{"title":"Oral Appliance Therapy for Obstructive Sleep Apnea: Clinical Benefits and Limitations","authors":"Yeongrok Lee, Jae Yong Lee, J. Choi","doi":"10.17241/smr.2023.01921","DOIUrl":"https://doi.org/10.17241/smr.2023.01921","url":null,"abstract":"Obstructive sleep apnea (OSA) is a condition characterized by recurrent upper airway obstruction during sleep. It is associated with a wide range of symptoms and complications. Management includes positive airway pressure (PAP), upper airway surgery, oral appliance therapy, positional therapy, and weight loss. Oral appliance therapy treats OSA through direct expansion of the upper airway or indirectly by preventing its collapse. Its effectiveness in improving apnea-hypopnea index and oxygen desaturation is gaining wider approval and the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine currently recommend oral appliance as an alternative therapy for those who are unable to PAP therapy. To achieve maximum benefits, it is essential to evaluate factors that can affect treatment outcomes as well as create devices tailored to the individual patient’s dentition and capable of manipulating the degree of mandible advancement. While most are minor and transient, patients should always be warned about the potential adverse effects on mastication and mandibular joint as they can negatively influence treatment compliance. Although PAP shows superior results in improving polysomnography parameters, oral appliance therapy displays comparable health outcomes and greater adherence. Additional studies on establishing patient selection, optimal titration procedure, and measuring objective adherence will further improve oral appliance therapy acceptance.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139130055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rapid Eye Movement Sleep Behavior Disorder: What Is Known and What Should Be Studied","authors":"In-Young Yoon","doi":"10.17241/smr.2023.02026","DOIUrl":"https://doi.org/10.17241/smr.2023.02026","url":null,"abstract":"Rapid eye movement sleep behavior disorder (RBD), characterized by vivid striking dreams and dream-enacting behaviors, can be classified as both young and old. RBD is young in that it was conceptualized as a distinct clinical disorder by Schenck et al. [1] in 1986, and it is old because it mainly affects older people. In Korea, an RBD case, confirmed by polysom-nography, was reported in 1994. REM sleep without atonia (RWA) on the polysomnography is requisite for RBD diagnosis. Currently, qualitative analysis of RWA is used as RWA quantification is burdensome and time-consuming. Notably, patients complaining of vigorous dreams and violent behaviors are occasionally diagnosed with obstructive sleep apnea or show no definite RWA, which may negate diagnosis based on clinical history or RBD questionnaires. Regarding pathophysiology, dopaminergic degeneration was investigated because of its close relationship with alpha-synucleinopathies. Studies using dopamine transporter (DAT) positron emission tomography (PET) or single photon emission computed tomography (SPECT) showed that dopamine (DA) dysfunction might be implicated in RBD. However, several findings suggest that other pathogenic processes can be involved; 1) in managing RBD symptoms, effectiveness of clonazepam with no influence on DA and little effect of dopaminergic drugs, 2) appearance of RBD in narcoleptic patients, 3) young RBD patients without progression to alpha-synucleinopathies, and 4) RBD symptoms induced by anti-depressants.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139130285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Subcutaneous Emphysema Following Nasal Positive Airway Pressure Therapy in a Patient With a History of Tongue Base Tumor Resection","authors":"Ki-Hwan Ji","doi":"10.17241/smr.2023.01753","DOIUrl":"https://doi.org/10.17241/smr.2023.01753","url":null,"abstract":"Positive airway pressure (PAP) therapy is chosen as the primary modality for most patients with obstructive sleep apnea due to its efficacy and safety. However, PAP therapy can cause potential side effects, including barotrauma, which in most cases is benign and manageable. Nevertheless, rare but serious complications, such as subcutaneous emphysema, may also occur. Here, I present a case of a middle-aged man with a history of tongue base tumor resection who developed subcutaneous emphysema in the neck following nasal PAP therapy. This case highlights the potential risk associated with previous surgical interventions and PAP therapy.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ebrahim Norouzi, Ali Zakei, Alexandra J. Bratty, Habibolah Khazaie
{"title":"The Relationship Between Slow Wave Sleep and Blood Oxygen Saturation Among Patients With Apnea: Retrospective Study","authors":"Ebrahim Norouzi, Ali Zakei, Alexandra J. Bratty, Habibolah Khazaie","doi":"10.17241/smr.2023.01725","DOIUrl":"https://doi.org/10.17241/smr.2023.01725","url":null,"abstract":"Background and Objective Prior research suggests that slow wave sleep (SWS) is disrupted in people with obstructive sleep apnea (OSA). However, it was not clear whether the reduction in SWS is related to abnormal breathing or the extent of OSA as determined by the minimum oxygen saturation. Further, there is limited research on the relationship between oxygen saturation and SWS. The present study examined the relationship between SWS and minimum oxygen saturation levels in patients with OSA.Methods The sample consisted of 589 patients with OSA (mean age: 48.54 years) who completed full-night polysomnography.Results Results showed that there was a significant difference in SWS scores across three apnea-hypopnea index (AHI) groups (AHI score 5–15 for mild apnea, 16–30 for moderate apnea, and >30 for severe apnea). Lower SWS scores were observed in the severe apnea group. Additionally, results indicated that as oxygen saturation decreased, the SWS scores decreased.Conclusions Results from this study indicate that oxygen saturation significantly predicts SWS amounts. These findings suggest that interventions for low oxygen saturation could enhance the amounts of SWS. The clinical ramifications of these findings are worthy of consideration.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haidar K. Ibrahim, Zainab Hasan Hashim, Younus Desher
{"title":"Sleep Quality Assessment in Correlation to Autonomic Nerve Function in Type 2 Diabetic Patients","authors":"Haidar K. Ibrahim, Zainab Hasan Hashim, Younus Desher","doi":"10.17241/smr.2023.01802","DOIUrl":"https://doi.org/10.17241/smr.2023.01802","url":null,"abstract":"Background and Objective Diabetes mellitus negatively impacts the quality of life of its patients. Autonomic dysfunction may disturb sleep quality by negatively affecting multiple systems, including, but not limited to, the cardiovascular, respiratory, and genitourinary tracts. The current study aims to assess sleep quality and examine the degree of correlation with autonomic nervous function in relatively well-controlled type 2 diabetic patients.Methods This study uses a cross-sectional design to assess sleep quality in 88 type 2 diabetic patients via the Pittsburg Sleep Quality Index (PSQI), accordingly dividing them into two groups: good or poor sleepers. Subsequently, the study evaluates autonomic nerves’ conductivity by measuring electrical skin conductance using Sudoscan for the hands and feet.Results Of 88 recruited patients, 53% showed poor sleep quality, with higher incidence in females. Autonomic nerve conductivity showed moderate damage in poor sleepers with 59.53 ± 13.35 μS and 59.68 ± 16.91 μS of hand and foot electrodes, respectively. Autonomic damage induces sleep disturbance mainly through increased nighttime voiding in 91.49% of the poor sleepers group compared to 41.46% in the good sleepers group. PSQI score was found to strongly and inversely correlate with autonomic nerve conductivity via hand electrodes, with a correlation coefficient of -0.62 and a determination coefficient of 0.39.Conclusion Poor sleep quality seems to be a significant problem even in relatively well-controlled type 2 diabetic patients with no diagnosed micro- or macrovascular complications. Autonomic dysfunction negatively affects the quality of sleep and leads to sleep disturbance by increasing nighttime micturition as one of its complications.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wafaa Bzeih, Sohyeong Kim, Kikyoung Yi, Seockhoon Chung
{"title":"No Association Between Insomnia Severity, and Discrepancy Between Desired Time in Bed and Desired Total Sleep Time Among Shift-Working Nursing Professionals","authors":"Wafaa Bzeih, Sohyeong Kim, Kikyoung Yi, Seockhoon Chung","doi":"10.17241/smr.2023.01704","DOIUrl":"https://doi.org/10.17241/smr.2023.01704","url":null,"abstract":"Background and Objective This study aimed to explore whether the discrepancy between a patient’s desired time in bed and desired total sleep time (DBST index) can be used as a tool to assess the insomnia severity of shift-working nursing professionals.Methods Two studies were conducted during two different times among two groups of shiftworking nursing professionals working in COVID-19 inpatient wards (study I), or nurses who witnessed patient death during the previous 2 years (study II), using a single voluntary survey. The survey was completed by a total of 366 participants: 226 in the first study, and 140 in the second. Participants’ age, sex, marital status, and past psychiatric history were collected. In addition to questions regarding the DBST index, the Glasgow Sleep Effort Scale (GSES), Dysfunctional Beliefs about Sleep-2 items (DBS-2), and the Insomnia Severity Index (ISI) were assessed.Results In both studies, the DBST index did not reflect insomnia severity, preoccupation with sleep, or dysfunctional beliefs about sleep in the linear regression analysis. In addition, ISI was expected by GSES (β = 0.67 in study I, β = 0.62 in study II, all p < 0.001) and DBS-2 (β = 0.16 in study II, p = 0.020), but not by the DBST index.Conclusions It was observed that the DBST index was not significantly associated with insomnia severity, preoccupation with sleep, or dysfunctional beliefs about sleep in two studies done among shift working-nursing professionals.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Positional Therapy for Obstructive Sleep Apnea: Therapeutic Modalities and Clinical Effects","authors":"Ki-Il Lee, Ji Ho Choi","doi":"10.17241/smr.2023.01837","DOIUrl":"https://doi.org/10.17241/smr.2023.01837","url":null,"abstract":"Obstructive sleep apnea (OSA) is characterized by recurrent occurrences of partial or complete collapse of the upper airway during sleep, leading to shallow breathing or breathing pauses. These repeated breathing disruptions can result in intermittent hypoxia, hypercapnia, hyperactivity of the sympathetic nervous system, and fragmented sleep patterns. Left untreated, OSA can have significant health implications, including various symptoms and serious consequences. Positional OSA is a subtype of OSA where during sleep, the severity of apnea events is significantly higher in the supine position. This condition can worsen respiratory parameters, such as apnea/hypopnea events, oxygen desaturation and arousals, and cardiovascular burdens. Positional therapy is a treatment approach used for patients with positional OSA. Typically, positional therapy involves encouraging the patient to avoid sleeping on their back, and instead sleep in a lateral position. Various modalities for positional therapy exist, including positional training using a tennis ball, alarm, or vest, and sleep positioning pillows. Novel electric-operated postural devices have also been developed. Positional therapy has shown promise in improving apneic events and lowest oxygen saturation in patients with position-dependent sleep apnea. In comparison to positive airway pressure treatment, positional therapy has been reported to demonstrate non-inferior effects, while achieving better compliance. Consequently, positional therapy can be a cost-effective and non-invasive therapeutic alternative for managing positional OSA.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Investigation of the Relationship Between Perceived Stress and Sleep Hygiene in High School Students","authors":"Çiğdem Müge Haylı, Dilek Demi̇r Kösem, Emrah Felek","doi":"10.17241/smr.2023.01788","DOIUrl":"https://doi.org/10.17241/smr.2023.01788","url":null,"abstract":"Background and Objective This study aimed to conduct a descriptive study to examine the relationship between perceived stress and sleep hygiene in high school students.Methods The data required for the research were collected online between December 16, 2022 and March 10, 2023. The study group of the research consisted of high school students. An online survey method, a socio-demographic data collection form, Perceived Stress Scale (PSS), and Sleep Hygiene Index (SHI) were obtained from 219 high school students living in Hakkari, Turkey, who were selected by the convenience sampling method, one of the nonprobability sampling methods. The independent sample t-test, ANOVA analysis, and Pearson correlation test were used to analyze the data.Results A total of 51.1% of the participating high school students were boys, and 48.9% were girls. A total of 35.6% of the participating high school students were 16 years old, 27.4% were 17 years old, 21.5% were 15 years old, and 15.5% were 18 years old. It was found that there was no significant difference (p > 0.05) between the PSS subdimensions and the SHI scores of high school students according to the variables, such as age, high school type, and class status. It was found that there was a significant relationship among the gender variable, the PSS subdimensions, and the SHI scale (p < 0.05).Conclusions It can be concluded that factors, such as age, high school type, and class status, did not affect the relationship between perceived stress and sleep hygiene in high school students and that the gender variable had an effect on the relationship between perceived stress and sleep hygiene. It is recommended that research to examine the relationship between perceived stress and sleep hygiene should be performed by expanding the samples.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sleep Disordered Breathing in Elderly: Current Evidence and Future Directions in Clinical Practice","authors":"Chol Shin","doi":"10.17241/smr.2023.01907","DOIUrl":"https://doi.org/10.17241/smr.2023.01907","url":null,"abstract":"Sleep disordered breathing (SDB) is a common problem in the general population, and its prevalence in the community of middle-aged subjects varies depending on several factors such as age, sex, race, body habitus measures including body mass index, etc [1-6]. Most common treatment of SDB in the world that has been widely used is continuous positive airway pressure (CPAP) through CPAP device, surgery, dental device, and so on [7]. When practicing sleep medicine in clinics, we often find out there are still uncharted areas that are yet to be discovered and need further elucidations. Due to lack of scientific evidences, there might be confusion in making decisions and diagnosing patients with declining compliance of CPAP machine due to older age, individual variation of upper airway anatomy, chronic medical problems in addition to taking medications, and those who experience cumbersome usage of mask on the top of mouth, nose, inside nose like “nasal pillow” type mask, etc. We all have been experiencing the same issue in the clinics without any definite solutions for those issues and reasons why it happens sometimes. And it is demonstrated that patients with moderate-to-severe obstructive sleep apnea syndrome (apnea-hypopnea index > 15 and/or Epworth Sleepiness Scale score > 10) mostly have poor compliance to CPAP device [8]. In our","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Restless Leg Syndrome in Hospitalized Psychiatric Patients in Mashhad","authors":"Mahboubeh Eslamzadeh, Aazam Sadat Heydari Yazdi, Tina Ansari Ram, Maryam Emadzadeh, Azade Heydarzade Mohamadrezakhan","doi":"10.17241/smr.2022.01354","DOIUrl":"https://doi.org/10.17241/smr.2022.01354","url":null,"abstract":"Background and Objective Sleep disorders, especially restless leg syndrome (RLS), have in recent years been recognized as common problems that increase the risk of mental disorders, anxiety, and depression, and lead to decreased quality of life and social isolation. The aim of this cross-sectional study was to evaluate the frequency of RSL in psychiatric patients admitted to Ibn Sina Hospital, Mashhad, Iran during 2020–2021.Methods Eligible individuals were selected using available sampling, and after determining the type of psychiatric disorder, the demographic and medical information of patients were recorded. The RLS assessment questionnaire was used to evaluate the purpose of the study.Results Of the 150 hospitalized patients with psychiatric disorders, 67 (44.7%) were male, and the mean age of the subjects was 34.63 ± 10.80 years. RLS was not observed in 100 patients (66.7%); however, mild RLS was shown in 33 patients (22%), while severe type was shown in 17 patients (11.3%). The prevalence of major depressive disorder and lithium consumption was significantly higher in people with RLS than in those without the syndrome (p = 0.047 and p = 0.012, respectively).Conclusions These results indicate that there is a relationship between the prevalence of RLS and some psychological disorders and medications that are commonly used in this field. Managing the symptoms of this syndrome by better understanding its predisposing factors can lead to better management of patients.","PeriodicalId":37318,"journal":{"name":"Sleep Medicine Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135032322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}