ (mean difference, -2.0 [95% CI -3.6 to -0.5]), and reduced daytime sleepiness (mean difference, -3.7 [95% CI -6.1 to -1.2]), and OSA severity (mean difference, -11.4 [95% CI -13.4 to -9.4 events/h]). Thus, physical exercise training was effective in improving subjective parameters and reducing the severity of OSA. Additional randomized clinical trials, however, should be performed to confirm these findings.

    更新日期:2020-01-15
  • Quantifyingperipheral sympathetic activations during sleep by means of an automatic method for pulse wave amplitude drop detection
    Sleep Med. (IF 3.360) Pub Date : 2020-01-13
    M. Betta; G. Handjaras; E. Ricciardi; P. Pietrini; J. Haba-Rubio; F. Siclari; R. Heinzer; G. Bernardi

    Sudden drops in pulse wave amplitude (PWA) measured by finger photoplethysmography (PPG) are known to reflect peripheral vasoconstriction resulting from sympathetic activation. Previous work demonstrated that sympathetic activations during sleep typically accompany the occurrence of pathological respiratory and motor events, and their alteration may be associated with the arising of metabolic and cardiovascular diseases. Importantly, PWA-dropsoften occurin the absence of visually identifiable cortical micro-arousalsand may thus represent a more accurate marker of sleep disruption/fragmentation. In this light,an objective and reproduciblequantification and characterization of sleep-related PWA-drops may offer avaluable, non-invasive approach for the diagnostic and prognostic evaluation of patients with sleep disorders. However, the manual identificationof PWA-drops represents a time-consuming practice potentially associated with high intra/inter-scorer variability. Sincevalidated algorithms are not readily available for research and clinical purposes, here we present a novel automated approach to detect and characterize significant drops in the PWA-signal. The algorithm was tested against expert human scorers who visually inspected correspondingPPG-recordings.Results demonstrated that the algorithm reliably detects PWA-drops and is able to characterize them in terms of parameterswith a potential physiological and clinical relevance, includingtiming, amplitude, duration and slope. Themethod is completely user-independent,processesall-nightPSG-data, automatically dealing with potential artefacts, sensor loss/displacements, and stage-dependent variability in PWA-time-series. Such characteristicsmake thismethod a valuablecandidate for the comparative investigation of largeclinical datasets, to gain a betterinsightinto the reciprocal links betweensympathetic activity, sleep-related alterations, and metabolic and cardiovascular diseases.

    更新日期:2020-01-13
  • Potential determinants during 'the first 1000 days of life' of sleep problems in school-aged children
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Margreet W. Harskamp; Ruth E. Kool; Lieke van Houtum; Laura S. Belmon; Anke Huss; Mai J.M. Chinapaw; Tanja G. Vrijkotte
    更新日期:2020-01-13
  • Different iron deposition patterns in hemodialysis patients with and without restless legs syndrome: A quantitative susceptibility mapping study
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Hao Wang; Xue Han; Mei Jin; Li-yan Wang; Zong-li Diao; Wang Guo; Peng Zhang; Zheng Wang; He-yu Ding; Han Lv; Zheng-yu Zhang; Peng-fei Zhao; Jing Li; Zheng-han Yang; Wen-hu Liu; Zhen-chang Wang

    Objective Brain iron deposition in hemodialysis (HD) patients increases over time. Iron deficiency in gray matter nuclei has been reported to lead to idiopathic restless legs syndrome (RLS) symptoms. Regardless of unpleasant RLS sensations, the patterns of iron deposition between hemodialysis patients with RLS (HD-RLS) and hemodialysis patients without RLS (HD-nRLS) are still unclear. To evaluate the differences in iron deposition patterns between HD-RLS and HD-nRLS patients, we utilized quantitative susceptibility mapping (QSM). Methods Twenty-four HD-RLS patients, 25 HD-nRLS patients and 30 age- and sex-matched healthy controls (HCs) were enrolled. The QSM was used to assess susceptibility values of the regions of interest (ROIs), including the caudate nucleus (CN), putamen (PUT), globus pallidus (GP), thalamus (THA), substantia nigra (SN), red nucleus (RN) and dentate nucleus (DN). Results HD duration was significantly longer in HD-RLS patients than in HD-nRLS patients (P < 0.05). The susceptibility of HD-RLS and HD-nRLS patients in PUT was higher than that in HCs (P < 0.05), illustrating elevated iron content in the nucleus. Compared with HD-nRLS patients, HD-RLS patients demonstrated reduced susceptibility in CN and PUT (both P < 0.05). Compared with HCs, HD-RLS patients displayed decreased susceptibility in DN (P < 0.05). Conclusions Different iron deposition patterns between HD-RLS and HD-nRLS patients in PUT and DN, which further support disturbed sensory processing in RLS, may be involved in RLS pathogenesis in HD patients.

    更新日期:2020-01-13
  • Sleep Duration Rather than Sleep Timing is Associated with Obesity in Adolescents
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Jun-Sang Sunwoo; Kwang Ik Yang; Jee Hyun Kim; Dae Lim Koo; Daeyoung Kim; Seung Bong Hong

    Objective We investigated differences in sleep patterns between obese and non-obese adolescents, and determined which sleep-related parameters were associated with a risk of adolescent obesity. Methods In this cross-sectional study, we evaluated 22,906 adolescents between 12 and 18 years of age (mean 15.2 ± 1.7 years; male 50.9%). Self-report questionnaires were used to assess body mass index (BMI) and sleep habits. Obesity was defined as a BMI-for-age ≥ 95th percentile. Weekend catch-up sleep (CUS) duration was calculated as the sleep duration on free days minus sleep duration on school days. We estimated mid-sleep time on free days corrected for oversleep on free days (MSFsc) and social jetlag. Then, we performed multivariate analysis for adolescent obesity and BMI, respectively. Results The prevalence of obesity was 6.0%. The average sleep duration (P = 0.017) and weekend CUS duration (P < 0.001) of obese adolescents were shorter than those of non-obese adolescents. However, there was no significant difference in MSFsc or social jetlag by the obesity status. After adjustment, obesity was significantly associated with short average sleep duration (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86 – 0.96) and short weekend CUS duration (OR 0.92, 95% CI 0.89 – 0.95). Similarly, BMI was inversely correlated with average sleep duration (B = -0.15, 95% CI -0.19 - -0.11) and weekend CUS duration (B = -0.09, 95% CI -0.11 – -0.06). Conclusions Our observations suggest that short sleep duration, rather than late MSFsc or social jetlag, was associated with adolescent obesity.

    更新日期:2020-01-13
  • Predictors of adherence to positive airway pressure therapy in children: A systematic review and meta-analysis
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Henrietta Blinder; Franco Momoli; Julia Bokhaut; Vanessa Bacal; Reuben Goldberg; Dhenuka Radhakrishnan; Sherri L. Katz

    Background While positive airway pressure (PAP) is effective for treating sleep-disordered breathing (SDB) in children, adherence is poor. Studies evaluating predictors of PAP adherence have inconsistent findings, and no rigorous reviews have been conducted. This systematic review aims to summarize the literature on predictors of PAP therapy adherence in children. Methods Studies evaluating baseline predictors of PAP therapy adherence in children (≤20 years) with SDB were included. We searched MEDLINE, Embase, CENTRAL, CINAHL, Clinicaltrials.gov, and the last four years of conference abstracts. Results were described narratively, with random-effects meta-analyses performed where feasible. Risk of bias and confidence in the evidence were assessed. Results We identified 50 factors evaluated across twenty-eight studies (21 full text articles, seven abstracts). The highest rates of PAP therapy adherence were most consistently found with female sex, younger age, Caucasian race, higher maternal education, greater baseline apnea-hypopnea index (AHI), and presence of developmental delay. Pooled estimates included odds ratios of 1.48 (95%CI: 0.75-2.93) favoring female sex, 1.26 (95%CI: 0.68-2.36) favoring Caucasian race, and a mean difference in AHI of 4.32 (95%CI: -0.61-9.26) events/hour between adherent and non-adherent groups. There was low quality evidence to suggest that psychosocial factors like health cognitions and family environment may predict adherence. Conclusion In this novel systematic review, we identified several factors associated with increased odds of PAP therapy adherence in children. These findings may help guide clinicians to identify and support children less likely to adhere to PAP therapy and should be considered when developing interventions to improve adherence.

    更新日期:2020-01-13
  • Validity of the Brief Infant Sleep Questionnaire (BISQ) in Brazilian children
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Bianca Del-Ponte; Mariana O. Xavier; Diego G. Bassani; Luciana Tovo-Rodrigues; Camila S. Halal; Aline Shionuma; Kauana Ferreira Ulguim; Iná S. Santos

    Objective To investigate the validity of the Brief Infant Sleep Questionnaire (BISQ), in assessing sleep quality in childhood. Methods Validation study with children from the Pelotas 2015 Birth Cohort. BISQ was applied to mothers when their children were 3, 6, 12, and 24 months of age. The poor sleep indicators analysed, as defined by BISQ, were > 3 wakings per night, nocturnal wakefulness > 1 hour and total sleep duration < 9/24 hours, compared to number of wakings per night and nocturnal and total sleep duration defined by actigraphy taken as the gold standard. The Actiwatch wGT3X-BT device was used by the child consecutively during five days at 3 and 6 months and for three days at 12 and 24 months. At each age the prevalence, sensitivity, specificity, accuracy, and positive (PPV) and negative predictive values (NPV) of each sleep indicator was calculated. Results 586 children were enrolled in the study. Nocturnal wakefulness > 1 hour was the most frequent indicator at all ages, with higher sensitivity (varying from 27.5% at 6 months to 54.8% at 3) and lower specificity (53.4% at 3 months to 79.4% at 6 months), in comparison to the other sleep indicators. Specificity for > 3 wakings and total sleep duration < 9 hours was greater than 85.0% at all the ages. Higher accuracies were observed for total sleep < 9 hours at 3 (85.6%), 6 (88.2%) and 12 months (73.6%) and for > 3 wakings at 24 months (84.5%). The sensitivity for the presence of at least one indicator decreased with age from 56.0% at three months to 35.8% at 24 months, whereas the specificity increased from 50.6% at three months to 63.8% at 24 months. Conclusion The high specificity of the BISQ sleep parameters supports the validity of parents' reports on sleep-related problems in childhood for use in epidemiological studies.

    更新日期:2020-01-11
  • Environmental open-source data sets and sleep-wake rhythms of populations: an overview
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Damien Leger; Christian Guilleminault

    Objective/Background In recent decades, the epidemiology of sleep disorders has mainly consisted of interviewing subjects through validated questionnaires; more recently, this has been done by assessing total sleep time (TST) per 24 hours via sleep logs or connected devices. Thus, a vast amount of data has helped demonstrate the decline of TST in most countries. Nonetheless, we believe from a societal and environmental point of view that sleep researchers have largely overlooked a wide-open field of data that may help us to better understand and describe global sleep wake rhythms (SWR), eg, data regarding the sleep environment. Methods Based on recent literature, we identified several environmental and societal fields that may have an effect on SWR. With the help of an expert panel, we selected the five most pertinent fields with multiple open-source data sets that may have an impact on human SWR. Then, we performed web-based research and proposed open-field data sets for each field, all of which are open to researchers and possibly scientifically associated with SWR. Results The open fields relevant to the environment that we selected were noise, light pollution, and radio frequencies. The two societal fields were transportation and internet use. The evolution of most of these fields in recent decades may explain (even partially) the decline in TST. Importantly, the open data sets in each field are widely available to sleep researchers. Conclusions SWR must be assessed not only by patient accounts, but also in terms of the evolution of environmental cues.

    更新日期:2020-01-11
  • Zao Ren An Shen for insomnia: A systematic review with meta-analysis
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Yoann Birling; Mingxian Jia; Guixia Li; Jerome Sarris; Alan Bensoussan; Xiaoshu Zhu

    Objective To assess the effectiveness and safety of Zao Ren An Shen (ZRAS), a Chinese herbal medicine formula, for the treatment of insomnia. Methods Seven databases, i.e. EMBASE, PubMed, the Cochrane library, and PsycINFO, Chinese National Knowledge Infrastructure, Wanfang and Chongqing VIP, were searched from their inception to the 6 November 2018. Controlled trials comparing the effectiveness or safety of ZRAS to conventional treatments, a placebo or no-treatment in an insomnia population were selected. Primary outcomes were: sleep quality (assessed with the Pittsburgh Sleep Quality Index), and the number of adverse events at post-treatment. The risk of bias was assessed with the Cochrane Collaboration’s tool and meta-analyses were performed using RevMan 5.3. Results A total of 19 studies (1,780 participants) were included. The effect of ZRAS on sleep quality (mean difference) was found to be superior compared to placebo in the sole placebo-controlled study located (-0.90 [-1.56, -0.24; 95% CI], p=0.007) and similar to Benzodiazepine Receptor Agonists (BzRAs) (0.17 [-0.29, 0.64]; 95% CI, p=0.46). The number of adverse events (relative risk) was lower for ZRAS than BzRAs (0.16 [0.12, 0.23; 95% CI], p<0.001). An overall high risk of bias was found in the selected studies. Conclusions The results favor ZRAS against BzRAs and placebo for the treatment of insomnia. However, the poor methodology of the studies prevents strong recommendations for ZRAS. Clinical trials with higher quality designs are required.

    更新日期:2020-01-11
  • Subjective nocturnal symptoms have different associations with depressive symptoms and anxiety than with daytime sleepiness in patients with obstructive sleep apnea
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Sang-Ahm Lee; Hyo Jae Kim; Yoojin Lee

    Background We determined the relationships among the subjective symptoms of sleep apnea and daytime sleepiness, depressive symptoms, and anxiety in adults with obstructive sleep apnea (OSA). Methods We developed the Subjective Apnea Severity Questionnaire (SASQ) to measure subjective OSA symptoms during the night and on waking in the morning. Construct validity and reliability were assessed. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and State Scale of State Trait Anxiety Inventory (STAI-S) were applied. Multiple linear regression analyses were performed, and the results were adjusted for several confounders. Results A total of 337 OSA patients were included. The SASQ consists of eight items with three domains. Cronbach’s α for the SASQ was 0.657. The mean SASQ score was 1.35 ± 0.59. Symptoms related to nocturnal breathing difficulties were associated with polysomnographic respiratory parameters. In the adjusted models, total SASQ scores were associated with ESS scores but not with BDI or STAI-S scores. Unlike other symptom groups, nocturnal breathing difficulties tended toward a positive relationship with ESS scores (p = 0.076), but were negatively related to BDI scores (p = 0.003) and STAI-S scores (p = 0.012). Symptoms related to nocturnal awakening or morning waking were either positively related or unrelated to ESS, BDI, and STAI-S scores. Conclusions The subjective OSA symptoms measured via the SASQ were associated with daytime sleepiness in adults with OSA, but not with depressive symptoms or anxiety. Nocturnal breathing difficulties were positively related to daytime sleepiness, but negatively related to depressive symptoms and anxiety.

    更新日期:2020-01-11
  • Portable diagnosis of sleep apnea with the validation of individual event detection
    Sleep Med. (IF 3.360) Pub Date : 2020-01-11
    Shumit Saha; Muammar Kabir; Nasim Montazeri; Maziar Hafezi; Bojan Gavrilovic; Kaiyin Zhu; Hisham Alshaer; Azadeh Yadollahi

    Study Objective To develop an algorithm for improving apnea hypopnea index (AHI) estimation which includes event by event validation and event duration estimation. The algorithm uses breathing sounds, respiratory related movements and blood oxygen saturation (SaO2). Methods Adults with suspected sleep apnea underwent overnight polysomnography (PSG) at Toronto Rehabilitations Institute. Simultaneously with PSG, breathing sounds and respiratory related movements were recorded over the suprasternal notch using the Patch. The Patch had a microphone and an accelerometer to record respiratory sounds and movement, respectively. First, we calculated the amount of drops in SaO2 from pulse oximeter. Subsequently, energy of breaths and accelerometer were extracted. Features were normalized, weighted, summed and passed through a threshold to estimate PatchAHI. PatchAHI was compared to the AHI obtained from PSG (PSGAHI). Furthermore, performance of event detection was evaluated using F1-score. Moreover, event duration difference between estimated and PSG-based events was compared. Results Data from 69 subjects were investigated. PatchAHI had high correlation with PSGAHI (r2 = 0.88). Considering a diagnostic AHI cut-off of ≥15, sensitivity and specificity were 91.42±11.92% and 89.29±7.62%, respectively. F1-score for individual event detection increased from 0.22±0.10 for AHI≤5 to 0.72±0.09 for AHI >30. Moreover, event duration difference between estimated events and PSG-based events was 5.33±8.17 sec. Conclusion Our proposed algorithm had high accuracy in estimating individual respiratory events during sleep. The algorithm can increase reliability of acoustic methods for diagnosis of sleep apnea at home.

    更新日期:2020-01-11
  • Does rem sleep behavior disorder change in the progression of parkinson’s disease?
    Sleep Med. (IF 3.360) Pub Date : 2020-01-10
    M. Figorilli; A.R. Marques; T. Vidal; L. Delaby; M. Meloni; B. Pereira; C. Lambert; M. Puligheddu; F. Durif; M.L. Fantini

    Objectives/Background REM Sleep Behavior Disorder (RBD) in Parkinson’s disease (PD) may be associated with a malignant phenotype. Despite its prognostic value, little is known about the time course of RBD in PD. In this study, we aimed to ascertain whether or not RBD is a stable feature in PD. In this study, we prospectively evaluated clinical and neurophysiological features of RBD, including REM Sleep Without Atonia (RSWA), in PD patients with RBD at baseline and after three years then assessed whether the changes in measures of RSWA parallel the progression of PD. Patients/Methods In sum, 22 (17M, mean age64.0±6.9years) moderate-to-advanced PD patients (mean PD duration at baseline:7.6±4.8years) with RBD, underwent a video-polysomnography (vPSG) recording and clinical and neuropsychological assessment at baseline and after three years. Results At follow-up, the self-assessed frequency of RBD symptoms increased in six patients, decreased in six and remained stable in 10, while RSWA measures significantly increased in all subjects. At follow-up, patients showed worse H&Y stage (p=0.02), higher dopaminergic doses (p=0.05) and they performed significantly worse in phonetic and semantic fluency tests (p=0.02;p=0.04). Changes in RSWA correlated significantly with the severity in levodopa-induced dyskinesia (r=0.61,p=0.05) and motor fluctuation (r=0.54,p=0.03) scores, and with the worsening of executive functions (r=0.78,p=0.001) and visuo-spatial perception (r=-0.57,p=0.04). Conclusion Despite the subjective improvement of RBD symptoms in one-fourth of PD patients, all RSWA measures increased significantly at follow-up, and their changes correlated with the clinical evolution of motor and non-motor symptoms. RBD is a long-lasting feature in PD and RSWA is a marker of the disease’s progression.

    更新日期:2020-01-11
  • Sleep time and sleep-related symptoms across two generations – results of the community-based RHINE and RHINESSA studies
    Sleep Med. (IF 3.360) Pub Date : 2020-01-10
    Eva Lindberg; Christer Janson; Ane Johannessen; Cecilie Svanes; Francisco Gomez Real; Andrei Malinovschi; Karl A. Franklin; Mathias Holm; Vivi Schlünssen; Nils Oskar Jogi; Thorarinn Gislason; Bryndis Benediktsdóttir

    Study Objectives To analyze the association between sleep-related symptoms and sleep length in parents and offspring in relation to other risk factors in both generations. Method The participants were parents (n=5,855, age 54.3+6.5 years, 45.2% men) who participated in the community-based RHINE study and one random member of their adult offspring (n=5,855, age 30.2+7.7 years, 41.5% men) who participated in the RHINESSA study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS. Results All sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and having children in offspring, as well as gender, smoking, physical activity, education and total number of children in parents, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20-1.93), DMS (1.34, 1.15-1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15-2.37), insomnia (1.39, 1.13-1.73), short sleep time (<6h/night) (2.51, 1.72-3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9h/night). Conclusion The familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems.

    更新日期:2020-01-11
  • Clinical Characteristics of Korean Pediatric Patients with Restless Legs Syndrome
    Sleep Med. (IF 3.360) Pub Date : 2020-01-10
    Sohyeon Kim; Keun Tae Kim; Gholam K. Motamedi; Yong Won Cho

    Objectives Restless legs syndrome (RLS) is a common neurological disorder but it is not sufficiently recognized in children and adolescents. It often overlaps with growing pains in children, and as a result the clinical characteristics of pediatric RLS are not well studied, especially in Asia. The purpose of this study is to investigate the clinical characteristics of pediatric RLS patients in Korea and compare it to those of adult RLS patients. Methods We retrospectively reviewed the medical records of all pediatric RLS patients (≤18 years) from January 2015 to December 2018 in a regional tertiary hospital sleep center. We randomly selected adult primary RLS patients without comorbid medical disorders from our sleep center’s dataset as controls. The number of controls was determined to be twice the number of pediatric RLS patients according to sample size calculation. The clinical and polysomnographic characteristics of both groups were compared. The independent t-test, chi-squared test, and Fisher’s exact test were used for analyzing quantitative data between the two groups and p<0.05 was considered statistically significant. Results Twenty-nine primary pediatric RLS patients and 57 adult RLS patients were enrolled. Pediatric RLS patients showed equal prevalence between sexes, as opposed to adults where there is female predominance. Ferritin level was significantly lower in pediatric patients, although it remained within the normal range. Also, pediatric RLS patients showed less severe RLS symptoms and had better sleep quality than adults did in both objective and subjective measures. In addition, PLMS was shown to be less common in pediatric RLS patients compared to adults. Conclusions Pediatric RLS patients showed relatively mild to moderate RLS symptoms and a smaller likelihood of experiencing PLMS than adult patients, which is comparable to similar western studies. Long-term evaluation of a patient’s clinical course through multicenter clinical studies is strongly suggested for the future.

    更新日期:2020-01-11
  • Daytime sleep state misperception in a tertiary sleep centre population
    Sleep Med. (IF 3.360) Pub Date : 2020-01-10
    M.S. Schinkelshoek; K. de Wit; V. Bruggink; R. Fronczek; G.J. Lammers

    Study objectives Sleep state misperception is common in various sleep disorders, especially in chronic insomnia with a prevalence ranging between 9-50%. Most prior studies used nocturnal polysomnography for the identification of sleep state misperception during nighttime. Our objective was to assess sleep state misperception during daytime in people with sleep disorders with excessive daytime sleepiness. Methods In this prospective observational study, we assessed the occurrence of, and factors influencing sleep state misperception in consecutive patients undergoing a routine multiple sleep latency test (MSLT) in a tertiary sleep-wake centre included between 2014 and 2017. Mixed models were applied to assess the influence of patients’ clinical data on sleep state perception. Results People with narcolepsy type 1 (n=33) and type 2 (n=14), idiopathic hypersomnia (n=56), obstructive sleep apnea (n=31) and insufficient sleep syndrome (n=31) were included. The prevalence of both classical and reverse sleep state misperception did not differ between the sleep disorders (mean 25%, range 8-37%) after correction for sleep stage, sleep onset latency and age. Longer sleep onset latency and reaching only non-rapid eye movement (REM) sleep stage 1 were significant predictors for classical sleep state misperception. Conclusions Sleep state misperception is common in people with narcolepsy type 1 and 2, idiopathic hypersomnia, obstructive sleep apnea and insufficient sleep syndrome. Classical sleep state misperception is more frequent in patients with longer sleep onset latencies who only reach non-REM sleep stage 1 during a nap.

    更新日期:2020-01-11
  • Developing a Behavioral Model of Restless Legs Syndrome Utilizing Mice with Natural Variances in Ventral Midbrain Iron
    Sleep Med. (IF 3.360) Pub Date : 2020-01-08
    Christopher J. Earley; Richard P. Allen; Byron C. Jones; Erica L. Unger

    Background The primary symptoms of Restless Legs Syndrome (RLS) are circadian-dependent, leading to increased activity or decreased rest, especially at night. The primary pathology in RLS is brain iron insufficiency despite normal systemic iron stores. Natural variances in brain and peripheral iron concentrations across recombinant inbred (RI) murine strains provide a biological model of RLS. The question is whether these RI mice strains show a behavioral analog to circadian-dependent clinical phenotype of RLS. Methods The home cage activity of eight female RI strains was measured over a 72-hour period. The ratio of the average activity in the last 2 hours of the active period relative to that in the total 12-hour active period (late active period activity ratio-LAPAR) was the primary outcome variable. The relation of average LAPAR scores to measures of ventral midbrain (VMB) iron was evaluated across strains in this study. Results RI strain 40 (LAPAR = 1.28) and RI strain 21 (LAPAR = 1.02) were the only strains to show an increased activity in the last part of the active period. ANOVA showed the increased activity was significantly greater during the last 2 hours compared to the preceding 10 hours of the active phase only for the RI strain 40. Average LAPAR across the eight strains did not significantly correlate with the VMB iron content (r=-0.27, p<0.10) but did correlate with changes in VMB iron with iron deficiency (r=0.71, p<0.05) and diurnal change in VMB iron (r=0.65, p<0.05). Conclusion The female RI strain 40 mice exhibited a distinct end-of-active-period behavior analogous to circadian-dependent clinical phenotype of RLS.

    更新日期:2020-01-09
  • Association between reduced serum BDNF levels and insomnia with short sleep duration among female hospital nurses
    Sleep Med. (IF 3.360) Pub Date : 2019-12-28
    Ryuji Furihata; Kaori Saitoh; Rei Otsuki; Sakiko Murata; Masahiro Suzuki; Maki Jike; Yoshitaka Kaneita; Takashi Ohida; Makoto Uchiyama

    Objective Previous studies have suggested that brain-derived neurotrophic factor (BDNF) is associated with sleep regulation in humans. However, its relationship with self-reported sleep problems has not been clarified. The aim of the present study was to examine the association between serum BDNF levels and sleep problems among hospital nurses. Methods Participants were enrolled from among nurses working at a general hospital in Tokyo, Japan. Data from 577 women (age: 35.45±10.90 years) were analyzed. This cross-sectional survey was conducted from November to December 2015. Serum BDNF concentrations were evaluated. Participants completed a self-reported questionnaire on sleep including the presence or absence of insomnia symptoms (ie, difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA)), and sleep duration. Insomnia with short sleep duration (ISS) was defined as: DIS, or DMS, or EMA; and <6 hours sleep duration. Results Among 577 participants, 21.3% reported insomnia, 41.4% slept less than 6 hours, and finally 12.5% suffered from ISS. Serum BDNF levels were significantly lower in subjects with ISS than in those without ISS. The serum BDNF levels in insomniacs were significantly lower than in non-insomniacs for short sleep duration (<6 h), while serum BDNF levels did not differ between insomniacs and non-insomniacs for normal sleep duration (≥6 h). Conclusion This is the first documented study to indicate that ISS is associated with reduced serum BDNF levels. These results may lead to clarification of the underlying pathophysiological relationship between BDNF and poor sleep.

    更新日期:2019-12-29
  • The McGill score as a screening test for obstructive sleep disordered breathing in children with co-morbidities
    Sleep Med. (IF 3.360) Pub Date : 2019-12-28
    Federica Trucco; Mark Rosenthal; Andrew Bush; Hui-Leng Tan

    Background The McGill score is used to stratify severity of oximetry in children referred for investigation of obstructive sleep apnoea (OSA) to identify those with more severe disease and prioritize treatment. We hypothesized that its Positive predictive value (PPV) and Negative predictive value (NPV) in detecting OSA differs significantly between children with medical conditions and otherwise healthy children. Methods We performed a two-year retrospective analysis of children referred for investigation of OSA who underwent a cardiorespiratory (CR) polygraphy study. McGill score was calculated from the oximetry trace blinded to polygraphy results. We looked at 2 definitions of OSA: Obstructive Apnoea Hypopnoea Index (oAHI) ≥1 and ≥5. McGill sensitivity, specificity, PPV and NPV were calculated. McGill score=1 was considered normal or inconclusive, >1 abnormal. Results We studied 312 children, 190 males (61%), median age 4.5 (2.4-7.9) years. 129 were otherwise healthy and 183 had associated medical conditions. The PPV of the McGill score was significantly lower in children with medical conditions than otherwise healthy children. The NPV was similar in both groups of children. Conclusions The higher number of false positives in children with medical conditions may be due to non-obstructive causes such as central apnoeas. Children with underlying lung disease are also more likely to desaturate following a brief apnoea or hypopnoea. Children with co-morbidities who have an abnormal McGill score should not be assumed to have OSA and need more detailed sleep studies to determine the reason for the oxygen desaturations.

    更新日期:2019-12-29
  • Contribution of transcranial magnetic stimulation in restless legs syndrome: pathophysiological insights and therapeutical approaches
    Sleep Med. (IF 3.360) Pub Date : 2019-12-24
    Raffaele Nardone; Luca Sebastianelli; Viviana Versace; Francesco Brigo; Stefan Golaszewski; Elke Pucks-Faes; Leopold Saltuari; Eugen Trinka

    Transcranial magnetic stimulation (TMS) may offer a reliable means to characterize significant pathophysiologic and neurochemical aspects of restless legs syndrome (RLS). Namely, TMS has revealed specific patterns of changes in cortical excitability and plasticity, in particular dysfunctional inhibitory mechanisms and sensorimotor integration, which are thought to be part of the pathophysiological mechanisms of RLS rather than reflect a non-specific consequence of sleep architecture alteration. If delivered repetitively, TMS is able to transiently modulate the neural activity of the stimulated and connected areas. Some studies have begun to therapeutically use repetitive TMS (rTMS) to improve sensory and motor disturbances in RLS. High-frequency rTMS applied over the primary motor cortex or the supplementary motor cortex, as well as low-frequency rTMS over the primary somatosensory cortex, seem to have transient beneficial effects. However, further studies with larger patient samples, repeated sessions, an optimized rTMS setup, and clinical follow-up are needed in order to corroborate preliminary results. We performed here a systematic search of all the studies that have used TMS and rTMS techniques in patients with RLS.

    更新日期:2019-12-25
  • Effects of sleep duration and weekend catch-up sleep on falling injury in adolescents: a population-based study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-24
    Jae Ho Chung; Jung Bin Kim; Ji Hyun Kim

    Objective This population-based study aimed to determine the effects of sleep deprivation and compensatory weekend catch-up sleep on the risk of falls in adolescents. Methods Data from the 2013 Korean Youth Risk Behavior Web-based Survey on 57,225 adolescents were investigated. Demographic, socioeconomic, sleep-related, health-related behavioral, and psychological variables were compared between fallers (n = 7,346) and non-fallers (n = 49,879). Multivariate logistic regression analysis using a hierarchical model was carried out to identify sleep-related factors (e.g., sleep duration, longer weekend catch-up sleep) independently contributing to the risk of falls. Results Compared to non-fallers, fallers were associated with a shorter sleep duration (p = 0.001) and later bedtimes on weekdays and weekends (p < 0.001). An average sleep duration of ≤ 5 h (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.12-1.34) and of 6 h (OR 1.12, CI 1.03-1.21) were associated with an increased risk of falls. By contrast, an average sleep duration of ≥ 9 h (OR 0.90, CI: 0.82-0.99) and longer weekend catch-up sleep (OR 0.94, CI: 0.89-0.99) were associated with a decreased risk of falls. Conclusion Our results corroborate previous suggestions that short sleep duration is a major risk factor for falls among adolescents. Moreover, our study provided a novel finding that longer sleep duration and longer weekend catch-up sleep may have a protective effect against falls. Our findings have important public health implications that modifying school schedules to increase sleep duration could reduce unintentional falls and injuries in school-aged adolescents.

    更新日期:2019-12-25
  • Polysomnography findings in Pediatric Spinal Muscular Atrophy Types 1-3
    Sleep Med. (IF 3.360) Pub Date : 2019-12-24
    Archana Chacko; Peter D. Sly; Leanne Gauld

    Background Sleep disordered breathing (SDB) causing sleep disturbance and daytime symptoms occurs in children with neuromuscular disorders. Although polysomnography (PSG) findings are well described in many neuromuscular disorders, there are only limited reports from children with spinal muscular atrophy (SMA). The aim of this study was to determine the sleep architecture and breathing characteristics and non-invasive ventilation (NIV) use in our pediatric SMA cohort. Methods We conducted a cross-sectional cohort study of all children with SMA in Queensland, Australia. Children were Nusinersen naïve and had a full diagnostic PSG in 2018. The PSG was scored and reported by a single pediatric sleep physician in accordance with American Academy of Sleep Medicine Criteria (2012). Results 31 children (18 males), 6 with Type 1, 16 with Type 2 and 9 with Type 3, aged 0.25-18.8 years old were studied. SDB was seen in each SMA type and was more pronounced during rapid eye movement (REM) sleep. Type 1: all patients exhibited SDB, three (50%) with central sleep apnea (CSA) and three (50%) with mixed disease. Type 2: five (31%) had CSA, one (6%) mixed disease, seven (44%) had early SDB and three (19%) had normal sleep breathing. Type 3: four (44%) children had CSA and five had early SDB. No child exhibited obstructive sleep apnea (OSA) alone. Starting NIV significantly reduced mean total PSG Apnea-Hyponea Index (AHI) scores from a grouped mean of 15.4 events per hour (SD ± 14.6; 95% CI 6.1-24.7) to 4.0 events per hour (SD ± 4.2, 95% CI 1.2-6.5, p= 0.01). Conclusion SDB is common in children with SMA and was present in all types. CSA was the most common disorder, with mixed SDB also present in type 1 and 2 SMA.

    更新日期:2019-12-25
  • Frequency and Outcomes of Primary Central Sleep Apnea in a Population-Based Study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-24
    Ioanna Kouri; Bhanu Prakash Kolla; Timothy I. Morgenthaler; Meghna P. Mansukhani

    Background Primary central sleep apnea (PCSA) is believed to be rare and data regarding its prevalence and long-term outcomes are sparse. We used the Rochester Epidemiology Project (REP) resources to identify all Olmsted County, Minnesota, residents with an incident diagnosis of PCSA and their clinical outcomes. Methods We searched the REP database for all residents with polysomnography-confirmed diagnoses of central sleep apnea between 2007-2015. From these, we reviewed the polysomnograms and medical records to find those who had PCSA based upon accepted diagnostic criteria. Data based on detailed review of the medical records, including all clinical notes and tests were recorded for analysis. Results Of 650 patients identified with CSA, 25 (3.8%; 23 male) had PCSA, which was severe in most patients (n=16, 64%). Twenty-three (92%) patients were prescribed and 18/23 (78.2%) adherent to positive airway pressure therapy. Median duration of follow-up was 4.4 years (IQR:4.2). Four (16%) patients were subsequently diagnosed with cardiac arrhythmias, one (4%) with unstable angina, 2 (8%) with heart failure, five (20%) with mild cognitive impairment (MCI)/dementia and two (8%) with depression. Six (25%) patients died (median time to death=5 years; IQR:4.8), 3 of whom had Lewy body dementia. Conclusions In this population-based study, PCSA was rare and when present, was severe in a majority of patients. The mortality rate was high. Most frequently observed disorders during follow-up were MCI/dementia followed by cardiac arrhythmias; it is possible that these entities were present and not recognized prior to the diagnosis of PCSA.

    更新日期:2019-12-25
  • Acute post-stroke restless legs syndrome: the body of caudate nucleus considerations
    Sleep Med. (IF 3.360) Pub Date : 2019-12-19
    Wu Xiuling; Xu Jinghong; Lu Baoquan

    Objectives To investigate the relationship between the lesion location and post-stroke restless legs syndrome (RLS). Methods A total of 376 patients with acute cerebral infarction were recruited from Tangshan Gongren Hospital, Department of Neurology between May 2016 and May 2017, all of whom were evaluated for RLS. Established RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG) in 2012. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS). The lesion location was evaluated with magnetic resonance imaging (MRI). The associations between the lesion location and post-stroke RLS were then analyzed by logistic regression. Results Forty-nine patients (13.03%) had RLS. The multivariate logistic regression model adjusting for post-stroke RLS risk factors including gender, age, history of hypertension, history of diabetes, history of stroke, smoking, drinking, body mass index (BMI), NIHSS, hemoglobin, platelet and homocysteine determined that body of caudate nucleus and pontine were significantly associated with post-stroke RLS with odds ratio (OR) of 26.26 (95% confidence interval (CI): 9.41–73.28,p<0.001) and OR of 4.37 (95% CI: 1.24–15.34, p=0.021). The stepwise logistic regression model with temporal lobe, parietal lobe, occipital lobe, frontal lobe, callosum, body of caudate nucleus, thalamus, lenticulo capsule, corona radiata, centrum semi-ovale and pontine as potential predictors yielded a predictor mode. The stepwise logistic regression predictor mode indicated that body of caudate nucleus and pontine predicted post-stroke RLS with similar OR to multivariate models of 23.61 (95% CI: 9.53–58.51, p<0.001) and 4.46 (95% CI: 1.38–14.4, p=0.012). Conclusions The ischemic infarcts located in body of caudate nucleus, pontine are significantly associated with post-stroke RLS. Body of caudate nucleus acute infarcts may play a role in the development of post-stroke RLS.

    更新日期:2019-12-19
  • Sleep duration and architecture in non-intubated Intensive Care Unit patients: An observational study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-18
    Stefano Romagnoli; Gianluca Villa; Lorenzo Fontanarosa; Lorenzo Tofani; Fulvio Pinelli; A. Raffaele De Gaudio; Zaccaria Ricci
    更新日期:2019-12-18
  • Predictors of the Initiation of Shift Work Disorder among Chinese Intern Nurses: A Prospective Study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-17
    Dingxuan Chen; Min Jiang; Xuliang Shi; Fulei Geng; Haiying Qi; Yuechu Zhang; Yuan Lai; Fang Fan

    Aim Individual vulnerability to shift work disorder (SWD) varies. The aim of the present study was to verify the individual characteristics that predicted SWD onset by following Chinese intern nurses who at baseline had not worked rotating or night shifts. Methods A total of 706 Chinese first-year intern female nurses aged 16-24 years were recruited. At baseline (T0), they reported demographic characteristics, insomnia symptoms and excessive sleepiness, trait neuroticism, sleep reactivity, morningness, and circadian flexibility and languidity. At the 3-month (T1) and 6-month (T2) follow-up, the SWD status was determined based on significant sleep disturbance and/or excessive sleepiness in the context of working a rotating shift schedule. Results and Conclusion s: The prevalence rates of SWD were 35.2% at T1 and 37.7% at T2. Two bivariate logistics regressions revealed that morningness (OR = 1.31, 95% CI = 1.09-1.58, T1; OR = 1.36, 95% CI = 1.12-1.65, T2), languidity (OR = 1.56, 95% CI = 1.28-1.90, T1), and sleep reactivity (OR = 1.29, 95% CI = 1.07-1.57, T1; OR = 1.31, 95% CI = 1.07-1.61, T2) predicted the onset of SWD, while flexibility (OR = 0.75, 95% CI = 0.62-0.90, T1) decreased the odds of SWD onset. By comparing nurses with SWD and nurses without SWD across all six months, morningness (OR = 1.58, 95% CI = 1.20-2.07), sleep reactivity (OR = 1.54, 95% CI = 1.16-2.04), languidity (OR = 1.70, 95% CI = 1.30-2.22), and flexibility (OR = 0.70, 95% CI = 0.54-0.90) showed significant effects on persistent SWD.

    更新日期:2019-12-18
  • Comparison of prevalence rates of Restless Legs Syndrome, self-assessed risks of Obstructive Sleep Apnea, and daytime sleepiness among patients with Multiple Sclerosis (MS), Clinically Isolated Syndrome (CIS) and Neuromyelitis Optica Spectrum Disorder (NMOSD)
    Sleep Med. (IF 3.360) Pub Date : 2019-12-17
    Vahid Shaygannejad; Dena Sadeghi Bahmani; Parisa Soleimani; Omid Mirmosayyeb; Mehran Barzegar; Babak Amra; Serge Brand

    Background Prevalence rates for Restless Legs Syndrome (RLS) and risk of Obstructive Sleep Apnea (OSA) in individuals with Neuromyelitis Optica Spectrum Disorder (NMOSD) and Clinically Isolated Syndrome (CIS) are unknown. The aims of the present study were to assess symptoms of RLS and self-assessed risks of OSA in individuals with NMOSD and CIS, to compare these prevalence rates with those of persons with multiple sclerosis (MS), and to associate RLS and OSA with EDSS scores and daytime sleepiness, fatigue, paresthesia, and medication. Methods A total of 495 individuals (mean age = 34.92 years, 84.9% females) were assessed. Of these, 24 had NMOSD, 112 had CIS and 359 had MS. Trained neurologists ascertained individuals’ neurological diagnoses, assessed their EDSS scores, and conducted a clinical interview to assess RLS. Additionally, participants completed questionnaires covering sociodemographic information, risks of snoring and obstructive sleep apnea, daytime sleepiness, fatigue, paresthesia and medication. Results Prevalence rates of RLS were 45.8% in NMOSD, 41.1% in CIS, and 28.7% in MS. Prevalence rates of self-assessed risks of OSA were 8.3% in NMOSD, 7.7% in CIS, and 7.8% in MS; these rates were not significantly different. Across the entire sample and within the diagnostic groups, RLS and OSA scores were unrelated to EDSS, daytime sleepiness, fatigue or medication. Conclusions Individuals with NMOSD, CIS and MS have high prevalence rates for RLS and self-assessed risks of OSAs, which are unrelated to EDSS, daytime sleepiness, fatigue, paresthesia, or medication. Sleep issues should be monitored during routine check-ups for individuals with NMOSD and CIS.

    更新日期:2019-12-18
  • Presentation of familiar odor induces negative dream emotions during rapid eye movement (REM) sleep in healthy adolescents
    Sleep Med. (IF 3.360) Pub Date : 2019-12-17
    Satomi Okabe; Mitsuo Hayashi; Takashi Abe; Kazuhiko Fukuda

    Objective Odor presentation is a crucial tool in the experimental investigation of dreaming since odors rarely cause arousal, and are processed in the brain during sleep. Our previous study demonstrated that the presentation of a preferred odor during rapid eye movement (REM) sleep-induced negative dream emotions. However, preference and familiarity of an odor are known to be strongly related to each other in olfactory perception. Consequently, the above result might have been due to the confounding effects of familiarity. Therefore, the present study was designed to clarify the effects of an individual’s degree of familiarity with an odor on negative emotions experienced when dreaming. Methods The airflow with phenylethyl alcohol (PEA: rose-like smell) was presented as a stimulus of experimental condition, and odorless airflow was presented as the control. Participants who were familiar (n = 7) and unfamiliar (n = 7) with the odor of PEA experienced both conditions during REM sleep in the second and later sleep cycle. Then, they were awakened, and they rated the characteristics of their dream using a questionnaire. Results and Conclusions Participants who were familiar with the odor of PEA rated their dreams more negatively in the experimental condition relative to the control condition. It is concluded based on these results that a familiar odor may induce negative emotion in dreams, possibly because familiar odors tend to be perceived more strongly, and the olfactory pathway has direct connections to the amygdala, which is primarily involved in processing negative emotions.

    更新日期:2019-12-18
  • Selective slow-wave sleep suppression affects glucose tolerance and melatonin secretion. The role of sleep architecture
    Sleep Med. (IF 3.360) Pub Date : 2019-12-17
    Yu.V. Ukraintseva; K.M. Liaukovich; K.A. Saltykov; D.A. Belov; А.N. Nizhnik

    Objectives Our study aimed to assess the impact of one night of slow-wave sleep (SWS) suppression on glucose tolerance, and explore whether melatonin plays a role in glucose tolerance impairment after SWS suppression. Methods In sum, 20 volunteers participated in two experimental sessions: a session with SWS suppression during one night’s sleep and a session with a regular night’s sleep (control). Each session included collecting seven salivary samples. The following morning, an oral glucose tolerance test (OGTT) was performed. Results SWS suppression effects depended on the individual blood glucose response to the OGTT. During the control session, ‘responders’ (N=11), already presented with low glucose tolerance, which further declined after SWS suppression. ‘Non-responders’ (N=9) experienced high glucose tolerance in both conditions. Among the responders, SWS suppression led to an increase in melatonin at the moment of awakening, while in non-responders melatonin increased during the first half of the night. In both conditions, responders were characterized by a shorter total sleep time (TST) and less rapid eye movement (REM) sleep. During SWS suppression, they had more non-rapid eye movement (NREM) stage 1 and longer nocturnal wakefulness. Responders and non-responders showed a comparable amount of SWS. Conclusions This study highlights three key findings: first, SWS suppression leads to an increase in salivary melatonin; second, melatonin’s effect on glucose tolerance depends on its secretion timing; and third, durations of REM sleep and nocturnal awakenings, appear to play an important role in melatonin secretion and glucose tolerance, indicating the potential clinical relevance of these findings for type 2 diabetes risk assessment.

    更新日期:2019-12-18
  • Gender differences in clinical findings and α-synucleiopathy-related markers in patients with idiopathic REM sleep behavior disorder
    Sleep Med. (IF 3.360) Pub Date : 2019-12-17
    Noboru Takeuchi; Taeko Sasai-Sakuma; Yuichi Inoue

    Background Rapid eye movement sleep behavior disorder (RBD) is a male-predominant parasomnia. Earlier clinical RBD patient studies showed gender differences of clinical symptoms and polysomnographic (PSG) findings. However, no previous investigated this issue by means of validated severity scales or by neuropsychological examination related to alpha-synucleinopathy. This study elucidates gender differences in clinical, physiological, and neuropsychological findings in Japanese idiopathic RBD (iRBD) patients. Methods From 220 patients with complaint of sleep-related vocalization or behaviors who visited Yoyogi Sleep Disorder Center from June 2003 through December 2016, 43 female (68.7±7.3 yr) and 141 male patients (66.7±6.7 yr) diagnosed as having iRBD by video-polysomnography (v-PSG) were selected. All subjects answered the RBD questionnaire (RBDQ-JP) and underwent olfactory function test (Sniffin’ Sticks test) and cognitive function test (MoCA-J). Results Female iRBD patients had later first symptom-witnessed age (sleep-talking 63.2±10.5 yr, behaviors 60.9±8.6 yr) than male patients (sleep-talking 59.1±8.8y, behaviors 64.7±8.9 yr). No gender difference was found in age at diagnosis, clinical severity (RBDQ-JP), or olfactory or cognitive function. Regarding electromyographic (EMG) findings during REM sleep, phasic EMG activity was higher in female patients (22.3±17.8% vs.16.5±16.1%), although no difference was found in tonic EMG activity. Conclusions Although female iRBD patient symptoms were first recognized later than those of male patients, they showed elevated EMG activity during REM sleep and showed deteriorated olfactory and cognitive function similarly to male patients at the first medical consultation. Results suggest that disease progression in female RBD patients is equivalent to that in male patients.

    更新日期:2019-12-18
  • Successful home respiratory polygraphy to investigate sleep-disordered breathing in children
    Sleep Med. (IF 3.360) Pub Date : 2019-12-17
    Marine Michelet; Sylvain Blanchon; Stéphane Guinand; Isabelle Ruchonnet-Métrailler; Anne Mornand; Hélène Cao Van; Constance Barazzone-Argiroffo; Regula Corbelli

    Objective Sleep-disordered breathing in children is common. Sleep tests, such as polygraphy (PG), which can be performed in a non-attended setting, are gaining in interest. PG has, however, been little studied in children with co-morbidities other than obstructive sleep apnea, and in particular, if performed in a non-attended setting. We report on the feasibility and interpretability of implementing PGs at home versus in hospital. Methods PGs were analyzed according to the setting (hospital or home) and sequence (initial or subsequent) in which they were performed. Non-interpretability was defined as absent or unreliable oxygen saturation by pulse oximetry (SpO2), and/or airflow and respiratory inductance plethysmography flow trace signals during the time analyzed. Results We retrospectively analyzed 400 PGs; 332/400 were initial PGs. Indications were: suspected obstructive sleep apnea (65%), obesity (13%), craniofacial malformations (5%), neuromuscular disease (4%), and other (13%) which included prematurity. 16% were recorded in hospitals and 84% at home. The mean age was 5.7 ±5.8 years and 7.3 ±4.5 years for the hospital and home groups, respectively. Interpretability was similar in both settings (87%). In the 68 subsequent PGs, interpretability was 84% when performed for follow-up and 96% when repeated for non-interpretability. Non-interpretability was predominantly due to a failure of the SpO2 channel. Conclusions PG performed at home is both feasible and interpretable for a variety of indications. Non-interpretability was not predictable in association with the setting, anthropometric data, or indication, independently of the sequence (initial or subsequent PG) in which the parameters were analyzed.

    更新日期:2019-12-18
  • Impact of Obstructive Sleep Apnea on Silent Cerebral Small Vessel Disease: A Systematic Review and Meta-analysis
    Sleep Med. (IF 3.360) Pub Date : 2019-12-16
    Anthipa Chokesuwattanaskul; Ploypin Lertjitbanjong; Charat Thongprayoon; Tarun Bathini; Konika Sharma; Michael A. Mao; Wisit Cheungpasitporn; Ronpichai Chokesuwattanaskul

    Background Cerebral small vessel disease (CSVD) is a well-known cause of vascular dementia, a leading medical morbidity in the aging population. Obstructive sleep apnea (OSA) has been validated as a cardiovascular risk factor. However, the relationship between these two clinical syndromes is not well established. We aimed to assess the association between OSA and CSVD. Methods Databases were searched from inception through May 2019. Studies that reported incidence or odd ratios of CSVD in patients with OSA were included. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results Fourteen observational studies comprising of 4,335 patients were included into the analysis. Compared to patients without OSA, patients with OSA were significantly associated with CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) with a pooled OR of 2.31 (95% CI, 1.46-3.66, I2 =79%) and 1.78 (95% CI, 1.06-3.01, I2 =41%), respectively. However, there was no significant association between OSA and findings of cerebral microbleeds (CMBs), with a pooled OR of 2.15 (95% CI, 0.64-7.29, I2 =55%). Conclusions Our study demonstrated the association between OSA and CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) when compared to patients without OSA. The absence of an association of CMBs findings with OSA could be due either by a lower sensitivity of neuroimaging techniques utilized to detect CMBs or a potentially different pathogenesis of CMBs.

    更新日期:2019-12-17
  • Abnormal night sleep duration and poor sleep quality are independently and combinedly associated with elevated depressive symptoms in Chinese rural adults: Henan Rural Cohort
    Sleep Med. (IF 3.360) Pub Date : 2019-12-16
    Jingjing Jiang; Yuqian Li; Zhenxing Mao; Fang Wang; Wenqian Huo; Ruihua Liu; Haiqing Zhang; Zhongyan Tian; Xiaotian Liu; Xia Zhang; Ruiqi Tu; Xinling Qian; Xue Liu; Zhicheng Luo; Ronghai Bie; Chongjian Wang

    Objective To assess the independent and combined effects of night sleep duration and sleep quality on depressive symptoms. Methods A total of 28202 participants (11236 males and 16966 females) aged 18-79 years from Henan Rural Cohort were included in current study. Night sleep duration and sleep quality were defined by Pittsburgh Sleep Quality Index (PSQI). Logistic regression and restricted cubic splines were applied to evaluate the association of night sleep duration and sleep quality with depressive symptoms. Results A U-shaped dose-response relationship between night sleep duration and depressive symptoms along with a J-shaped relationship between sleep quality and depressive symptoms was observed. Compared with reference group (7-<8h), shorter sleep duration (<6h) and longer sleep duration (>=10h) were associated with increased risk of depressive symptoms in male (short sleep: Odds Ratio (OR) = 1.84, 95% confidence interval (CI), 1.34-2.52; long sleep: OR = 1.56, 95%CI, 1.01-2.42) and female (short sleep: OR = 2.19, 95%CI, 1.77-2.70; long sleep: OR = 1.51, 95%CI, 1.10-2.10). Compared with good sleepers, poor sleepers were 4.23-fold (95%CI:3.54-5.06) and 3.87-fold (95%CI: 3.41-4.40) increased odds of depressive symptoms in male and female. Furthermore, participants with longer night sleep duration (>=10h) and poorer sleep quality had strongest effect on depressive symptoms (male: OR = 6.64, 95%CI, 3.21-13.74; female: OR = 7.76, 95%CI, 5.00-12.02). Conclusions Extreme night sleep duration and poor sleep quality were independently and combinedly related to elevated depressive symptoms, suggesting that keeping optimal night sleep duration and good sleep quality maybe benefit for maintaining mental health. Trial Registration Chinese Clinical Trial Register. Registration number: ChiCTR-OOC-15006699.

    更新日期:2019-12-17
  • Sleep Heart Rate Variability Assists the Automatic Prediction of Long-term Cardiovascular Outcomes
    Sleep Med. (IF 3.360) Pub Date : 2019-12-16
    Lulu Zhang; Huili Wu; Xiangyu Zhang; Xinfa Wei; Fengzhen Hou; Yan Ma

    Objective We aimed to investigate the association between sleep HRV and long-term cardiovascular disease (CVD) outcomes, and further explore whether HRV features can assist the automatic CVD prediction. Methods We retrospectively analyzed polysomnography (PSG) data obtained from 2111 participants in the Sleep Heart Health Study, who were followed up for a median of 11.8 years after PSG acquisition. During follow-up, 1252 participants suffered CVD events (CVD group) and 859 participants remained CVD-free (non-CVD group). HRV measures, derived from time-domain and frequency-domain, were calculated. Regression models were created to determine the independent predictor for long-term CVD outcomes, and to explore the association between HRV and CVD latency. Furthermore, based on HRV and other clinical features, a model was trained to automatically predict CVD outcomes using eXtreme Gradient Boosting algorithm. Results Compared with the non-CVD group, decreased HRV during sleep was found in the CVD group. HRV, particularly its component of high frequency (HF), was demonstrated to be independent predictor of CVD outcomes. Moreover, normalized HF was positively correlated with CVD latency. The proposed prediction model achieved a total accuracy of 75.3%, in which sleep HRV features served as a supplement to the well-recognized CVD risk factors, such as aging, adiposity and sleep disorders. Conclusions Association between sleep HRV and long-term CVD outcomes was demonstrated here, suggesting that altered HRV during sleep might occur many years prior to the onset of CVD. Machine learning models, combining sleep HRV and other clinical characteristics, should be promising in the early prediction of CVD outcomes.

    更新日期:2019-12-17
  • Sleep Quality and Health Related Problems of Shift Work Among Resident Physicians: A Cross-sectional Study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-15
    Roa'a Jaradat; Amro Lahlouh; Mohamed Mustafa

    Objectives Shift work is defined as any irregular work schedule that extends beyond the usual 9 am to 5 pm time frame. Evidence from outside medicine suggests that it may be related to detrimental health outcomes. Our objective from this study is to evaluate sleep quality, health risks, and chronic diseases among post-graduate resident physicians who work on rotating shifts at a large tertiary health care center. Study design A self-reported questionnaire-based cross-sectional study. Methods Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) while anxiety and depression were estimated through the four-item patient health questionnaire for anxiety and depression (PHQ-4). Associations between sleep quality and the following: Gender, PHQ-4 stage, year of residency, number of on-calls per month and subjective fatigue; memory impairment; and lack of concentration was investigated. Results A total of 201 resident physicians participated in the study (60.7% males, median; IQR age: 27 years [26-29]). More than one third of subjects were smokers, 41.3% were overweight, and 16.4% were obese. The majority (90%) reported poor sleep quality, 38.3% mild PHQ-4, 21.4% moderate PHQ-4, and 18.9% severe PHQ-4. Residents having 6 on-calls or more per month had significantly poorer sleep quality (p: 0.03), as well as higher anxiety and depression scores compared to their counterparts. Poor sleep quality was markedly associated with moderate PHQ-4, subjective fatigue, and lack of concentration (p: 0.026, 0.004 and 0.001, respectively). Subjective difficulty with concentration was reported in 86.6% of resident physicians and was significantly higher as the number of on-calls per month is 3 or more. Most residents report subjective fatigue (92.5%) while subjective memory impairment was prevalent in 68.7%. Irritable bowel syndrome was the most prevalent chronic disorder (13%), followed by heartburn or gastrointestinal ulcers and disc prolapse(6% and 3.5%, respectively). Conclusions Resident physicians have considerable risk for developing severe diseases. Our findings suggest that several modifications should be undertaken to enhance work facilities, limit working hours, and raise awareness among post-graduate resident physicians.

    更新日期:2019-12-17
  • Revisiting the value of polysomnographic data in insomnia: more than meets the eye
    Sleep Med. (IF 3.360) Pub Date : 2019-12-13
    Thomas Andrillon; Geoffroy Solelhac; Paul Bouchequet; Francesco Romano; Max-Pol Le Brun; Marco Brigham; Mounir Chennaoui; Damien Léger
    更新日期:2019-12-17
  • Sleep patterns and sleep deprivation recorded by actigraphy in 4th-grade and 5th-grade students
    Sleep Med. (IF 3.360) Pub Date : 2019-12-13
    Ao Li; Siteng Chen; Stuart F. Quan; Graciela E. Silva; Charlotte Ackerman; Linda S. Powers; Janet M. Roveda; Michelle M. Perfect

    Objective This study investigates sleep patterns of 4th- and 5th-grade students using actigraphy. Methods The study included 257 students enrolled in a Southwestern US school district who participated in a novel sleep science curriculum during the Spring 2016-17 and Fall 2017-18 semesters and met the study inclusion criteria. As part of this curriculum, participants underwent 5 to 7 days of continuous wrist actigraphy and completed an online sleep diary. Results Approximately two-thirds of the 9-11-year-old 4th- and 5th-grade students slept less than the minimum 9 hours per night recommended by both the American Academy of Sleep Medicine/Sleep Research Society and the National Sleep Foundation. The sleep midpoint time on weekends was about 1 hour later than on weekdays. There was a significant effect of age on sleep duration. Compared to 9-year old students, a larger proportion of 10-year old students had a sleep duration less than 8.5 hours. Boys had shorter sleep duration than girls, and a larger percentage of boys obtained less than 9 hours of sleep compared to girls. Conclusions Insufficient sleep is a highly prevalent condition among 9-11-year-old 4th- and 5th-grade elementary students. Importantly, there is a difference between sleep patterns on weekdays and weekends which may portend greater problems with sleep in adolescence and young adulthood.

    更新日期:2019-12-13
  • The association between 25-hydroxyvitamin D levels and children’s sleep–wake patterns: a prospective cohort study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-12
    Yujiao Deng; Guanghai Wang; Xiuxia Ye; Yanrui Jiang; Qingmin Lin; Shumei Dong; Yuanjin Song; Lixia Zhu; Min Meng; Wen Li; Qi Zhu; Wanqi Sun; Fan Jiang

    Objective To explore the association between vitamin D in cord blood or in venous blood and children’s sleep–wake patterns at 2 years of age. Methods Data were from 209 children in a birth cohort, Shanghai Sleep Birth Cohort Study (SSBC). 25-Hydroxyvitamin D (25(OH)D) was assessed in cord blood and venous blood samples at 2 years of age by electrochemiluminescence immunoassay. Children’s sleep–wake patterns were measured with the Brief Infant Sleep Questionnaire (BISQ) and Acti-Watch at 2 years of age. Results The prevalence of vitamin D deficiency (defined as <50 nmol/L) was 50.4% in cord blood and 28% at 2 years of age. The cord blood 25(OH)D level was not significantly associated with children’s sleep at 2 years of age. Children with 25(OH)D deficiency at 2 years old had shorter reported and actigraphic night sleep duration (NSD) and total sleep duration (TSD) than those with normal 25(OH)D concentration. 25(OH)D level at 2 years old was positively associated with night and total sleep duration (βreported-NSD = 0.6, p=0.011; βreported-TSD = 0.6, p=0.029; βactigraphic-NSD = 0.82, p=0.003; βactigraphic-TSD = 0.78, p=0.006), but was not associated with daytime sleep duration. There was no significant association between 25(OH)D level with night waking duration and midpoint of sleep either measured subjectively or objectively. Conclusion We found that not cord blood 25(OH)D level but 2-year-old 25(OH)D level was associated with children’s sleep–wake patterns at 2 years of age. These findings suggest more attention should be paid to the assessment of 25(OH)D levels in children with short sleep duration.

    更新日期:2019-12-13
  • Obstructive sleep apnea in Parkinson’s disease: a study in 239 Chinese patients
    Sleep Med. (IF 3.360) Pub Date : 2019-12-12
    Yuan Shen; Yun Shen; Zhi-Feng Dong; Ping-Lei Pan; Hai-chun Shi; Chun-Feng Liu

    Objective Our objective was to explore the clinical characteristics of Parkinson’s disease (PD) comorbidity with obstructive sleep apnea (OSA), explore the correlation between OSA and PD features and identify factors that are independent predictors of OSA in PD patients. Methods Two-hundred and thirty-nine PD patients were divided into two groups according to the presence of OSA (apnea–hypopnea index (AHI) score ≥5) (PD-OSA vs PD-non-OSA). Blinded to sleep apnea status, participants underwent an extensive assessment to determine demographic features, concomitant disease, disease severity, polysomnography characteristics and non-motor symptoms (NMSs). Results Of the 239 patients, 66 (27.62%) had an AHI score ≥5, including 14.2% (34/239) with mild, 6.7% (16/239) with moderate, and 6.7% (16/239) with severe sleep apnea. The binary logistic regression analyses indicated that age and male gender were risk factors for OSA, while rapid eye movement sleep disorder (RBD) and higher levodopa dosage equivalents (LDEs) were protective factors for OSA. PD-OSA patients had higher Epworth Sleepiness Scale (ESS) scores than those of PD-non-OSA patients. No differences were found for other NMSs between groups. Conclusion Our data suggest that OSA in PD was lower in patients with RBD and higher LDEs. RBD and higher LDEs were significant protective factors for OSA in PD. OSA in PD was increased with age and male gender. Age and male gender were risk factors for OSA in PD. OSA can aggravate excessive daytime somnolence in PD patients but is not associated with other NMSs.

    更新日期:2019-12-13
  • Sleep quality in acromegaly and changes after transsphenoidal surgery: A prospective longitudinal study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-12
    Yi Zhang; Xiaopeng Guo; Jinzhu Guo; Lijun Wang; Haiyan Zhao; Yanyan Wang; Jike Wang; Xuefei Sun; Wenwen Jiang; Ge Liu; Zhiyuan Xiao; Nan Cong; Jiwei Qi; Shiyuan Han; Zihao Wang; Lu Gao; Xinjie Bao; Ming Feng; Bing Xing

    Objective To elucidate the sleep quality characteristics and factors related to either good or poor sleep quality in acromegaly patients before surgery and to explore sleep quality changes after transsphenoidal surgery and the factors related to these changes. Methods We prospectively enrolled 39 acromegaly patients and 78 patients with nonfunctioning pituitary adenomas. Scales for anxiety, depression, disease stigma and nasal condition were evaluated. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered before surgery as well as one month and three months after surgery. Results A higher percentage of acromegaly patients had poor sleep quality compared to controls (35.9% vs. 5.1%, p<0.001). In addition, acromegaly patients experienced worse subjective sleep quality, extended sleep latency, increased sleep disturbance and decreased daytime functioning. Higher scores for anxiety, disease stigma and sinonasal outcomes were correlated with worse sleep quality in acromegaly patients. At one month after transsphenoidal surgery, we found worse subjective sleep quality, extended sleep latency, shortened sleep duration, impaired sleep efficiency and increased sleep disturbance in acromegaly patients. At three months postoperatively, most impaired PSQI domains in acromegaly patients recovered to preoperative levels. The use of soluble gauze was related to decreased sleep quality at one month after surgery and severe anxiety and depression were related to improved sleep quality at three months after surgery. Conclusions Sleep quality was reduced in acromegaly patients. Moreover, sleep quality initially worsened after surgery but later recovered. Emotional problems and the use of soluble gauze were related factors. Clinical trial registration None.

    更新日期:2019-12-13
  • The relationship between self-reported habitual snoring and hyperuricemia among Chinese urban adults: A cross-sectional study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-11
    Xiaolu Xiong, Fangfang He, Gongrui Sun, Yizhuo Li, Yanteng Shi, Xiaolong Ge, Shasha Zheng, Rong Xu

    Background Growing evidence suggests an independent relationship between habitual snoring and metabolic abnormalities. Currently, there are few data available on the association between snoring and hyperuricemia. Therefore, we evaluated the cross-sectional association between snoring and serum uric acid (UA) concentration and ascertain the effects of different snoring intensities on hyperuricemia among Chinese urban adults in Nanjing. Methods We performed a cross-sectional study including 7699 participants (4197 men and 3502 women) from Nanjing Drum Tower Hospital aged ≥18 years over a two year (ie, 2016–2018) period. All participants were divided into four groups based on Snoring scores. Questionnaires, physical examinations and biochemical tests were conducted. Hyperuricemia was defined as levels of serum UA > 6.8mg/dL in males and > 6.0mg/dL in females. We used a generalized linear model to investigate the association between snoring and serum UA concentration and logistic regression model to investigate the association between snoring and likelihood of having hyperuricemia in the age-, sex-adjusted model and in a multivariable model adjusting for demographic factor, plasma lipid profiles, blood glucose, blood pressure, smoking, and alcohol consumption. Results The prevalence of hyperuricemia was 10.05% in the studied population and gradually increased across the snoring scores (P < 0.0001). We found that mild snoring, moderate, and severe snoring intensity were associated with high serum UA in the age-, sex-adjusted model and in a multivariable model adjusting for demographic and lifestyle/behavioral risk factors. The association was insisted with the addition of variables related to clinical outcomes such as diabetes, hypertension, and high-cholesterol levels. Conclusions Our results showed self-reported habitual snoring was associated with higher serum UA concentration among Chinese urban adults. Findings of this study indicate the significance of early detection and treatment of snoring to prevent hyperuricemia.

    更新日期:2019-12-11
  • Sleep habits and sleep characteristics at age 1 year in the ELFE birth cohort study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-11
    Sabine Messayke, Patricia Franco, Anne Forhan, Marie-Noëlle Dufourg, Marie-Aline Charles, Sabine Plancoulaine

    Objective Infant sleep plays a critical role in normal development. Sleep problems, including sleep onset difficulties (SODs) and night waking (NW), range from 20% to 30% in infants and young children and can be persistent over time up to adulthood. Young French children seem to have longer sleep durations and less sleep troubles than their counterparts worldwide. Here, we aimed at describing infant sleep characteristics (total sleep time (TST)/24 h, NW, and SODs) and associated sleep habits in infants at age 1 year from the French nationwide birth cohort ELFE. Methods This study included 11,783 infants with information on both sleep characteristics and sleep habits (parental presence when falling asleep, eating to fall asleep, sucking a pacifier or finger to sleep and sleep arrangement and location). Associations were studied by multinomial logistic regression analyses adjusted for familial and infant characteristics. Results Mean TST was 13h36min including 2h54min of naps; 20% of the infants had TST ≤12h/24h. About 46% did not present SOD or NW, 16% had frequent SODs and 22% had NW >1 night in 2. Parental presence, feeding to fall asleep and infant sleep arrangements were frequent in infants with short sleep duration (≤12h/24h), NW and SODs. Non-nutritive sucking was associated with risk of NW, SOD and TST >14h/24h. Parental room sharing was associated with NW. Conclusion This work provides new information on infant sleep arrangements and non-nutritive sucking that should be accounted for when considering sleep behaviors. In addition, most identified sleep habits associated with poor sleep characteristics may be amenable to change.

    更新日期:2019-12-11
  • Cohort effects associated with reduced sleep duration in adolescents
    Sleep Med. (IF 3.360) Pub Date : 2019-12-11
    Changmin Yoo

    Objective The purpose of this study is to examine how the sleep duration changes during adolescence across the 7th, 8th, 9th, and 10th grade periods, and to determine whether there is a difference between the cohorts. Method For these purposes, we used the latent growth curve modeling and the multi-group analysis involving 2081 students (2000-birth cohort data) and 2254 students (1997-birth cohort data) who participated in the Korean Children and Youth Panel Survey. The data were collected using a stratified multistage cluster sampling method. Results Sleep duration became shorter as age increased. Furthermore, the sleep duration of the 2000-birth cohort became shorter than the sleep duration of the 1997-birth cohort. Specifically, the mean value of the initial sleep duration of the 2000-birth cohort was 8.09 hours, which was significantly shorter than the initial value 8.36 hours of the sleep duration of the 1997-birth cohort. In addition, multi-group analysis revealed that the trajectories of sleep duration and its predictors were varied by cohort. Specifically, parent supervision, peer relationship, and electronic media factors (smartphone dependency, time spent on using computer and playing games) explained the cohort effect. Conclusion These findings suggest that environmental factors such as increasing use of electronic media or pressure regarding higher education to adolescents could be associated with reduced sleep duration.

    更新日期:2019-12-11
  • Are there gender differences in the severity and consequences of sleep disordered in children?
    Sleep Med. (IF 3.360) Pub Date : 2019-12-09
    Rosemary SC. Horne, Chelsea Ong, Aidan Weichard, Gillian M. Nixon, Margot J. Davey

    Objectives In adults there is a distinct gender difference in the prevalence and severity of sleep disordered breathing (SDB), however there have been limited studies examining the effects of gender in children with SDB. We aimed to compare the effects of gender on severity of SDB, blood pressure, sleep and respiratory characteristics, quality of life, behaviour and executive function. Methods We included 533 children aged 3-18 years, who underwent standard pediatric overnight polysomnography between 2004-2016. Blood pressure was recorded prior to each study. Quality of life, behavior and executive function and were assessed with parental questionnaires. Children were grouped by gender and SDB severity based on their obstructive apnea hypopnea index (OAHI) into non-snoring controls, Primary Snoring (PS) (OAHI≤1 event/h), Mild OSA (OAHI>1-≤5 events/h) and moderate/severe (MS) OSA (OAHI>5 events/h) and compared data with 2-way ANOVA. Results 298 boys and 235 girls were studied. There were no differences in age, BMI z-score, SDB severity or sleep characteristics or blood pressure between genders. Diastolic blood pressure was elevated in females with MS OSA compared to males (P<0.05). Quality of life, behavior and executive function scores were all elevated in the SDB groups compared to controls. Females with MS OSA exhibited more internalizing behavioral problems compared to males (59.2 ± 2.4 vs. 51.4 ± 2.3, P<0.05). Conclusions In contrast to studies in adults, we identified no gender differences in the severity or consequences of SDB in children, other than females with moderate-severe OSA exhibiting more internalizing problems and higher diastolic blood pressure.

    更新日期:2019-12-09
  • Impaired Neurobehavioral Alertness Quantified by the Psychomotor Vigilance Task is Associated with Depression in the Wisconsin Sleep Cohort Study
    Sleep Med. (IF 3.360) Pub Date : 2019-12-04
    David T. Plante, Erika W. Hagen, Laurel A. Ravelo, Paul E. Peppard

    Background Excessive daytime sleepiness plays an important role in the presentation and course of mood disorders. Standard objective measures of daytime sleep propensity are of little to no value in depressive illness. This study examined the psychomotor vigilance task (PVT), an objective measure of neurobehavioral alertness, and its cross-sectional and longitudinal associations with depressive symptomatology in the Wisconsin Sleep Cohort Study. Methods The sample consisted of 1569 separate 10-minute PVT assessments conducted in 942 unique individuals. Cross-sectional and longitudinal conditional logistic regression models were used to estimate associations between the primary outcome of depression symptomatology (adjusted Zung scale≥50) and six separate PVT variables: mean reciprocal reaction time (1/RT); total lapses (RTs≥500msec; LAPSE); total false responses (FALSE); reciprocal of the mean of the 10% fastest (FAST) and 10% slowest (SLOW) RTs; and slope of the linear regression line for all transformed 1/RTs (SLOPE). Results In fully-adjusted cross-sectional models, 1/RT, LAPSE, FAST, and SLOW were each significantly associated with depression, such that worse neurobehavioral alertness was associated with higher odds of depressive symptomatology. Similar, though attenuated, findings were observed in fully-adjusted conditional longitudinal models that examined within-subject changes in depression status in the subset of participants with repeated PVT assessments. FALSE and SLOPE were not associated with depression in either cross-sectional or conditional longitudinal models. Conclusions These findings suggest components of the PVT are associated with depressive symptomatology. Further research is indicated to clarify the role of the PVT in the assessment of hypersomnolence in mood disorders.

    更新日期:2019-12-04
  • Pharmacokinetics of pitolisant in children and adolescents with narcolepsy
    Sleep Med. (IF 3.360) Pub Date : 2019-12-04
    Michel Lecendreux, Giuseppe Plazzi, Patricia Franco, Evelyne Jacqz-Aigrain, Philippe Robert, Thierry Duvauchelle, Jean-Charles Schwartz

    Objective To evaluate the pharmacokinetic profile and tolerability of pitolisant, a selective histamine 3 (H3)−receptor antagonist/inverse agonist, in children and adolescents with narcolepsy. Methods This multicenter, open-label, single-dose study of pitolisant 17.8 mg enrolled patients aged 6 through 17 years with a diagnosis of narcolepsy. Blood samples were collected at prespecified time points for analysis of pharmacokinetic parameters, including maximum serum concentration (Cmax) and area under the serum concentration−time curve from time 0 to 10 hours (AUC0–10h). Pharmacokinetic parameters were compared across three prespecified age groups: younger pediatric patients (aged 6 to <12 years), older pediatric patients (aged 12 to <18 years), and a historical comparison group of young adults (aged 18 to <45 years). Results Of the 25 enrolled patients, 24 were included in the pharmacokinetic analysis. Pitolisant Cmax and AUC0–10h were greater (by 52% and 73%, respectively) in the younger (n = 12) versus older (n = 12) pediatric subgroup. These parameters were lower in the young adult group (n = 13) by 51% and 48%, respectively, compared with the older pediatric patients, and by 68% and 70%, respectively, compared with the younger pediatric patients. There were six treatment-emergent adverse events: headache (three), dizziness (one), diarrhea (one), and vomiting (one). Conclusions After single-dose administration, the exposure parameters of pitolisant were significantly greater in the younger compared with older pediatric patients with narcolepsy. Pitolisant doses up to 17.8 mg/d (in children with body weight <40 kg) or 35.6 mg/d are appropriate for further evaluation in pediatric patients. Trial Registration EudraCT Number: 2013-001505-93.

    更新日期:2019-12-04
  • Matrix metalloproteinase 9 (MMP9) level and MMP9 -1562C>T in patients with obstructive sleep apnea: a systematic review and meta-analysis of case-control studies
    Sleep Med. (IF 3.360) Pub Date : 2019-12-04
    Xiaolian Fang, Jun Chen, Wei Wang, Guoshuang Feng, Xiaodan Li, Xin Zhang, Yamei Zhang, Jie Zhang, Zhifei Xu, Jun Tai, Xin Ni

    Background The peripheral level of matrix metalloproteinase (MMP)-9 and polymorphism of MMP9 -1562C>T in patients with obstructive sleep apnea (OSA) remains controversial. Therefore, the aims of this systemic review and meta-analysis are to assess the MMP9 level in OSA patients and identify the relationship between MMP9 -1562C>T and OSA susceptibility. Methods This systematic review was performed following the PRISMA guideline. We searched for studies in major databases, identifying those indexed from inception to July 3, 2019 which related to MMP9 level, MMP9 -1562C>T and OSA. The pooled standardized mean differences (SMDs) and 95% confidence interval (CI) of MMP9 levels were calculated. In addition, the relationship between MMP9 -1562C>T and OSA susceptibility was assessed by three genetic models. The heterogeneity analysis and calculation of the pooled odds ratio (OR) were also performed, followed by quality assessment using the Newcastle-Ottawa Scale (NOS). Results In sum, our review included 15 eligible studies regarding MMP9 level and three regarding MMP9 -1562C>T. The pooled results showed that peripheral level of MMP9 was increased in OSA patients (SMD = 1.37; 95% CI = 1.15–1.59). Furthermore, significant difference of MMP9 level can be found between severe and mild-to-moderate OSA patients (SMD = 28.17; 95% CI = 4.23–52.11) or between moderate-severe and mild OSA (SMD = 36.62; 95% CI = 12.19–61.04). However, no relationship was observed between MMP9 -1562C>T and OSA susceptibility in three genetic models (Homozygote model, OR = 1.37; 95% CI = 0.87–2.18); (Recessive model, OR = 1.42; 95% CI = 0.83–2.42); (Allele model, OR = 1.07; 95% CI = 0.96–1.18). Conclusions This systemic review and meta-analysis indicated that the level of MMP9 was increased in patients with OSA and this increase is relevant to OSA severity. Moreover, the relationship between MMP9 -1562 C>T and OSA susceptibility has currently not been proven by current merging values. Further analyses with larger sample size are required to verify these associations.

    更新日期:2019-12-04
  • Measures of Functional Outcomes, Work Productivity, and Quality of Life From a Randomized, Phase 3 Study of Solriamfetol in Participants With Narcolepsy
    Sleep Med. (IF 3.360) Pub Date : 2019-12-04
    Helene A. Emsellem, Michael J. Thorpy, Gert Jan Lammers, Colin M. Shapiro, Geert Mayer, Giuseppe Plazzi, Dan Chen, Lawrence P. Carter, Kathleen F. Villa, Lawrence Lee, Diane Menno, Jed Black, Yves Dauvilliers
    更新日期:2019-12-04
  • Sleep quality and gestational diabetes in pregnant women: A systematic review and meta-analysis
    Sleep Med. (IF 3.360) Pub Date : 2019-12-03
    Bingqian Zhu, Changgui Shi, Chang G. Park, Sirimon Reutrakul

    Poor sleep quality is very common among pregnant women. Gestational diabetes mellitus (GDM) has been related to various adverse maternal and neonatal outcomes. The aim of this systematic review was to examine the association between poor sleep quality and gestational diabetes risk. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in five electronic databases from inception to February 2019. Studies that examined the relationship between sleep quality and glucose in pregnant women were screened for eligibility. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated from aggregate data using a fixed-effect model. Thirteen non-experimental studies (n = 21,194 women) were eligible for inclusion. Poor sleep quality was measured using subjective questionnaires in nine studies and objective methods (actigraphy or polysomnography) in four studies. GDM was typically diagnosed following standard guidelines. Eight studies were included in the meta-analysis for GDM. Overall, self-reported poor sleep quality was a significant risk factor for GDM (pooled OR=1.43, 95%CI: 1.16,1.77, p=0.001). Three studies examined the association between objective sleep quality and GDM, but no significant relationship was observed. Subjective poor sleep quality was related to an increased risk for GDM, while objectively measured sleep quality was not. This review was limited by the assessment of sleep quality. Future larger studies are warranted to examine the effects of sleep quality on glucose metabolism in pregnancy. Ideally, these studies should measure sleep quality using both validated questionnaires and objective methods. These will provide further directions for improving sleep during pregnancy and exploring its effects on glucose metabolism.

    更新日期:2019-12-04
  • Sleep disturbances and associated factors among 2-6-year-old male children with autism in Bhubaneswar, India
    Sleep Med. (IF 3.360) Pub Date : 2019-11-30
    Priyadarsini Samanta, Durga Prasad Mishra, Ansuman Panigrahi, Jayanti Mishra, Laxman Kumar Senapati, Jayaprakash Russel Ravan

    Background Sleep disturbances are considered one of the significant comorbidities of autism; they negatively impact the quality of life of children with autism as well as their parents or caregivers. This study aimed to determine the prevalence of sleep disturbances in Indian male children diagnosed with autism and examine the association of lifestyle behaviors and socio-demographic characteristics with sleep problems. Methods The present cross-sectional study was conducted in Bhubaneswar city in the year 2018, involving mothers of 100 male children with autism aged 2 – 6 years. We used a children’s sleep habits questionnaire (CSHQ) to evaluate the sleep problems in children with autism and a semi-structured schedule for gathering information regarding lifestyle behaviors and socio-demographic characteristics. Results The overall prevalence of parent-reported sleep problems was 93%; the most prevalent CSHQ subscales were: bedtime resistance (95%), sleep anxiety (85%), and sleep duration (81%). The mean ISAA score of the study sample was 133.89±19.59, where 12%, 71%, and 17% of the children had mild, moderate, and severe autism, respectively. Multiple linear regression analysis revealed that variables such as autism severity, screen time, caffeine intake, physical activity, maternal age, child's age, and birth weight were significantly associated with the CSHQ subscales. Conclusion The prevalence of parent-reported sleep problems is very high among the male children with autism in Bhubaneswar, India, and there is an urgent need for interventional measures for appropriate management of this problem among these children.

    更新日期:2019-11-30
  • Sex-specific sleep apnea screening questionnaires: closing the performance gap in women
    Sleep Med. (IF 3.360) Pub Date : 2019-11-30
    Fré A. Bauters, Sarah Loof, Katrien B. Hertegonne, Julio A. Chirinos, Marc L. De Buyzere, Ernst R. Rietzschel

    Background The availability of poly(somno)graphy [P(S)G] for sleep apnea (SA) diagnosis is limited, making pre-test case evaluation an important challenge. The Neck, Obesity, Snoring, Age, Sex (NoSAS) and STOP-Bang (SBQ) scores are accepted screening tests, but their sex-specific performance in the general population is unknown. Objective To compare the sex-specific diagnostic characteristics of the NoSAS and SBQ scores, and to optimize the performance of these tools for men and women. Methods Participants from a population-based cohort (n=2205) underwent clinical evaluation, including NoSAS, SBQ, and home polygraphy. Results We obtained successful polygraphy in 1809 participants. Moderate-to-severe SA was present in 11.7%. Diagnostic performance indices of NoSAS and the SBQ calculated on the overall group (men + women) overestimated the performance in both sexes separately. The sensitivity of NoSAS for an apnea/hypopnea index (AHI) ≥15 h-1 was acceptable in men (87.1%), but low in women (55.3%). The reverse was true for the specificity (39.9% in men, 87.4% in women). A similar sex-specific difference in diagnostic performance was seen with the SBQ. Using women-specific cut-offs for the scores (NoSAS ≥6 or SBQ ≥2) and neck circumference (>35 cm) increased the sensitivity in women to levels similar to men (88.5 and 87.2%). Although specificity decreased, it still remained higher than in men. Conclusion In women, the sensitivity of NoSAS and the SBQ is too low for SA screening in the general population. Sex-specific cut-offs reverse this imbalance and achieve test sensitivities in women similar to those in men, whilst still retaining higher specificities than in men. Sleep questionnaires performance reporting should be sex-stratified.

    更新日期:2019-11-30
  • Preliminary Study of the Association of Serum Irisin Levels with Poor Sleep Quality in Rheumatoid Arthritis Patients
    Sleep Med. (IF 3.360) Pub Date : 2019-11-30
    Rania M. Gamal, Mona Embarek Mohamed, Nevin Hammam, Noha Abo El Fetoh, Ahmed M. Rashed, Daniel E. Furst

    Study Objectives Sleep disorders are significant problems in patients with rheumatoid arthritis (RA) and are associated with poor quality of life. Irisin is myokine which may have anti-inflammatory and energy regulatory roles. This study assessed the association of serum irisin levels with the quality of sleep and disease activity in RA patients. Methods Fifty-eight RA patients and 30 matched healthy controls were included. Disease activity score in 28 joints (DAS28-ESR) and the patients’ global score were calculated. RA patients were grouped according to the Pittsburgh Sleep Quality Index score (PSQI) into good-sleepers (group 1) defined as a PQSI score <=5 and poor sleepers (group 2) with a PSQI > 5. Serum irisin levels were measured for both patients and controls by commercially available enzyme-linked immunosorbent assay kits. Results Poor sleep quality was found in 26 (45%) of the RA patients. Irisin levels were significantly lower in RA patients with poor sleep compared to those with good sleep and healthy controls (p<0.001). Serum irisin levels correlated inversely with disease duration, morning stiffness duration, DAS28-ESR, global score, and total PSQI score (r= -0.722 to -0.263 & p values <=0.001-0.04) indicating a possible anti-inflammatory role of irisin in RA patients. The analysis employed Student's t-test, ANOVA, and Pearson correlation. Conclusions Irisin levels were decreased in RA patients with poor sleep quality compared to RA patients with good sleep quality and healthy controls, indicating a possible association of decreased serum irisin with sleep impairment in RA patients.

    更新日期:2019-11-30
  • Non-respiratory complaints are main reasons for disturbed sleep post lung transplant
    Sleep Med. (IF 3.360) Pub Date : 2019-11-27
    Vishal Sawhney, Harish Seethamraju, Claire Bourguet, Max Hirshkowitz, Venketa Bandi, Amir Sharafkhaneh

    Background Poor sleep is prevalent in lung transplant recipients and affects quality of life negatively. To improve quality of sleep, it’s important to identify the causes of poor sleep. We conducted a survey to identify the reasons for poor sleep quality in the recipients. Methods We surveyed lung transplant recipients (2003-2010) at Baylor College of Medicine/The Methodist Hospital lung transplant center. We used a compilation of questionnaires, including Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire, Epworth Sleepiness Scale (ESS) and Short Form 36 (SF36). Descriptive analysis was performed on the responses. Results Of the 167 participants, 54 responded (32.3%) with mean age 60.6 years (SD 9.8), 48% male, and a mean post-transplant BMI of 27 (SD 4.7). The responders reported a long mean sleep latency of 33.2 min (SD 32.5), poor sleep quality (74% with PSQI score > 5), excessive daytime sleepiness (ESS > 9 in 29%), poor physical QOL with SF36 mean score of 41.3 (SD 9.4), and high risk for OSA (48.2%). About 30% and 72% reported sleep initiation and maintenance insomnia, respectively. The poor sleep quality was due to “getup to go to bathroom” (85%), “cough or snore loudly” (33%), “have pain” (27.8%), and “feel too cold” (27.8%). 5% reported “Can’t breathe comfortably” as reason for poor sleep. Conclusions The recipients reported poor sleep and quality of life. The non-respiratory complaints were important factors for poor sleep. Attention to these factors may help to outline better management strategies to improve sleep in lung transplant recipients.

    更新日期:2019-11-28
  • Increased incidence of colorectal cancer with obstructive sleep apnea: A nationwide population-based cohort study
    Sleep Med. (IF 3.360) Pub Date : 2019-03-07
    Chao-Yang Chen, Je-Ming Hu, Cheng-Jung Shen, Yu-Ching Chou, Yu-Feng Tian, Yong-Chen Chen, San-Lin You, Chi-Feng Hung, Tzu-Chiao Lin, Cheng-Wen Hsiao, Chun-Yu Lin, Chien-An Sun

    Background Epidemiological studies on the obstructive sleep apnea (OSA) and cancer relationship in humans are inconsistent. Furthermore, there are limited prospective studies on the association between OSA and the risk of colorectal cancer (CRC). This retrospective cohort study examined the longitudinal relationship between OSA and CRC in a nationwide population-based cohort. Methods We identified 4180 individuals newly diagnosed with OSA (the exposed cohort) and randomly selected 16,720 age- and sex-matched subjects without OSA (the nonexposed cohort) between 2000 and 2008 from Taiwan’s National Health Insurance Research Database. The Kaplan−Meier method was used for calculating the cumulative incidence of CRC in each cohort. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and the accompanying 95% confidence intervals (CIs) for the association between OSA and CRC. Results After adjusting for potential confounders, patients with OSA were associated with a significantly higher risk of CRC than those without OSA (adjusted HR, 1.80; 95% CI, 1.28–2.52). The cumulative incidence of CRC was significantly higher in the OSA cohort than in the comparison cohort (log-rank test, p < 0.001). Furthermore, the association between OSA and CRC appeared to be enhanced with increasing frequency of OSA medical visits (adjusted HR [95% CI] was 1.61 [0.97–2.66] and 1.86 [1.26–2.75] for one visit and two or more visits, respectively). Conclusion This population-based cohort study demonstrated that OSA was associated with an increased risk of CRC. Further large-scale prospective studies are needed to confirm our results.

    更新日期:2019-11-28
  • Sleep parameters measured by accelerometry: descriptive analyses from the 22-year follow-up of the Pelotas 1993 Birth Cohort
    Sleep Med. (IF 3.360) Pub Date : 2019-11-26
    Andrea Wendt, Inácio Crochemore Mohnsan da Silva, Helen Gonçalves, Maria Cecilia F Assunção, Ana Maria B Menezes, Fernando C. Wehrmeister

    Objective To describe the sleep time window (STW), total sleep time (TST), and sleep percent [SP = (TST/STW) × 100] by accelerometry in a population-based young adult cohort in Brazil. Methods Cross-sectional analysis with a 22-year sample (N = 2462). Sleep variables were measured using an accelerometer. The devices were worn on the non-dominant wrist for approximately seven days. A raw data analysis using the GGIR package was performed. The following sleep variables were extracted: TST, STW, and SP. Linear regression was used to adjust averages. All analyses were stratified according to sex. A comparison between weekday and weekend averages was also conducted. Results The means of TST, STW, and SP for men were 5.9 hours, 7.1 hours, and 83.1%, respectively. For women, the means of TST, STW, and SP were 6.4 hours, 7.6 hours, and 84.6%, respectively. Women presented a higher means of all outcomes compared to men (p<0.001). After adjusting for both sexes, white skin color and not working or studying were associated with higher TST. Individuals not working or studying presented higher means of STW and lower sleep SP. Women with children who were less than two years of age presented lower values of three evaluated outcomes. Regarding behavior and health condition variables, obesity was associated with lower STW only for men. Physical activity was associated with higher SP and risk drinking with lower TST and STW only for women. Conclusion Differences between sexes were observed in TST, STW, and SP. Women presented a higher means of all outcomes. Socioeconomic variables were associated with both sexes, but having children and behavior/health conditions differed between sexes.

    更新日期:2019-11-26
  • Effects of CPAP for Patients with OSA on Visual Sensitivity and Retinal Thickness
    Sleep Med. (IF 3.360) Pub Date : 2019-11-23
    Pei-Wen Lin, Hsin-Ching Lin, Michael Friedman, Hsueh-Wen Chang, Anna M. Salapatas, Meng-Chih Lin, Yung-Che Chen

    Objective Obstructive sleep apnea/hypopnea syndrome (OSA) could compromise oxygenation of the optic nerve and cause glaucomatous optic neuropathy; there has been no study to investigate the microstructure changes of the optic nerve and retina in OSA patients before and after continuous positive airway pressure (CPAP) therapy. In this study, we assess whether treatment with CPAP might improve visual sensitivity and retinal thickness in patients with OSA. Methods Patients with OSA were prospectively recruited and referred for ophthalmologic evaluation at baseline and three months after CPAP treatment. Each patient underwent an ophthalmological exam, standard automated perimetry (SAP), and optical coherence tomography (OCT) exam. Peripapillary retinal nerve fiber layer (RNFL) and macular layer (ML) thickness parameters were measured. The SAP, RNFL, and ML thickness parameters before and after treatment were compared. Results A total of 32 OSA patients were consecutively enrolled. At baseline, the mean deviation (MD) of SAP was -2.15 ± 1.90 decibels (dB). After CPAP treatment, the MD was -1.38 ± 1.37 dB (p= 0.017). Regarding the OCT parameters, the inferior quadrant and nasal-inferior sector of RNFL thickness significantly improved after treatment (p= 0.025 and 0.004, respectively). The ML thickness in the superior-inner sector, inferior-outer sector, nasal-outer sector, superior hemisphere, and inferior hemisphere were also significantly improved after treatment. Improvement of ML thickness in the superior-inner sector positively correlated with the apnea/hypopnea index (r=0.405, p=0.022) and desaturation index (r=0.473, p=0.006) on pre-treatment polysomnography. Conclusion The treatment of CPAP could improve visual sensitivity and increase retinal thickness in patients with OSA.

    更新日期:2019-11-26
  • Long-term health and socioeconomic consequences of childhood and adolescent-onset of narcolepsy
    Sleep Med. (IF 3.360) Pub Date : 2019-11-20
    Poul Jennum, Rikke Ibsen, Jakob Kjellberg

    Objectives There is limited information about the long-term consequences of childhood- and adolescent-onset narcolepsy on educational and social factors. Here, we estimate the long-term socioeconomic consequences and health care costs of narcolepsy. Methods The prospective cohort study included Danish individuals with narcolepsy onset in childhood or adolescence, diagnosed between 1994 and 2015. Health care costs and socioeconomic data were obtained from nationwide administrative and health registers. One hundred seventy-one patients were compared with 680 controls (mean index age, 15.2 years; SD, 3.4 years) matched for age, gender, and other sociodemographic characteristics. Results Comparing the narcolepsy patient and control groups at age 20 years we found: 1) no differences in parental educational level; 2) patients had a significantly lower educational level than controls; 3) patients had significantly lower grade-point averages; 4) patients had a lower employment rate and lower-income, even when transfer payments were considered; and 5) patients’ initial health care costs were higher. Patients had a higher mortality rate than controls, although the difference was not statistically significant. Conclusion Narcolepsy is associated with a significant influence on educational level, grading, social outcome, and welfare consequences. The development of narcolepsy is independent of parental social level.

    更新日期:2019-11-20
  • Impact of sleep opportunity on asthma outcomes in adolescents
    Sleep Med. (IF 3.360) Pub Date : 2019-07-23
    Lisa J. Meltzer, Dean W. Beebe, Stephanie Jump, Kassie Flewelling, D. Sundström, Michael White, Pamela L. Zeitlin, Matthew J. Strand

    Rationale Insufficient sleep is associated with a number of negative health outcomes; as most adolescents obtain <7 h of sleep per night, it is important to understand how sleep impacts asthma among adolescents. Objectives To examine the impact of sleep opportunity on asthma in adolescents. Methods In this study, 54 adolescents with asthma (12–17 years, 69% female, 65% Caucasian) participated in a randomized, cross-over sleep manipulation trial, including a sleep stabilization week, five nights of a “Short” sleep opportunity (time in bed: 6.5 h/night), and five nights of a “Long” sleep opportunity (time in bed: 9.5 h/night). Wake times were consistent across all three study weeks. Primary outcomes were lung function (daily peak expiratory flow rate, weekly spirometry) and functional asthma outcomes (daily asthma symptoms, Asthma Control Questionnaire, PROMIS Asthma Impact Scale). Markers of inflammation were also explored. Measurements and main results Compared to the Long sleep week, during the Short sleep week, morning FEV1 was lower (p = 0.006), while asthma symptoms and albuterol use was higher (p < 0.05), and asthma showed a trend towards greater negative impact on daily life (p = 0.07). No differences were found for weekly measures of lung function or inflammation. Conclusions An insufficient sleep opportunity negatively impacts objective and subjective daily symptoms of asthma in adolescents, as well as health related quality of life. As most adolescents are significantly sleep deprived, it is important to target sleep health in the treatment of asthma.

    更新日期:2019-11-19
  • Prevalence and neurophysiological correlates of sleep disordered breathing in pediatric type 1 narcolepsy
    Sleep Med. (IF 3.360) Pub Date : 2019-07-11
    Marco Filardi, Nurhak Demir, Fabio Pizza, Stefano Vandi, Elena Antelmi, Silvia Noce, Oliviero Bruni, Giuseppe Plazzi

    Study objectives To investigate the prevalence and neurophysiological correlates of obstructive sleep disordered breathing (OSA) in type 1 narcolepsy (NT1) children and adolescents. Methods Thirty-eight, drug-naïve, NT1 children and adolescents and 21 age- and sex-balanced clinical controls underwent nocturnal polysomnography (PSG) and multiple sleep latency test (MSLT). According to the rules for pediatric population, an obstructive apnea-hypopnea index (Obstructive AHI) ≥ 1 (comprising obstructive and mixed events), defined comorbid OSA. Results NT1 children showed higher prevalence of overweight/obesity and severe nocturnal sleep disruption (lower sleep efficiency, and increased N1 sleep stage percentage) coupled with higher motor activity (periodic limb movement index [PLMi] and REM atonia index) compared to clinical controls. Sleep-related respiratory variables did not differ between NT1 and clinical controls (OSA prevalence of 13.2% and 4.8%, respectively). NT1 children with OSA were younger and showed lower N2 sleep stage percentage and higher PLMi than NT1 children without comorbid OSA. Overweight/obesity was not associated with OSA in NT1. Conclusions Despite higher body mass index (BMI), OSA prevalence did not differ between children with NT1 and clinical controls. OSA in pediatric NT1 patients is a rare and mild comorbidity, further contributing to nocturnal sleep disruption without effects on daytime sleepiness.

    更新日期:2019-11-18
  • TOX3 gene variant could be associated with painful restless legs
    Sleep Med. (IF 3.360) Pub Date : 2019-07-11
    Elias G. Karroum, Prabhjyot S. Saini, Lynn M. Trotti, David B. Rye
    更新日期:2019-11-18
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