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Schramm P, Das N, Schneiderman E, German Z, Hui J, Wilson D, Spence JS, Moura P, Chapman SB. Snoring Remediation with Oral Appliance Therapy Potentially Reverses Cognitive Impairment: An Intervention Controlled Pilot Study. Geriatrics (Basel) 2021; 6:geriatrics6040107. [PMID: 34842718 PMCID: PMC8628661 DOI: 10.3390/geriatrics6040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Respiration rate (RR) dynamics entrains brain neural networks. RR differences between mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in response to oral appliance therapy (OAT) are unknown. This pilot study investigated if RR during stable sleep shows a relationship to pathological severity in subjects with MCI and AD who snore and if RR is influenced following stabilization of the upper airway using OAT. The study cohort was as follows: cognitively normal (CN; n = 14), MCI (n = 14) and AD (n = 9); and a sub-population receiving intervention, CN (n = 5), MCI (n = 7), AD (n = 6) subjects. The intervention used was an oral appliance plus a mouth shield (Tx). RR maximum (max) rate (breaths/minute) and RR fluctuation during 2116 stable sleep periods were measured. The Montreal cognitive assessment (MoCA) was administered before and after 4 weeks with Tx. Baseline data showed significantly higher RR fluctuation in CN vs. AD (p < 0.001) but not between CN vs. MCI (p = 0.668). Linear mixed model analysis indicated Tx effect (p = 0.008) for RR max. Tx after 4 weeks lowered the RR-max in MCI (p = 0.022) and AD (p < 0.001). Compared with AD RR max, CN (p < 0.001) and MCI (p < 0.001) were higher with Tx after 4 weeks. Some MCI and AD subjects improved executive and memory function after 4 weeks of Tx.
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Affiliation(s)
- Preetam Schramm
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
- Correspondence:
| | - Namrata Das
- Center for BrainHealth, University of Texas at Dallas, Dallas, TX 75235, USA; (N.D.); (J.S.S.); (S.B.C.)
- McLean Hospital, Harvard Medical School Affiliate, 115 Mill St, Belmont, MA 02478, USA
| | - Emet Schneiderman
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
| | - Zohre German
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
| | - Jason Hui
- Department of Comprehensive Dentistry, Texas A&M University College of Dentistry, Dallas, TX 75246, USA;
| | - Duane Wilson
- College of Dental Medicine, University of New England, Portland, ME 04103, USA;
| | - Jeffrey S. Spence
- Center for BrainHealth, University of Texas at Dallas, Dallas, TX 75235, USA; (N.D.); (J.S.S.); (S.B.C.)
| | - Pollyana Moura
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; (E.S.); (Z.G.); (P.M.)
| | - Sandra B. Chapman
- Center for BrainHealth, University of Texas at Dallas, Dallas, TX 75235, USA; (N.D.); (J.S.S.); (S.B.C.)
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Mishra P, Jaseja H, Goyal M. A critical analysis of the purported role of hypoxaemia in the comorbidity of obstructive sleep apnoea and epilepsy. Clin Physiol Funct Imaging 2021; 41:4-9. [PMID: 33068455 DOI: 10.1111/cpf.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023]
Abstract
Obstructive sleep apnoea (OSA) is a globally prevalent sleep disorder of significant health concern and confounded with several comorbidities resulting in adverse effect(s) on quality of life in patients afflicted with it. Of particular interest is the enigmatic high comorbidity of OSA with epilepsy, the exact underlying pathophysiology of which remains elusive despite a multitude of research performed in the last four decades. Hypoxaemia, which is an important characteristic feature found in OSA during apnoeic spells, has been implicated in the high comorbidity of OSA with epilepsy, the basis of which rests upon hypoxaemia-mediated brain damage, subcortical release phenomenon, oxidative stress and neuroinflammatory reactions. However, several studies present contradictory evidences that potentially refute the hypoxaemia-based mechanism. Additionally, the role of hypercapnia thatgenerally accompanies hypoxaemia during apnoeic spells, cannot be overlooked and is known to be potentially protective against neuronal hyperexcitability. Thus, hypoxaemia theory implicated in the high comorbidity of OSA and epilepsy appears weak and refutable. This brief paper studies and critically analyses the role of hypoxaemia in conjunction with hypercapnia in the underlying pathophysiology of the comorbidity.
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Affiliation(s)
- Priyadarshini Mishra
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Manish Goyal
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Ahmadzadeh S, Luo J, Wiffen R. Review on Biomedical Sensors, Technologies and Algorithms for Diagnosis of Sleep Disordered Breathing: Comprehensive Survey. IEEE Rev Biomed Eng 2020; 15:4-22. [PMID: 33104514 DOI: 10.1109/rbme.2020.3033930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper provides a comprehensive review of available technologies for measurements of vital physiology related parameters that cause sleep disordered breathing (SDB). SDB is a chronic disease that may lead to several health problems and increase the risk of high blood pressure and even heart attack. Therefore, the diagnosis of SDB at an early stage is very important. The essential primary step before diagnosis is measurement. Vital health parameters related to SBD might be measured through invasive or non-invasive methods. Nowadays, with respect to increase in aging population, improvement in home health management systems is needed more than even a decade ago. Moreover, traditional health parameter measurement techniques such as polysomnography are not comfortable and introduce additional costs to the consumers. Therefore, in modern advanced self-health management devices, electronics and communication science are combined to provide appliances that can be used for SDB diagnosis, by monitoring a patient's physiological parameters with more comfort and accuracy. Additionally, development in machine learning algorithms provides accurate methods of analysing measured signals. This paper provides a comprehensive review of measurement approaches, data transmission, and communication networks, alongside machine learning algorithms for sleep stage classification, to diagnose SDB.
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D'Souza B, Norman M, Sullivan CE, Waters KA. TcCO 2 changes correlate with partial obstruction in children suspected of sleep disordered breathing. Pediatr Pulmonol 2020; 55:2773-2781. [PMID: 32687262 DOI: 10.1002/ppul.24966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Pediatric sleep disordered breathing (SDB) is characterized by long periods of partial upper airway obstruction (UAO) with low apnea-hypopnea indices (AHI). By measuring snoring and stertor, Sonomat studies allow quantification of these periods of partial UAO. AIM To determine whether transcutaneous CO2 (TcCO2 ) levels correlate with increasing levels of partial UAO and to examine patterns of ΔTcCo2 in the transitions from (a) wakefulness to sleep and (b) non-rapid eye movement (NREM) to rapid eye movement (REM) sleep. METHODS This was a retrospective review of sleep studies in seven asymptomatic controls aged 7 to 12 years and 62 symptomatic children with suspected SDB and no comorbidities, aged 2 to 13 years. Both groups underwent overnight polysomnography, including continuous TcCO2 , at one of two pediatric hospitals in Sydney. Changes in carbon dioxide levels between wake to NREM (sleep onset) and NREM to REM sleep were evaluated using an all-night TcCO2 trace time-linked to a hypnogram. Paired Sonomat recordings were used to quantify periods of UAO in the symptomatic group. RESULTS The ΔTcCO2 at sleep onset was greater in SDB children than controls and ΔTcCO2 with sleep onset correlated with the duration of partial obstruction (r = .60; P < .0001). Children with an increase in TcCO2 from NREM to REM had a higher number of snoring and stertor events compared to those in whom TcCO2 decreased from NREM to REM (91 vs 30 events/h; P = < .0001). CONCLUSIONS In children without comorbidities, the measurement of TcCO2 during sleep correlates with indicators of partial obstruction.
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Affiliation(s)
- Bebe D'Souza
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Norman
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Colin E Sullivan
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen A Waters
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
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Perez de Vargas Sansalvador IM, Lopez Ruiz N, Erenas M, Capitan Vallvey LF, Coleman S, Diamond D, Fernandez Ramos MD. Towards an autonomous microfluidic sensor for dissolved carbon dioxide determination. Microchem J 2018. [DOI: 10.1016/j.microc.2018.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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An Official American Thoracic Society Workshop Report: Noninvasive Identification of Inspiratory Flow Limitation in Sleep Studies. Ann Am Thorac Soc 2018; 14:1076-1085. [PMID: 28665698 DOI: 10.1513/annalsats.201704-318ws] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This report summarizes the proceedings of the American Thoracic Society Workshop on the Noninvasive Identification of Inspiratory Flow Limitation in Sleep Studies held on May 16, 2015, in Denver, Colorado. The goal of the workshop was to discuss methods for standardizing the scoring of flow limitation from nasal cannula pressure tracings. The workshop began with presentations on the physiology underlying flow limitation, existing methods of scoring flow limitation, the effects of signal acquisition and filtering on flow shapes, and a review of the literature examining the adverse outcomes related to flow limitation. After these presentations, the results from online scoring exercises, which were crowdsourced to workshop participants in advance of the workshop, were reviewed and discussed. Break-out sessions were then held to discuss potential algorithms for scoring flow limitation. Based on these discussions, subsequent online scoring exercises, and webinars after the workshop, a consensus-based set of recommendations for a scoring algorithm for flow limitation was developed. Key conclusions from the workshop were: (1) a standardized and automated approach to scoring flow limitation is needed to provide a metric of nonepisodic elevated upper airway resistance, which can then be related to clinical outcomes in large cohorts and patient groups; (2) at this time, the most feasible method for standardization is by proposing a consensus-based framework, which includes scoring rules, developed by experts (3) hardware and software settings of acquisition devices, including filter settings, affect the shape of the flow curve, and should be clearly specified; and (4) a priority for future research is the generation of an open-source, expert-derived training set to encourage and support validation of automated flow limitation scoring algorithms.
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Mateika JH, Panza G, Alex R, El-Chami M. The impact of intermittent or sustained carbon dioxide on intermittent hypoxia initiated respiratory plasticity. What is the effect of these combined stimuli on apnea severity? Respir Physiol Neurobiol 2017; 256:58-66. [PMID: 29097171 DOI: 10.1016/j.resp.2017.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 11/28/2022]
Abstract
The following review explores the effect that intermittent or sustained hypercapnia coupled to intermittent hypoxia has on respiratory plasticity. The review explores published work which suggests that intermittent hypercapnia leads to long-term depression of respiration when administered in isolation and prevents the initiation of long-term facilitation when administered in combination with intermittent hypoxia. The review also explores the impact that sustained hypercapnia alone and in combination with intermittent hypoxia has on the magnitude of long-term facilitation. After exploring the outcomes linked to intermittent hypoxia/hypercapnia and intermittent hypoxia/sustained hypercapnia the translational relevance of the outcomes as it relates to breathing stability during sleep is addressed. The likelihood that naturally induced cycles of intermittent hypoxia, coupled to oscillations in carbon dioxide that range between hypocapnia and hypercapnia, do not initiate long-term facilitation is addressed. Moreover, the conditions under which intermittent hypoxia/sustained hypercapnia could serve to improve breathing stability and mitigate co-morbidities associated with sleep apnea are considered.
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Affiliation(s)
- Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, United States.
| | - Gino Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, United States
| | - Raichel Alex
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, United States
| | - Mohamad El-Chami
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, 48201, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, United States
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Rimpilä V, Jernman R, Lassila K, Uotila J, Huhtala H, Mäenpää J, Polo O. Upper-airway flow limitation and transcutaneous carbon dioxide during sleep in normal pregnancy. Sleep Med 2017; 36:67-74. [DOI: 10.1016/j.sleep.2017.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 12/31/2022]
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Thom SR, Bhopale VM, Hu J, Yang M. Inflammatory responses to acute elevations of carbon dioxide in mice. J Appl Physiol (1985) 2017; 123:297-302. [PMID: 28495847 DOI: 10.1152/japplphysiol.00343.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/05/2017] [Accepted: 05/05/2017] [Indexed: 01/12/2023] Open
Abstract
Health risks are described from elevated indoor air carbon dioxide (CO2), which often ranges from 1,000 to 4,000 ppm, but the mechanisms are unknown. Here, we demonstrate that mice exposed for 2 h to 2,000 or 4,000 ppm CO2 exhibit, respectively, 3.4 ± 0.9-fold (SE, n = 6) and 4.1 ± 0.7-fold (n = 10) elevations in circulating microparticles (MPs); neutrophil and platelet activation, and vascular leak in brain, muscle, and distal colon. Interleukin (IL)-1β content of MPs also increases after 2,000 ppm by 3.8 ± 0.6-fold (n = 6) and after 4,000 ppm CO2 by 9.3 ± 1.1-fold (n = 10) greater than control. CO2-induced vascular damage is abrogated by treating mice with an antibody to IL-1β or an IL-1β receptor inhibitor. Injecting naïve mice with CO2-induced MPs expressing a protein found on mature neutrophils recapitulates vascular damage as seen with elevated CO2, and destruction of MPs in CO2-exposed mice abrogates vascular injuries without altering neutrophil or platelet activation. We conclude that environmentally relevant elevations of CO2 trigger neutrophils to generate MPs containing high concentrations of IL-1β that cause diffuse inflammatory vascular injury.NEW & NOTEWORTHY Elevated levels of CO2 are often found in indoor air and cause adverse health effects, but the mechanisms have not been identified. In a murine model, environmentally relevant levels of CO2 were found to cause diffuse vascular damage because neutrophils are stimulated to produce microparticles that contain high concentrations of interleukin-1β.
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Affiliation(s)
- Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Veena M Bhopale
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - JingPing Hu
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ming Yang
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Anttalainen U, Tenhunen M, Rimpilä V, Polo O, Rauhala E, Himanen SL, Saaresranta T. Prolonged partial upper airway obstruction during sleep - an underdiagnosed phenotype of sleep-disordered breathing. Eur Clin Respir J 2016; 3:31806. [PMID: 27608271 PMCID: PMC5015642 DOI: 10.3402/ecrj.v3.31806] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/10/2016] [Indexed: 12/31/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea-hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment.
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Affiliation(s)
- Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland;
| | - Mirja Tenhunen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- Department of Medical Physics, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Ville Rimpilä
- School of Medicine, University of Tampere, Tampere, Finland
| | - Olli Polo
- Unesta Research Center, Tampere, Finland
- Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland
| | - Esa Rauhala
- Department of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
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Wang D, Thomas RJ, Yee BJ, Grunstein RR. Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J Appl Physiol (1985) 2016; 120:1484. [DOI: 10.1152/japplphysiol.01008.2015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- David Wang
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
- NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia; and
| | - Robert J. Thomas
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brendon J. Yee
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
- NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia; and
| | - Ronald R. Grunstein
- Sleep & Circadian Group, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
- NHMRC Centre of Research Excellence in Sleep Medicine-NeuroSleep, Woolcock Institute of Medical Research, The University of Sydney, Australia
- Central Clinical School, The University of Sydney, Sydney, Australia; and
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