Sleep最新文献 - Book学术

Symptom Subtypes of Obstructive Sleep Apnea 10 Years Later: Past, Present and Future.

IF 5.6 2区医学

Sleep Pub Date : 2025-04-09 DOI: 10.1093/sleep/zsaf082

Brendan T Keenan, Lichuan Ye, Grace W Pien, Ulysses J Magalang, Bryndis Benediktsdottir, Thorarinn Gislason, Allan I Pack

{"title":"Symptom Subtypes of Obstructive Sleep Apnea 10 Years Later: Past, Present and Future.","authors":"Brendan T Keenan, Lichuan Ye, Grace W Pien, Ulysses J Magalang, Bryndis Benediktsdottir, Thorarinn Gislason, Allan I Pack","doi":"10.1093/sleep/zsaf082","DOIUrl":"https://doi.org/10.1093/sleep/zsaf082","url":null,"abstract":"As first described in Iceland over 10 years ago and since replicated across thousands of diverse subjects from community-based and clinical cohorts throughout the world, there exist different subtypes of obstructive sleep apnea (OSA) characterized by patient-reported symptoms. Subtypes defined by excessive sleepiness, disturbed sleep, and minimal symptoms have been consistently identified across these various cohorts, and are often joined by a moderately sleepy subtype. Identifying symptom subtypes using cluster analysis provided a data-driven approach to formalize the concept of symptomatic differences among patients with OSA that has been discussed for decades in prior research, and has important implications for future research and clinical applications. Current evidence favors excessive sleepiness as a marker of increased cardiovascular risk related to OSA, but there remains an opportunity for more research on non-cardiovascular endpoints. The framework of symptom subtypes can inform future randomized clinical trials, which are challenging in patients with excessive sleepiness, but both feasible and clinically important in the other subtypes. Symptom heterogeneity should also be used to move beyond a one-size-fits-all approach to treatment recommendations, including consideration of whether patients with minimally symptomatic OSA require or receive any benefits from therapy. Studies to identify the underlying mechanisms of different symptom presentations, demonstrate short-term reliability, determine the minimum number of questions required for accurate identification, and implement a tool for assigning subtypes in routine clinical practice are needed in order to realize the full potential of symptom subtypes to inform more personalized medicine approaches.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What will the impact be of use of tirzepatide in patients with obstructive sleep apnea (OSA)?

IF 5.6 2区医学

Sleep Pub Date : 2025-04-04 DOI: 10.1093/sleep/zsaf045

Allan Pack, Ronald Grunstein, Babak Mokhlesi, Silke Ryan, Richard Schwab, David Gozal

{"title":"What will the impact be of use of tirzepatide in patients with obstructive sleep apnea (OSA)?","authors":"Allan Pack, Ronald Grunstein, Babak Mokhlesi, Silke Ryan, Richard Schwab, David Gozal","doi":"10.1093/sleep/zsaf045","DOIUrl":"https://doi.org/10.1093/sleep/zsaf045","url":null,"abstract":"The SURMOUNT-OSA trial evaluated the impact of the weight loss drug tirzepatide in obese patients with obstructive sleep apnea (OSA). The primary endpoint assessed was a change in the apnea-hypopnea index (AHI) after 52 weeks in individuals on the drug compared to placebo. There were robust decrements in AHI with resolution of OSA in approximately 50% of subjects. These impressive results raise the question: what role will this medication play in routine management of OSA? This Forum article asked four opinion leaders to give their views. All agreed that tirzepatide will play a major role, but there were different opinions as to what that role will be. There was a fairly broad view that the role in primary treatment would be limited, given how long it takes to get an effect, whereas CPAP gives immediate benefit. Thus, initially the drug will likely be used in concert with CPAP. After weight loss is achieved, there will be consideration as to whether CPAP can be stopped. Opinion leaders argued that there are opportunities for treatment of obesity hypoventilation syndrome that require study. Other primary outcomes need to be investigated as well. Moreover, studies comparing drug treatment with CPAP need to be considered. The high cost of the drug could increase already existing disparities in care. There are concerns about long-term adherence, but current data are largely about the initial drugs of this type. In conclusion, the precise guidelines for optimal tirzepatide use in OSA remain to be determined.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isolated cataplexy without subjective and objective sleepiness in a hypocretin-deficient patient-is it narcolepsy? 一名视网膜下素缺乏症患者无主观和客观嗜睡症状的孤立性惊厥--是嗜睡症吗？

IF 5.6 2区医学

Sleep Pub Date : 2025-04-04 DOI: 10.1093/sleep/zsaf052

Knar Gevorgyan, Janina Tepperberg, Tamara Scharf, Zhongxing Zhang, Ramin Khatami

引用次数: 0

Frequency and Longitudinal Course of Autonomic Reflex Testing Abnormalities in Isolated REM Sleep Behavior Disorder.

IF 5.6 2区医学

Sleep Pub Date : 2025-03-29 DOI: 10.1093/sleep/zsaf087

Hash Brown Taha, Jennifer Zitser, Mitchell G Miglis

{"title":"Frequency and Longitudinal Course of Autonomic Reflex Testing Abnormalities in Isolated REM Sleep Behavior Disorder.","authors":"Hash Brown Taha, Jennifer Zitser, Mitchell G Miglis","doi":"10.1093/sleep/zsaf087","DOIUrl":"https://doi.org/10.1093/sleep/zsaf087","url":null,"abstract":"Study objectives: Autonomic dysfunction is common across the α-synucleinopathies including isolated RBD (iRBD), however the presence, severity and distribution of autonomic dysfunction as a risk factor for phenoconversion in iRBD remains unclear. We aimed to characterize autonomic reflex testing (ART) abnormalities in a cohort of participants with iRBD and assess them as phenoconversion biomarkers.Methods: We performed ART on 45 individuals with iRBD and evaluated the ability of ART components (sympathetic cholinergic, cardiovagal, sympathetic adrenergic) to predict phenoconversion using univariate and multivariate models combined with measures of olfaction, cognition, motor function, and skin biopsy assessment of dermal synuclein.Results: Forty-one individuals with iRBD were enrolled (age 66.7 ± 7.4 yrs, 27% female), and followed annually for an average of 2.9 ± 2.4 yrs, with four participants lost to follow-up. Eight participants with iRBD phenoconverted during their follow-up period (3 Parkinson's disease, 4 dementia with Lewy bodies and 1 multiple system atrophy), yielding a phenoconversion rate of 6.6% per year. Eighty-seven percent of iRBD participants had an abnormal baseline ART, and 100% had an abnormal follow-up ART. A combination of MDS-UPDRS III score and cardiovagal dysfunction (abnormal HRVdb) best predicted phenoconversion (AUC = 0.77), especially when combined with iRBD disease duration (AUC = 0.89).Conclusions: ANS dysfunction was common and spanned all domains of autonomic function. Cardiovagal function was the most common domain affected and most predictive of phenoconversion, especially if combined with motor examination and disease duration. Longitudinal studies with larger sample sizes are needed to confirm these findings.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fitbit-Measured Sleep Duration in Young Adolescents is Associated with Functional Connectivity in Attentional, Executive Control, Memory, and Sensory Networks.

IF 5.6 2区医学

Sleep Pub Date : 2025-03-29 DOI: 10.1093/sleep/zsaf088

Ozerk Turan, Jonathan Garner, Amal Isaiah, Maylin Palatino, Thomas Ernst, Ze Wang, Linda Chang

{"title":"Fitbit-Measured Sleep Duration in Young Adolescents is Associated with Functional Connectivity in Attentional, Executive Control, Memory, and Sensory Networks.","authors":"Ozerk Turan, Jonathan Garner, Amal Isaiah, Maylin Palatino, Thomas Ernst, Ze Wang, Linda Chang","doi":"10.1093/sleep/zsaf088","DOIUrl":"https://doi.org/10.1093/sleep/zsaf088","url":null,"abstract":"Study objectives: Adolescents often do not sleep as much as recommended by most national guidelines, which may impact their brain development. The current study aims to evaluate the relationship between objective assessment of sleep duration measured with actigraphy, and brain network connectivity on functional magnetic resonance imaging (fMRI).Methods: We used data from the two-year follow-up of the Adolescent Brain Cognitive Development (ABCD) study comprising 3,799 adolescents, ages 10 to 13 years old, to assess the relationship between sleep duration, measured by two weeks of Fitbit-derived actigraphy, and brain network connectivity derived from resting-state fMRI, using linear regression models. Linear regression analysis was also used to investigate the interaction between participant sex and sleep duration on brain network connectivity.Results: We identified both positive and negative correlations between mean sleep duration and 6 within brain network and 30 between-network pairs. These included networks involved in attention (Dorsal and Ventral Attention networks), executive control (Cingulo-Opercular and Default Mode networks), memory (Retrosplenial Temporal network), and sensory function (Auditory and Sensorimotor networks). We also identified sex-specific effects in three network pairs (Auditory - Retrosplenial Temporal, Retrosplenial Temporal - Sensorimotor, and Visual - Visual) and sex differences in functional connectivity across 23 distinct within- and between-network connections.Conclusions: Sleep duration is associated with the functional network connectivity in attentional, executive control, memory, and sensory networks during early adolescence. The identification of sex-specific effects in select network pairs underscores the importance of sex as a biological variable in studies of adolescent sleep and brain development.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Determinants of Transvenous Phrenic Nerve Stimulation-Induced Improvements in LV Function in Central Sleep Apnea and Heart Failure. 经静脉膈神经刺激改善中枢性睡眠呼吸暂停和心力衰竭患者左心室功能的决定因素

IF 5.6 2区医学

Sleep Pub Date : 2025-03-28 DOI: 10.1093/sleep/zsaf085

Ali Azarbarzin, Neda Esmaeili, Daniel Vena, Ludovico Messineo, Susan Redline, Scott McKane, Andrew Wellman, Shahrokh Javaheri, Scott A Sands

{"title":"Determinants of Transvenous Phrenic Nerve Stimulation-Induced Improvements in LV Function in Central Sleep Apnea and Heart Failure.","authors":"Ali Azarbarzin, Neda Esmaeili, Daniel Vena, Ludovico Messineo, Susan Redline, Scott McKane, Andrew Wellman, Shahrokh Javaheri, Scott A Sands","doi":"10.1093/sleep/zsaf085","DOIUrl":"https://doi.org/10.1093/sleep/zsaf085","url":null,"abstract":"Study objectives: Central sleep apnea (CSA) is common in heart failure (HF) patients but its treatment's impact on cardiac function is unclear. Transvenous phrenic nerve stimulation (TPNS) is an emerging CSA therapy that may improve long-term left ventricular systolic function (LVEF) in HF. Given the cardiovascular risk of sleep apnea appears contingent on respiratory-event-related heart rate surges (\"high ∆HR\"), we hypothesized that TPNS treatment may preferentially improve LVEF in CSA patients with high ∆HR.Methods: In the remedē® System pivotal trial, ∆HR was calculated from baseline polysomnography in patients with HF. Primary analysis quantified whether treatment-related change in left ventricular ejection fraction (∆LVEF; echocardiography, biplane method) vs. control was greater in \"high ∆HR\" (>14.6 beats/min, i.e.,fourth quartile) vs. \"low ∆HR (≤4.2 beats/min, i.e., first quartile)\" at 6 months (treatment-by-\"high ∆HR\" interaction). Longitudinal analysis quantified whether favorable LVEF changes from baseline were maintained longer term (6-12 months).Results: In primary analysis (N=79, M:F=74:5, LVEF=34±12% [mean±SD]), TPNS vs. control was associated with a markedly greater improvement in LVEF in patients with high ∆HR vs. low ∆HR (estimate [95%CI]: +7.8[0.37,15.2]%, P-interaction=0.04). In longitudinal analysis, LVEF increased in patients with high ∆HR at 6, 9, and 12 months (+2.5[-0.1,5.1]%, +3.9[1.2,6.5]%, +3.7[1.0,6.4]% from baseline, respectively) but not among low ∆HR (-0.1[-2.8, 2.6]%; -0.3[-3.1, 2.4]%; -0.8[-3.7, 2.1]%).Conclusions: Compared to low ∆HR, patients with high ∆HR showed greater LVEF improvement with TPNS for CSA. High ∆HR, a potential reflection of CSA-related sympathetic overactivity, may identify those who benefit most from CSA treatment.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insights about Travel-Related Sleep Disruption from 1.5 Million Nights of Data.

IF 5.6 2区医学

Sleep Pub Date : 2025-03-24 DOI: 10.1093/sleep/zsaf077

Adrian R Willoughby, Raphael Vallat, Ju Lynn Ong, Michael W L Chee

{"title":"Insights about Travel-Related Sleep Disruption from 1.5 Million Nights of Data.","authors":"Adrian R Willoughby, Raphael Vallat, Ju Lynn Ong, Michael W L Chee","doi":"10.1093/sleep/zsaf077","DOIUrl":"https://doi.org/10.1093/sleep/zsaf077","url":null,"abstract":"Study objectives: Growing adoption of reliable wearable sleep trackers has made it possible to analyze multi-night, objective sleep data from travelers on a scale hitherto not possible. This study was designed to complement previous studies of jet lag and circadian realignment conducted under highly controlled laboratory conditions and small-scale field studies typically involving specialist samples such as professional athletes.Methods: De-identified sleep data from 15 days before and after 64,847 trips from 57,240 Oura Ring users were analyzed. Trips were at least 1000km and originated from North America and Europe. We characterized the evolution of sleep timing, duration and macro-architecture, considering the influence of number of time zones crossed, direction of travel, and habitual sleep patterns.Results: Sleep disruption began with curtailed sleep on the night before travel because of early awakening. Sleep duration was shorter during and immediately following travel but returned to within ~12 minutes of baseline after ~2 days. In contrast, changes in sleep timing and sleep architecture were considerably slower to recover, with sleep timing not returning to baseline after 15 days. Sleep disruption was more severe with eastward travel and across more time zones. Inter-individual differences in both sleep duration and timing equilibrated with travel.Conclusions: Both structural and intrinsic circadian factors influence sleep during travel. Sleep homeostatic mechanisms drive recovery of sleep duration quickly although architecture is still compromised. Realignment of sleep timing to the new time zone takes significantly longer.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cognitive Behavioral Therapy for Insomnia: A Transdiagnostic Intervention?

IF 5.6 2区医学

Sleep Pub Date : 2025-03-24 DOI: 10.1093/sleep/zsaf079

Daniel L Hall, Kimberly A Arditte Hall, Gabrielle Liverant, Elyse R Park, Mark J Gorman, Emma G Balkind

引用次数: 0

Racial Disparities in Obstructive Sleep Apnea Care in the United States.

IF 5.6 2区医学

Sleep Pub Date : 2025-03-24 DOI: 10.1093/sleep/zsaf078

Adrianna I Acevedo-Fontanez, Sanjay R Patel

{"title":"Racial Disparities in Obstructive Sleep Apnea Care in the United States.","authors":"Adrianna I Acevedo-Fontanez, Sanjay R Patel","doi":"10.1093/sleep/zsaf078","DOIUrl":"https://doi.org/10.1093/sleep/zsaf078","url":null,"abstract":"As with much of medicine, racial health disparities exist in the care of patients with obstructive sleep apnea (OSA). These disparities impact all aspects of care from screening and diagnosis to treatment and long-term management. Substantial barriers exist for Black and other historically marginalized racial groups in the US to obtain evaluation for OSA, exacerbated by knowledge deficits about OSA. These barriers result in disease severity being much greater at the time of clinical diagnosis. Many screening and diagnostic tools used in OSA care were adopted based on their utility in White populations without consideration of their performance in other racial groups. For example, the reduced sensitivity of pulse oximetry in detecting desaturations in people with darker skin pigmentation has been heretofore ignored in defining hypopnea. In terms of treatment, outcomes from common therapies are worse in many racial minority groups. Adherence to continuous positive airway pressure (CPAP) is substantially lower and adenotonsillectomy is less effective in resolving OSA and more likely to produce respiratory complications in Black compared to White patients. Many coverage policies further exacerbate racial disparities in OSA care. Interventions such as greater utilization of home sleep apnea testing and automated feedback messaging of CPAP use exist that can help reduce disparities. However, the development of a more diverse workforce and prioritization of health equity in developing every step of OSA care will be necessary to ultimately eliminate racial disparities.","PeriodicalId":22018,"journal":{"name":"Sleep","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is a Good Night's Sleep One of the Keys to Successful Aging?

IF 5.6 2区医学

Sleep Pub Date : 2025-03-24 DOI: 10.1093/sleep/zsaf081

Armand M Ryden, Cathy A Alessi

引用次数: 0