Journal of Clinical Sleep Medicine最新文献

{"title":"Respiratory center function in patients under adaptive servoventilation: etiology and outcome.","authors":"Isabel Martinez-Gonzalez Posada, Ramón Fernández Álvarez, Andres Ortiz Reyes, Marina Acebo Castro, Ines Ruiz Alvarez, Pablo Lozano Cuesta, Claudia Madrid Carvajal, Maria Vazquez López, Marta Garcia Clemente, Gemma Rubinos Cuadrado","doi":"10.5664/jcsm.11764","DOIUrl":"10.5664/jcsm.11764","url":null,"abstract":"<p><strong>Study objectives: </strong>Central sleep apnea (CSA) is a sleep disorder characterized by instability in the respiratory center's function, leading to an excessive ventilatory response. The most effective treatment for these patients is adaptive servoventilation (ASV). We hypothesize that individuals with CSA may exhibit hyperresponsiveness of the respiratory center, and ASV treatment could normalize its function. We aimed to measure the ventilatory response to hypercapnia and its relationship with the outcomes following ASV treatment.</p><p><strong>Methods: </strong>A prospective study with repeated measurements was conducted on patients with CSA treated with ASV. A ventilatory response to a hypercapnia test was performed using p0.1/pEtCO₂ determinations: a first determination at the time of inclusion and a second one after at least 6 months of ASV treatment. We used the Pearson correlation test and the comparison of means (<i>t</i> test) for independent and paired variables for statistical analysis. A p0.1/pEtCO₂ value of 0.43 cmH₂O/mmHg was considered the reference value.</p><p><strong>Results: </strong>We analyzed 46 participants, 82% male. The apnea-hypopnea index was 47 events/h (23), and the central apnea-hypopnea index was 27 events/h (12). The initial p0.1/pEtCO₂ was 0.48 (standard deviation: 0.24) cmH₂O/mmHg, significantly higher than the reference value (<i>P</i> = .02). After ASV treatment, 63% of participants had a normalized p0.1/pEtCO₂, which decreased to 0.37 (standard deviation: 0.23) cmH₂O/mmHg and was significantly lower than the initial value (<i>P</i> = .015) and comparable to the reference value (<i>P</i> = .26). CSA secondary to opioid use had a substantially lower p0.1/pEtCO₂: 0.27 cmH₂O/mmHg (standard deviation: 0.11; <i>P</i> = .021).</p><p><strong>Conclusions: </strong>Ventilatory response to hypercapnia in patients with CSA and ASV treatment could differentiate phenotypes and impact therapeutic decisions.</p><p><strong>Citation: </strong>Posada IM-G, Álvarez RF, Ortiz Reyes A, et al. Respiratory center function in patients under adaptive servoventilation: etiology and outcome. <i>J Clin Sleep Med</i>. 2025;21(9):1539-1545.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1539-1545"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep apnea in individuals with spinal cord injury.","authors":"Abdulghani Sankari, Ahmad Aldwaikat, Moustafa Habra, Anan Salloum, Salam Zeineddine, Nishtha Pandya, Jennifer L Martin, M Safwan Badr","doi":"10.5664/jcsm.11752","DOIUrl":"10.5664/jcsm.11752","url":null,"abstract":"<p><strong>Study objectives: </strong>To determine the rate of sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI) and its types (central sleep apnea and obstructive sleep apnea, and a comorbid central and obstructive sleep apnea and to assess the response to treatment using positive airway pressure (PAP) (defined as an apnea-hypopnea index (AHI) of less than 5 events/h on initial PAP titration) in individuals with SCI.</p><p><strong>Methods: </strong>Individuals with SCI who underwent a full night of diagnostic polysomnography from 2010-2024 to determine the type of SDB and its severity using the AHI and central apnea index. The inclusion criteria were individuals with chronic SCI at low cervical or thoracic (at C4-T6 levels) who are not mechanically ventilated or had tracheostomies. \"Central sleep apnea\" is diagnosed with an AHI of 5+ events/h and a central apnea index of at least 50% of the AHI. \"Obstructive sleep apnea only\" is identified by an AHI of 5+ events/h and a central apnea index of less than 5 events/h. Comorbid central and obstructive sleep apnea is characterized by an AHI of 5+ events/h, with a central apnea index over 5 events/h but under 50% of the total AHI. The positive response to PAP therapy was based on the AHI level of less than 5 events/h after initiating PAP treatment and based on remote monitoring data.</p><p><strong>Results: </strong>Among the 81 individuals who met the inclusion criteria, 12 patients (15%) were diagnosed with comorbid central and obstructive sleep apnea, 4 patients (5%) presented with central sleep apnea only, 56 patients (69%) had obstructive sleep apnea, and 8 patients (10%) exhibited no SDB. In a subset of participants (n = 51) hypopneas were classified as obstructive or central events based on American Academy of Sleep Medicine definition and revealed that approximately one-third (32%) had central or comorbid central and obstructive sleep apnea, 63% had obstructive sleep apnea, and 6% did not have SDB on polysomnography. A total of 35 (47%) individuals diagnosed with SDB underwent PAP titration and were prescribed PAP. Twenty (27%) individuals received PAP treatment, and only 17 (23%) continued their use for the initial 3 months. Only 11 patients (15%) demonstrated responsiveness to PAP on day 90 (AHI < 5 events/h during therapy).</p><p><strong>Conclusions: </strong>SDB is extremely common in individuals with SCI. The efficacy of PAP therapy is suboptimal, and adherence rates decline significantly over time.</p><p><strong>Citation: </strong>Sankari A, Aldwaikat A, Habra M, et al. Sleep apnea in individuals with spinal cord injury. <i>J Clin Sleep Med</i>. 2025;21(9):1529-1537.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1529-1537"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between sleep apnea and dizziness: a scoping review.","authors":"Eunjin Kim, Dahee Wi, Yoonjung Kim, Jiae Lee","doi":"10.5664/jcsm.11710","DOIUrl":"10.5664/jcsm.11710","url":null,"abstract":"<p><strong>Study objectives: </strong>Dizziness in people with sleep apnea remains relatively underrecognized, despite accumulating evidence of this relationship from recent studies. This scoping review aimed to summarize evidence from existing research on the relationship between sleep apnea and dizziness.</p><p><strong>Methods: </strong>We used Arksey and O'Malley's 5-stage framework to structure and guide this scoping review. We searched the Embase, PubMed, CINAHL, and Cochrane Library databases, along with a hand search.</p><p><strong>Results: </strong>A total of 21 studies were finally included in this scoping review. Studies encompassed case reports, cross-sectional studies, retrospective cohort studies, and quasi-experimental studies. This review identified both a higher incidence of dizziness among people with sleep apnea and a greater prevalence of sleep apnea among people with dizziness, compared with their healthy counterparts. Additionally, across the majority of included studies, significant associations were found between the degree of dizziness and sleep apnea or its related parameters. Studies consistently reported that continuous positive airway pressure treatment led to either complete or partial resolution of dizziness in people with sleep apnea.</p><p><strong>Conclusions: </strong>Overall, evidence from existing articles collectively indicates that sleep apnea is related to dizziness. However, many of the included studies were limited by their cross-sectional design and relatively small sample size. Results of this scoping review suggest that it may be beneficial to consider the potential relationship between sleep apnea and dizziness while evaluating patients. Further research is needed to validate a causal effect of sleep apnea on dizziness.</p><p><strong>Citation: </strong>Kim E, Wi D, Kim Y, Lee J. Relationship between sleep apnea and dizziness: a scoping review. <i>J Clin Sleep Med</i>. 2025;21(9):1597-1609.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1597-1609"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-emergent central sleep apnea after initiation of hypoglossal nerve stimulator.","authors":"Jonathan Tam, Farnaz Abbasmoradi, Lourdes M DelRosso","doi":"10.5664/jcsm.11728","DOIUrl":"10.5664/jcsm.11728","url":null,"abstract":"<p><p>Treatment-emergent central sleep apnea occurs when primary obstructive sleep apnea improves with positive airway pressure treatment, but central events emerge or persist. Although documented with positive airway pressure and other treatment modalities, emergence of central sleep apnea has rarely been reported with hypoglossal nerve stimulation. In this case report, we present 2 patients who developed central apnea during hypoglossal nerve stimulator titration with emergence of central events at higher voltages. Central apneas resolved in both patients at follow-up when maintained at stable voltages; however, in 1 patient, central apnea recurred upon trialing higher voltages. These cases demonstrate that treatment-emergent sleep apnea can also be considered as a potential consequence of treatment of obstructive sleep apnea with hypoglossal nerve stimulator.</p><p><strong>Citation: </strong>Tam J, Abbasmoradi F, DelRosso LM. Treatment-emergent central sleep apnea after initiation of hypoglossal nerve stimulator. <i>J Clin Sleep Med.</i> 2025;21(9):1639-1642.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1639-1642"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep quality measured by cardiopulmonary coupling spectrogram in pregnant women predicts neonatal outcomes.","authors":"Yue-Nan Ni, Hugi Hilmisson, Solveig Magnusdottir, Zongan Liang, Ying Chen, Robert Joseph Thomas","doi":"10.5664/jcsm.11768","DOIUrl":"10.5664/jcsm.11768","url":null,"abstract":"<p><strong>Study objectives: </strong>We assessed the impact of objective sleep quality during pregnancy, estimated using cardiopulmonary coupling sleep spectrograms, on neonatal outcomes.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Cardiopulmonary coupling analysis was done using the raw photoplethysmogram signal within the oximetry sensor (photoplethysmogram) from a home apnea sleep test. High- and low-frequency coupling reflect stable and unstable sleep, respectively. A multicomponent Sleep Quality Index integrates sleep stability and fragmentation. Regression analysis was done to identify the relationship between cardiopulmonary coupling metrics and neonatal outcomes.</p><p><strong>Results: </strong>Oximetry/photoplethysmogram data from the early and middle term of pregnancy (3,003 and 2,168 participants in early-term and middle-term pregnancy, respectively) were available. A high Sleep Quality Index score in early-term pregnancy decreased the risk of small gestational age (odds ratio [OR] 0.297, 95% confidence interval [CI] 0.147-0.603, <i>P</i> < .01) and an Apgar score < 7 at 5 minutes (OR 0.368, 95% CI 0.158-0.857, <i>P</i> = .02). A higher Sleep Quality Index score in middle-term pregnancy was associated with an Apgar score < 7 at 1 (OR 0.472, 95% CI 0.275-0.810, <i>P</i> < .01) and 5 minutes (OR 0.274, 95% CI 0.107-0.704, <i>P</i> < .01). An increased high-frequency coupling/low-frequency coupling ratio in early-term pregnancy was a predictor for reduced preterm birth risk (OR 0.955, 95% CI 0.920-0.991, <i>P</i> = .01) and in middle-term pregnancy was related to increased preterm birth (OR 0.828, 95% CI 0.749-0.916, <i>P</i> = .01) and Apgar score < 7 at 5 minutes (OR 0.784, 95% CI 0.659-0.932, <i>P</i> < .01) risks. Increasing percentage of the narrow band of total estimated sleep time across pregnancy, which is a biomarker of sleep fragmentation, added the risk of small gestational age (OR 1.053, 95% CI 1.009-1.099, <i>P</i> < .01).</p><p><strong>Conclusions: </strong>Sleep quality measured by cardiopulmonary coupling spectrograms was associated with neonatal outcomes. Sleep quality may be a target for clinical care during pregnancy.</p><p><strong>Citation: </strong>Ni Y-N, Hilmisson H, Magnusdottir S, Liang Z, Chen Y, Thomas RJ. Sleep quality measured by cardiopulmonary coupling spectrogram in pregnant women predicts neonatal outcomes. <i>J Clin Sleep Med.</i> 2025;21(9):1567-1577.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1567-1577"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actigraphy-derived sleep fragmentation index: convergent validity and associations with clinical outcomes.","authors":"Dana Saleh, Suzanne M Bertisch, Michelle Reid, Andrew Lim, Shaun Purcell, Susan Redline","doi":"10.5664/jcsm.11754","DOIUrl":"10.5664/jcsm.11754","url":null,"abstract":"<p><strong>Study objectives: </strong>Wake after sleep onset and sleep efficiency derived from actigraphy are common assessments of sleep fragmentation (or continuity). The sleep fragmentation index (SFI), measuring the frequency of sleep-wake transitions, is less understood. This study examined (1) the convergent validity between SFI and other sleep metrics obtained by actigraphy and polysomnography; and (2) associations of SFI with sleep symptoms, obstructive sleep apnea, periodic limb movement index, and cognition (Digit Symbol Coding test).</p><p><strong>Methods: </strong>Cross-sectional analysis using logistic and multiple regression analyses adjusted for potential confounders. 1,908 participants in the Multi-Ethnic Study of Atherosclerosis study who underwent 7-day actigraphy and polysomnography. The sample was 53.9% female; age 68.3 ± 9.1 years (mean ± standard deviation); apnea-hypopnea index 19.5 ± 17 events/h; and SFI 20.09 ± 6.99.</p><p><strong>Results: </strong>Higher SFI was associated with older age, male sex, Black race, smoking, body mass index, obstructive sleep apnea, and polysomnography-based metrics of sleep architecture. SFI was strongly correlated with actigraphy-measured sleep efficiency (<i>r</i> = -.75; <i>P</i> < .0001) and wake after sleep onset (<i>r</i> = .63; <i>P</i> < .0001), and modestly correlated with polysomnography-wake after sleep onset, apnea-hypopnea index, and arousal index (<i>r</i>s = 0.23-0.27; <i>P</i>s < .0001). In adjusted analyses, each standard deviation unit increase in SFI was associated with 1.1-1.4 higher odds of insomnia symptoms, sleepiness, obstructive sleep apnea, an elevated periodic limb movement index, and with lower Digit Symbol Coding test scores (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>The results support the convergent validity between actigraphy-estimated SFI and actigraphy-wake after sleep onset and sleep efficiency. SFI showed modestly stronger associations with clinical symptoms compared to other fragmentation variables, supporting its utility as a marker of sleep continuity.</p><p><strong>Citation: </strong>Saleh D, Bertisch SM, Reid M, Lim A, Purcell S, Redline S. Actigraphy-derived sleep fragmentation index: convergent validity and associations with clinical outcomes. <i>J Clin Sleep Med</i>. 2025;21(9):1557-1565.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1557-1565"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atomoxetine plus oxybutynin for symptomatic snoring and airflow limitation in individuals without moderate-to-severe obstructive sleep apnea.","authors":"Nicole Calianese, Lauren B Hess, Daniel Vena, Robert Konefal, Dwayne L Mann, Luigi Taranto-Montemurro, Suzanne M Bertisch, Tamar Sofer, Ali Azarbarzin, Laura K Gell, Scott A Sands","doi":"10.5664/jcsm.11760","DOIUrl":"10.5664/jcsm.11760","url":null,"abstract":"<p><strong>Study objectives: </strong>Sleep-disordered breathing is incompletely characterized by the apnea-hypopnea index. Although typically viewed as milder disease, snoring and flow limitation can yield major deficits in sleep health for both patients and their bed partners. Here we tested whether a combined noradrenergic and antimuscarinic intervention to activate pharyngeal muscles yields improved snoring loudness and flow limitation severity, plus self-reported outcomes, by snorers and their bed partners.</p><p><strong>Methods: </strong>In a randomized placebo-controlled double-blind crossover study, adults with loud habitual snoring took atomoxetine plus oxybutynin for 10 days before bedtime at full adult doses (80 and 5 mg, respectively; half-dose run-in on days 1-3) and at half-doses (40 and 2.5 mg, respectively). Baseline polysomnography with tracheal sound recording established baseline snoring (mean loudness > 75 dB) and an apnea-hypopnea index of < 15 events/h. Mixed models compared full and half-doses to placebo in snoring loudness, flow limitation, and snoring self-evaluation and bed-partner evaluation scores, adjusting for baseline and period effects (intention-to-treat analysis).</p><p><strong>Results: </strong>Fifteen participants were randomly assigned and 13 completed all treatment periods. Snoring loudness was reduced with full dose (-9.3 [-19.6, -2.9] dB; difference [95% confidence interval]) and half-dose (-9.0 [-17.8, -3.2] dB) vs placebo (102.2 dB), equivalent to a two-thirds reduction in snoring amplitude. Flow-limitation severity was also meaningfully reduced (both doses). The Snoring Bed-Partner Evaluation Scale was reduced with the half-dose only (-2.8 [-5.3, -0.4] points from 10.1 on placebo). Self<i>-</i>evaluation scores were lowered exclusively in 7 of the 15 participants with bothersome snoring at baseline (treatment × subgroup interactions).</p><p><strong>Conclusions: </strong>In patients with habitual snoring, atomoxetine plus oxybutynin at half- and full doses improves snoring and flow limitation. A half-dose may also improve bed-partner outcomes.</p><p><strong>Clinical trial registration: </strong>Registry: ClinicalTrials.gov; Name: Pharmacological Intervention for Symptomatic Snoring; URL: https://clinicaltrials.gov/study/NCT03720353; Identifier: NCT03720353.</p><p><strong>Citation: </strong>Calianese N, Hess LB, Vena D, et al. Atomoxetine plus oxybutynin for symptomatic snoring and airflow limitation in individuals without moderate-to-severe obstructive sleep apnea. <i>J Clin Sleep Med.</i> 2025;21(9):1579-1590.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1579-1590"},"PeriodicalIF":2.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autonomic responses to respiratory events and risk of chronic kidney disease in obstructive sleep apnea.","authors":"Mohammadreza Hajipour, Andrew E Beaudin, Joshua B Hicks, Ali Abdul Ghafoor, Jill K Raneri, Aj Hirsch Allen, Zahra Izadi, Rachel Jen, Tetyana Kendzerska, Fréderic Series, Robert P Skomro, Rebecca Robillard, R John Kimoff, Sidney Fels, Amrit Singh, Sofia B Ahmed, Ali Azarbarzin, Najib T Ayas, Patrick J Hanly","doi":"10.5664/jcsm.11852","DOIUrl":"https://doi.org/10.5664/jcsm.11852","url":null,"abstract":"<p><strong>Study objectives: </strong>Obstructive sleep apnea (OSA)-related hypoxemia, measured by hypoxic burden (HB), is associated with chronic kidney disease (CKD). OSA-related autonomic response may also be associated with CKD. This study examined whether individuals with high HB and varying autonomic responses to OSA have a different risk of CKD progression compared to those with low HB.</p><p><strong>Methods: </strong>Polysomnography data from the multi-centre Canadian Sleep and Circadian Network cohort were analyzed. HB was defined as the area under event-related oxygen desaturation curves during sleep. Autonomic responses were assessed using \"vasoconstriction burden\" (VCB: area under photoplethysmography declines, reflecting vascular reactivity) and heart rate response to events (ΔHR, reflecting cardiac autonomic response). Estimated glomerular filtration rate and urine albumin:creatinine ratio were used to identify participants at risk of CKD progression. This risk was compared across individuals with high HB(≥median) and varying levels of autonomic responses relative to those with low HB.</p><p><strong>Results: </strong>Data from 421 participants were analyzed. The odds of CKD progression was higher in those with high vs low HB. Compared to the low HB group, individuals with high HB and low VCB (lowest quartile) were at increased risk of CKD progression (odds ratio [95% CI] = 2.49 [1.23,5.05]), whereas the risk was not significantly elevated in those with the high VCB (highest quartile). In contrast, within high HB, both high (highest quartile) and low ΔHR (lowest quartile) groups were at increased risk of CKD progression compared to those with low HB.</p><p><strong>Conclusions: </strong>Autonomic response to respiratory events improves risk stratification for CKD progression in OSA. VCB and ΔHR show distinct associations with this risk.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.","authors":"Dennis H Auckley, Reena Mehra, Karin G Johnson, Martha E Billings, Gerard Carandang, Yngve Falck-Ytter, Rami N Khayat, Reem A Mustafa, Cinthya Pena-Orbea, Ashima S Sahni, Susheel P Patil, Sunil Sharma","doi":"10.5664/jcsm.11866","DOIUrl":"https://doi.org/10.5664/jcsm.11866","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on management of obstructive sleep apnea in medically hospitalized adults.</p><p><strong>Methods: </strong>The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials and observational studies that addressed interventions for the management of obstructive sleep apnea in medically hospitalized adults. Statistical analyses were performed to determine the clinical meaningfulness of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations.</p><p><strong>Results: </strong>The literature search resulted in 5,159 studies out of which 27 studies provided data suitable for statistical analyses. The task force provided a detailed summary of the evidence along with the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an American Academy of Sleep Medicine clinical practice guideline.","authors":"Reena Mehra, Dennis H Auckley, Karin G Johnson, Martha E Billings, Gerard Carandang, Yngve Falck-Ytter, Rami N Khayat, Reem A Mustafa, Cinthya Pena-Orbea, Ashima S Sahni, Sunil Sharma, Susheel P Patil","doi":"10.5664/jcsm.11864","DOIUrl":"https://doi.org/10.5664/jcsm.11864","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The purpose of this guideline is to establish clinical practice recommendations for the management of obstructive sleep apnea (OSA) in medically hospitalized adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. The task force provided a summary of the relevant literature and the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Good practice statement: &lt;/strong&gt;The following good practice statement is based on expert consensus, and its implementation is necessary for the appropriate and effective management of hospitalized adults with sleep-disordered breathing: For medically hospitalized adults with an established diagnosis of sleep-disordered breathing and on active treatment, existing treatment should be continued rather than withheld, unless contraindicated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations: &lt;/strong&gt;The following recommendations are intended as a guide for clinicians in managing medically hospitalized adults with OSA. Each recommendations statement is assigned a strength (\"Strong\" or \"Conditional\"). A \"Strong\" recommendation (i.e., \"We recommend…\") is one that clinicians should follow under most circumstances. A \"conditional\" recommendation (i.e., \"We suggest…\") is one that requires that the clinician use clinical knowledge and experience and strongly consider the patient's values and preferences to determine the best course of action.&lt;/p&gt;&lt;p&gt;&lt;p&gt;1. For medically hospitalized adults at increased risk for OSA, the AASM suggests in-hospital screening for OSA as part of an evaluation and management pathway that incorporates diagnosis and treatment with positive airway pressure rather than no in-hospital screening. (Conditional recommendation, low certainty of evidence).&lt;/p&gt;&lt;p&gt;&lt;p&gt;\u0000 &lt;i&gt;Remarks: Screening may include validated questionnaires and/or screening with overnight high-resolution pulse oximetry (HRPO). When considering in-hospital screening as part of a management pathway, 1) patients who place a lower value on the potential reduction of clinically meaningful outcomes (e.g., cardiovascular events) and place a higher value on the possible downsides associated with the use of positive airway pressure (PAP) (e.g., sleep disruption, discomfort), or 2) clinicians who perceive that the diagnosis or management of OSA may interfere with medical care, would reasonably decline OSA screening or PAP during the hospitalization. High risk for OSA is defined by signs and symptoms that suggest moderate to severe OSA (e.g., excessive dayt","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}