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Foresi A, Vitale T, Prestigiacomo R, Ranieri P, Bosi M. Accuracy of positive airway pressure titration through telemonitoring of auto-adjusting positive airway pressure device connected to a pulse oximetry in patients with obstructive sleep apnea. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:740-747. [PMID: 37385297 PMCID: PMC10435960 DOI: 10.1111/crj.13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE In COVID-19 era, all forms of access of patients to the sleep units should be reduced as much as possible when implementing telemedicine. In the field of obstructive sleep apnea (OSA) therapy with positive airway pressure (PAP) devices, telemedicine includes the use of built-in software (BIS) and storage of PAPs and remote-controlled data (BISrc data) that are processed and transmitted daily to sleep units. We compared two methods of evaluating the final residual severity of OSA patients in home PAP titration: BISrc data versus nocturnal portable multichannel monitoring (PM) data in PAP (reference method) and to verify whether the efficacy PAP therapy guided by BISrc data was clinically adequate. METHODS We conducted a real-life prospective study in newly diagnosed patients with OSA. Patients used an auto-adjusting positive airway pressure (AirSense 10 ResMed) with a pulse oximeter that allows daily transfer of BISrc data (apnea hypopnea index [AHI] and SaO2 ) and remote changes in ventilator setting. Once the PAP titration was completed, the pressure value or ranges were kept constant for 3 days and home PM was repeated. RESULTS There were 41 patients with moderate to severe OSA who completed the study. When considering AHI only, the diagnostic accuracy of BISrc on the third day was equal to 97.5%; when considering AHI > 10/h, ODI > 10/h, and SaO2 < 90%, the diagnostic accuracy slightly decreased to 90.2%. CONCLUSION In clinical practice, the two measurement methods are equivalent. The use of BISrc data for home titration would reduce the access to sleep units. We urge that widespread use of BISrc be promoted in the current practice of management of OSA.
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Affiliation(s)
- Antonio Foresi
- Lung Function and Sleep UnitASST Nord‐Milano, Sesto San Giovanni HospitalMilanItaly
| | - Tommaso Vitale
- Lung Function and Sleep UnitASST Nord‐Milano, Sesto San Giovanni HospitalMilanItaly
| | | | - Piera Ranieri
- Department of Medicine and RehabilitationIstituto Clinico Sant'AnnaBresciaItaly
| | - Marcello Bosi
- Sleep UnitVilla Igea, Ospedali Privati ForlìForlìItaly
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Chen PY, Viet-Nhi NK, Chen YC, Kao YL, Dang LH, Hung SH. Factors Associated with the Underestimation of Manual CPAP Titration Pressure. Healthcare (Basel) 2023; 11:healthcare11101436. [PMID: 37239722 DOI: 10.3390/healthcare11101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
During the SARS-CoV-2 pandemic, the use of in-laboratory positive airway pressure (PAP) titration studies was not routinely suggested. PAP pressure prediction calculations are emerging as alternative methods for the treatment of these patients. The underestimation of PAP titration pressure usually leads to unsatisfactory results for PAP therapy. This study aimed to evaluate the factors associated with the underestimation of PAP titration pressure when using PAP pressure prediction equations. Estimated PAP pressure formulas based on body mass index (BMI) and apnea-hypopnea index (AHI) were chosen to validate the accuracy of equations in the successful prediction of titration pressure. Among 341 adult patients diagnosed with obstructive sleep apnea (OSA) by overnight polysomnography (PSG) and who received overnight PAP titration in order to select a successful pressure, the mean age of the total subjects was 55.4 years old and 78.9% of patients were male. The average BMI and AHI scores were 27.1 ± 4.8 and 37 ± 21.7, respectively. After multivariate stepwise regression analysis, the odds ratio of participants with a pretitration AHI was 1.017 (95% CI: 1.005-1.030). Only the severity of OSA was significantly different between the underestimated group and the adequately assessed group. In conclusion, a high AHI, but not BMI, is associated with an underestimated CPAP titration pressure in adult patients with OSA.
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Affiliation(s)
- Po-Yueh Chen
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Nguyen-Kieu Viet-Nhi
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yen-Chun Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yi-Lin Kao
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Luong Huu Dang
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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Kwon M, Oh J. Factors Affecting Sleep Quality of College Students during the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020416. [PMID: 36837616 PMCID: PMC9958765 DOI: 10.3390/medicina59020416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
Background and Objectives: The purpose of this study was to identify the correlation between college students' fear of coronavirus disease 2019 (COVID-19), intolerance of uncertainty, and sleep quality during the COVID-19 pandemic, and to identify factors affecting sleep quality. Materials and Methods: Data were collected through an online survey of 310 college students from three universities located in three regions in Korea. Results: The average sleep quality score of college students was 4.76 ± 2.86 points, the average fear of COVID-19 was 14.01 ± 5.05 points, and the average intolerance of uncertainty was 31.50 ± 7.92 points. Fear of COVID-19 and intolerance of uncertainty were positively correlated (r = 0.302, p < 0.001). Sleep quality was positively correlated with fear of COVID-19 (r = 0.246, p < 0.001). Sleep quality was positively correlated with intolerance of uncertainty (r = 0.212, p < 0.001). Health status was the most powerful factor that affected sleep quality (β = 0.377, p < 0.001). The next most powerful factors that affected sleep quality were fear of COVID-19 (β = 0.164, p = 0.003) and intolerance of uncertainty (β = 0.122, p = 0.027), respectively. Conclusions: These results are expected to be used as basic data for the development of health intervention programs to protect and improve the psychological well-being of college students by improving their sleep quality.
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Affiliation(s)
- Mihyoung Kwon
- Department of Nursing, College of Life and Health, Pai Chai University, Daejeon 35345, Republic of Korea
| | - Jihyun Oh
- Department of Nursing, College of Nursing and Health, Kongju National University, Kongju 32588, Republic of Korea
- Correspondence: ; Tel.: +82-41-850-0301; Fax: +82-41-850-0315
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Correa-Naranjo MI, Camargo-Camargo L, Acosta-Camargo L, Ramos-Clason EC, López-Velásquez N. MoCA-T como herramienta de evaluación remota para precisar deterioro cognitivo en pacientes con SAHOS moderado a severo. NEUROLOGÍA ARGENTINA 2023. [PMCID: PMC9930070 DOI: 10.1016/j.neuarg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
La pandemia de COVID-19 ha dado lugar al surgimiento de herramientas tecnológicas que permiten la valoración de pacientes de forma remota. La prueba de evaluación cognitiva de Montreal, versión telefónica (MoCA-T), es una de ellas. Se considera como un recurso de la telemedicina que permite la tamización cognitiva a distancia en épocas de pandemia y en la población con dificultades en el acceso a los centros de salud. El deterioro cognitivo leve (DCL) es un hallazgo usual en pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS); sin embargo, no se ha estudiado la aplicación de pruebas telefónicas para su tamización cognitiva. El objetivo principal de este trabajo es determinar la frecuencia de deterioro cognoscitivo mediante la aplicación de MoCA-T como prueba de tamización remota en pacientes con SAHOS moderado y severo. Para ello, se aplicó la prueba de MoCA-T en 104 pacientes entre 18 y 65 años con diagnóstico polisomnográfico de SAHOS moderado y severo, excluyéndose a pacientes con comorbilidades que afectasen las capacidades cognoscitivas. Se obtuvieron resultados anormales de MoCA-T en el 43% de los pacientes, siendo los dominios cognitivos de la memoria y la atención los más comúnmente afectados. Finalmente, los resultados anormales de MoCA-T se correlacionaron con la autopercepción de las dificultades en la memoria, estando más frecuentemente alterada en quienes manifestaron quejas cognitivas. La prueba MoCA-T podría ser una herramienta tecnológica breve, validada y factible para realizar el tamizaje cognitivo de pacientes con SAHOS en épocas de pandemia y en pacientes con barreras asistenciales.
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Affiliation(s)
- Maria Isabel Correa-Naranjo
- Médico. Residente IV año Neurología Clínica, Programa de Neurología, Universidad del Sinú EBZ, Seccional Cartagena, Colombia,Autor para correspondencia
| | - Loida Camargo-Camargo
- Médico. Esp. Neurología. Docente programa de Neurología Clínica, Universidad del Sinú EBZ, Seccional Cartagena, Colombia
| | - Laura Acosta-Camargo
- Médico. Esp. Neurología. Docente programa de Neurología Clínica, Universidad del Sinú EBZ, Seccional Cartagena, Colombia
| | - Enrique Carlos Ramos-Clason
- Médico. M. Sc. Salud Pública. Coordinador de investigaciones posgrados médico quirúrgicos, Universidad del Sinú EBZ, Seccional Cartagena, Colombia
| | - Norman López-Velásquez
- Neuropsicólogo, Doctor en Neurociencia Cognitiva, Docente programa de Psicología, Universidad de la Costa, Barranquilla, Colombia
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Prasad S, Arunachalam S, Boillat T, Ghoneima A, Gandedkar N, Diar-Bakirly S. Wearable Orofacial Technology and Orthodontics. Dent J (Basel) 2023; 11:24. [PMID: 36661561 PMCID: PMC9858298 DOI: 10.3390/dj11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.
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Affiliation(s)
- Sabarinath Prasad
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Sivakumar Arunachalam
- Orthodontics and Dentofacial Orthopedics, School of Dentistry, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Thomas Boillat
- Design Lab, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Ahmed Ghoneima
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
| | - Narayan Gandedkar
- Discipline of Orthodontics & Paediatric Dentistry, School of Dentistry, University of Sydney, Sydney, NSW 2006, Australia
| | - Samira Diar-Bakirly
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 50505, United Arab Emirates
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Sico JJ, Koo BB, Perkins AJ, Burrone L, Sexson A, Myers LJ, Taylor S, Yarbrough WC, Daggy JK, Miech EJ, Bravata DM. Impact of the coronavirus disease-2019 pandemic on Veterans Health Administration Sleep Services. SAGE Open Med 2023; 11:20503121231169388. [PMID: 37152838 PMCID: PMC10158800 DOI: 10.1177/20503121231169388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives To understand the impact of the coronavirus disease-2019 pandemic on sleep services within the United States Department of Veterans Affairs using separate surveys from "pre-COVID" and pandemic periods. Methods Data from a pre-pandemic survey (September to November 2019) were combined with data from a pandemic-period survey (August to November 2020) to Veterans Affairs sleep medicine providers about their local sleep services within 140 Veterans Affairs facilities). Results A total of 67 (47.9%) facilities responded to the pandemic online survey. In-lab diagnostic and titration sleep studies were stopped at 91.1% of facilities during the pandemic; 76.5% of facilities resumed diagnostic studies and 60.8% resumed titration studies by the time of the second survey. Half of the facilities suspended home sleep testing; all facilities resumed these services. In-person positive airway pressure clinics were stopped at 76.3% of facilities; 46.7% resumed these clinics. Video telehealth was either available or in development at 86.6% of facilities and was considered a lasting addition to sleep services. Coronavirus disease-2019 transmission precautions occurred at high rates. Sleep personnel experienced high levels of stress, anxiety, fear, and burnout because of the pandemic and in response to unexpected changes in sleep medicine care delivery. Conclusions Sleep medicine services within the Veterans Affairs evolved during the pandemic with many key services being interrupted, including in-lab studies and in-person positive airway pressure clinics. Expansion and initiation of telehealth sleep services occurred commonly. The pandemic adversely affected sleep medicine personnel as they sought to maintain access to care.
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Affiliation(s)
- Jason J Sico
- Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Jason J Sico, VA Connecticut Healthcare System, Mailing Code 689GF, VA Annex, 200 Edison Road, Orange, CT, 06477, USA.
| | - Brian B Koo
- Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA
- Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Anthony J Perkins
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Laura Burrone
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ali Sexson
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Laura J Myers
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Stanley Taylor
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - W Claibe Yarbrough
- Medicine Service, VA North Texas Healthcare System, Dallas, TX, USA
- Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine & Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Edward J Miech
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
| | - Dawn M Bravata
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Sleep testing during the pandemic. Sleep Med 2023; 101:375-383. [PMID: 36495759 PMCID: PMC9678386 DOI: 10.1016/j.sleep.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the U.S. healthcare system, reducing the capacity available for unrelated conditions, such as sleep disordered breathing, and increasing concerns about the safety of in-lab testing. This study characterizes how the pandemic impacted the assessment of sleep disordered breathing and use of associated services. METHODS Sleep testing claims occurring between January 2019 and June 2021 were extracted from the database of a national healthcare organization. Utilization was trended. Logistic regressions were run to assess the association between quarter of initial testing, whether testing was followed by treatment, and whether testing was followed by a clinical visit with a diagnosis related to sleep apnea, after controlling for patient-related factors. A Cox proportional hazards model assessed factors influencing time to treatment. Finally, a logistic regression assessed factors influencing the finality of home-based testing. RESULTS In Q2 2021, home-based testing utilization was 134% of its initial level, while in-lab and split night testing were both at 61% of initial levels. Patients receiving initial home-based testing did not significantly differ in their likelihood of treatment, but were significantly less likely to have a clinical visit for sleep apnea (P < 0.01). Patients initially tested in 2021 were treated significantly more quickly than those initially tested in Q1 2019. Home-based testing occurring in Q4 2019 or later was significantly more likely to be definitive than home-based testing occurring Q1 2019. CONCLUSIONS Home-based sleep testing increased significantly and durably in 2020, and was associated with faster time to treatment than initial in-lab testing.
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Pini N, Ong JL, Yilmaz G, Chee NIYN, Siting Z, Awasthi A, Biju S, Kishan K, Patanaik A, Fifer WP, Lucchini M. An automated heart rate-based algorithm for sleep stage classification: Validation using conventional polysomnography and an innovative wearable electrocardiogram device. Front Neurosci 2022; 16:974192. [PMID: 36278001 PMCID: PMC9584568 DOI: 10.3389/fnins.2022.974192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The rapid advancement in wearable solutions to monitor and score sleep staging has enabled monitoring outside of the conventional clinical settings. However, most of the devices and algorithms lack extensive and independent validation, a fundamental step to ensure robustness, stability, and replicability of the results beyond the training and testing phases. These systems are thought not to be feasible and reliable alternatives to the gold standard, polysomnography (PSG). Materials and methods This validation study highlights the accuracy and precision of the proposed heart rate (HR)-based deep-learning algorithm for sleep staging. The illustrated solution can perform classification at 2-levels (Wake; Sleep), 3-levels (Wake; NREM; REM) or 4- levels (Wake; Light; Deep; REM) in 30-s epochs. The algorithm was validated using an open-source dataset of PSG recordings (Physionet CinC dataset, n = 994 participants, 994 recordings) and a proprietary dataset of ECG recordings (Z3Pulse, n = 52 participants, 112 recordings) collected with a chest-worn, wireless sensor and simultaneous PSG collection using SOMNOtouch. Results We evaluated the performance of the models in both datasets in terms of Accuracy (A), Cohen's kappa (K), Sensitivity (SE), Specificity (SP), Positive Predictive Value (PPV), and Negative Predicted Value (NPV). In the CinC dataset, the highest value of accuracy was achieved by the 2-levels model (0.8797), while the 3-levels model obtained the best value of K (0.6025). The 4-levels model obtained the lowest SE (0.3812) and the highest SP (0.9744) for the classification of Deep sleep segments. AHI and biological sex did not affect scoring, while a significant decrease of performance by age was reported across the models. In the Z3Pulse dataset, the highest value of accuracy was achieved by the 2-levels model (0.8812), whereas the 3-levels model obtained the best value of K (0.611). For classification of the sleep states, the lowest SE (0.6163) and the highest SP (0.9606) were obtained for the classification of Deep sleep segment. Conclusion The results of the validation procedure demonstrated the feasibility of accurate HR-based sleep staging. The combination of the proposed sleep staging algorithm with an inexpensive HR device, provides a cost-effective and non-invasive solution deployable in the home environment and robust across age, sex, and AHI scores.
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Affiliation(s)
- Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Ju Lynn Ong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gizem Yilmaz
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas I. Y. N. Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhao Siting
- Electronic and Information Engineering, Imperial College London, London, United Kingdom
| | - Animesh Awasthi
- Department of Biotechnology, Indian Institute of Technology, Kharagpur, India
| | - Siddharth Biju
- Department of Biotechnology, Indian Institute of Technology, Kharagpur, India
| | | | | | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
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Sethi Y, Kaiwan O, Bassiony M, Vora V, Agarwal P, Gajwani N, Garg K, Sai BS, Prakash A, Gohel S, Roy D. Psychological Assessment of Family Caregivers of Patients With COVID-19 in the United States of America and India. Cureus 2022; 14:e29267. [PMID: 36277544 PMCID: PMC9576189 DOI: 10.7759/cureus.29267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has highlighted the shortcomings worldwide in terms of preparedness protocols related to epidemics. A key area of research that is evidently overlooked across the globe is the mental health of family caregivers taking care of patients with COVID-19. In light of this, this study aimed to engage in a comparative analysis between the two worst affected countries, India and the United States of America (USA), which differ considerably in their demography, socio-epidemiological factors, and health system efficiency. Methods A cross-sectional study was conducted among 1,250 family caregivers of patients with COVID-19 in India and the USA to assess their stress, anxiety, and sleep disturbance levels using the 10-item Perceived Stress Scale (PSS-10), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Pittsburgh Sleep Quality Index (PSQI), respectively. Psychological assessment questionnaires were administered through online mode, which gathered demographic information and responses on several self-reporting scales. The main outcome measures were self-reported ratings on PSS, GAD-7 scale, and PSQI. Results We found that 75.4% of the family members of COVID-19 patients suffered from mental health issues. The scores of all three scales were higher in caregivers from the USA than in India, more evident and pronounced in caregivers of hospitalized patients. The test scores were statistically significant (p<0.05) indicating a negative impact of having a dependent member in the family, being married, being of younger age, and having a longer duration of COVID-19 infection. Vaccines were found to have a life-enhancing effect. Conclusion Our findings highlight that the mental health of family caregivers is an ignored aspect and must be addressed. We recommend the implementation of well-researched and appropriate legislation, treatment programs, and health policies that involve not only the patients but also their families.
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Grote L. Lessons for sleep medicine learned from the COVID-19 pandemic. Breathe (Sheff) 2022; 18:220146. [PMID: 36340821 PMCID: PMC9584547 DOI: 10.1183/20734735.0146-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, sleep medicine services were dramatically reduced worldwide. Implementation of mitigation strategies was suggested by expert organisations and helped to restart sleep medicine services. Distance communication and monitoring during diagnosis, treatment initiation, and treatment follow-up have been used widely, in particular for patients with sleep apnoea. Follow-up studies demonstrate both advantages and potential disadvantages with the use of these new technologies. Emerging epidemiological evidence suggests that obstructive sleep apnoea may be an independent risk factor for adverse outcome in COVID-19, including an increased risk for hospitalisation and elevated mortality. Experimental studies explaining the underlying mechanisms behind these findings are warranted.
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Affiliation(s)
- Ludger Grote
- Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden,Centre for Sleep and Wake Disorders, Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Corresponding author: Ludger Grote ()
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Fietze I, Laharnar N, Bargiotas P, Basoglu OK, Dogas Z, Drummond M, Fanfulla F, Gislason T, Gouveris H, Grote L, Hein H, Jennum P, Joppa P, van Kralingen K, Kvamme JA, Lombardi C, Ludka O, Mallin W, Marrone O, McNicholas WT, Mihaicuta S, Montserrat J, Pillar G, Pataka A, Randerath W, Riha RL, Roisman G, Saaresranta T, Schiza SE, Sliwinski P, Svaza J, Steiropoulos P, Tamisier R, Testelmans D, Trakada G, Verbraecken J, Zablockis R, Penzel T. Management of obstructive sleep apnea in Europe - A 10-year follow-up. Sleep Med 2022; 97:64-72. [PMID: 35724441 DOI: 10.1016/j.sleep.2022.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time. METHODS The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice. RESULTS 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). CONCLUSION In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.
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Affiliation(s)
- Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Department of Medicine, The Fourth People' Hospital of Guangyuan City, China; The Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov, First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | - Panagiotis Bargiotas
- Sleep and Motion Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, University of Split, School of Medicine, Split, Croatia
| | - Marta Drummond
- Sleep and Non-Invasive Ventilation Unit, Hospital São João, Medicine Faculty of Porto University, Porto, Portugal
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Clinical Scientific Institutes Maugeri IRCCS, Pavia, Italy
| | - Thorarinn Gislason
- Medical Faculity, University of Iceland, Reykjavik, Iceland; Landspitali University Hospital, Reykjavik, Iceland
| | - Haralampos Gouveris
- Sleep Medicine Center & Department of Otolaryngology, University Medical Center, Mainz, Germany
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Holger Hein
- Sleep Disorders Center, Reinbek/Geesthacht, Germany
| | - Poul Jennum
- Dansk Center for Sovnmedicin, Klinisk neurofysiologisk afdeling, Rigshospitalet, Glostrup, Denmark
| | - Pavol Joppa
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J.Safarik University and L. Pasteur University Hospital, Kosice, Slovakia
| | | | | | - Carolina Lombardi
- Sleep Disorders Center, Dept. Medicine and Surgery, University of Milano-Bicocca & Instituto Auxologico Italiano, IRCCS, Dept. of Cardiology, S. Luca Hospital, Milan, Italy
| | - Ondrej Ludka
- Dep. of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Faculty Medicine, Masaryk University, Brno, Czech Republic
| | - Wolfgang Mallin
- LKH Graz II, Standort Enzenbach, Gratwein - Strassengel, Austria
| | - Oreste Marrone
- CNR Institute for Research and Biomedical Innovation, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Giora Pillar
- Sleep Clinic, Carmel Hospital, Technion Faculty of Medicine, Haifa, Israel
| | - Athanasia Pataka
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessalonika, Greece
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Little France, UK
| | - Gabriel Roisman
- Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Department of Pulmonary Diseases and Clinical Allegology, University of Turku, Turku, Finland
| | - Sophia E Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Juris Svaza
- Department of Anaesthesiology and Sleep Laboratory, Riga Stradins University, Riga, Latvia
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Renauld Tamisier
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Georgia Trakada
- Department of Clinical Therapeutics, Division of Pulmonnary Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Rolandas Zablockis
- Center of Pulmonology and Allergology, Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Saratov State University, Saratov, Russia
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12
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Michalek-Zrabkowska M, Poreba R, Gac P, Frosztega W, Wojakowska A, Wieckiewicz M, Kanclerska J, Macek P, Wieckiewicz W, Mazur G, Martynowicz H. Telemetric Assessment of Continuous Positive Airways Pressure (CPAP) Effectiveness and Adherence in Obstructive Sleep Apnea during COVID-19 Pandemic. Biomedicines 2022; 10:biomedicines10051011. [PMID: 35625748 PMCID: PMC9138500 DOI: 10.3390/biomedicines10051011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023] Open
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder. In the pandemic times of the new coronavirus SARS-CoV-2, CPAP (Continuous Positive Airway Pressure) therapy of obstructive sleep apnea became even more challenging. After the pandemic outbreak in March 2020, most CPAP treatment recommendations changed because of rising concerns about CPAP usage safety for patients and their families. Therefore, we examined the effectiveness of CPAP and adherence to the therapy of 149 adults with obstructive sleep apnea in the period of two years from 4 March 2019 to 3 March 2021 (before pandemic breakout and during the first year of pandemic). Data on CPAP parameters and adherence to therapy were obtained via a telemetric system. Together, our results demonstrated that the COVID-19 pandemic had no significant impact on CPAP therapy parameters and adherence in whole study group. However, detailed analysis acknowledged that some demographic and clinical features influenced CPAP therapy. The results showed that across subgroups of patients differentiated on the basis of age, gender, co-existing diabetes mellitus, or hypertension, the COVID-19 pandemic seemed to affect CPAP effectiveness. Our results provide a good starting point for discussion on CPAP therapy recommendations during pandemic times.
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Affiliation(s)
- Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Pawel Gac
- Division of Environmental Health and Occupational Medicine, Department of Population Health, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland
- Correspondence: ; Tel.: +48-71-784-15-01
| | - Weronika Frosztega
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Justyna Kanclerska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Wlodzimierz Wieckiewicz
- Department of Prostodontics, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (M.M.-Z.); (R.P.); (W.F.); (A.W.); (J.K.); (P.M.); (G.M.); (H.M.)
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13
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Sampol J, Sáez M, Martí S, Pallero M, Barrecheguren M, Ferrer J, Sampol G. Impact of home CPAP treated obstructive sleep apnea on COVID-19 outcomes in hospitalized patients. J Clin Sleep Med 2022; 18:1857-1864. [PMID: 35404224 PMCID: PMC9243267 DOI: 10.5664/jcsm.10016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To investigate the association between moderate or severe obstructive sleep apnea (OSA) treated with home continuous positive airway pressure (CPAP) and severe coronavirus disease 2019 (COVID-19). METHODS Retrospective study of patients admitted for COVID-19. Patients with OSA treated with home CPAP were identified and for each of them we selected 5 patients admitted consecutively in the following hours. The main outcome of the study was the development of severe COVID-19, defined as: a) death, or b) a composite outcome of death or the presence of severe hypoxemic respiratory failure at or during admission. The association between CPAP-treated OSA and these outcomes was estimated by logistic regression analysis after applying inverse probability of treatment weighting using a propensity score-weighting approach. RESULTS Of the 2059 patients admitted, 81 (3.9%) were receiving treatment with home CPAP. Among the 486 patients included in the study, 19% died and 39% presented the composite outcome. The logistic regression analysis did not show an association of CPAP treatment either with death (OR [95% CI]: 0.684 [0.332-1.409], p:0.303) or with the composite outcome (OR [95% CI]: 0.779 [0.418-1.452], p:0.432). Death was associated with age (OR [95% CI]: 1.116 [1.08-1.152], p<0.001) and number of comorbidities (OR [95% CI]: 1.318 [1.065-1.631], p:0.012), and the composite outcome was associated with male sex (OR [95% CI]: 2.067[1.19-3.589], p:0.01) and number of comorbidities (OR [95% CI]:1.241 [1.039-1.484], p:0.018). CONCLUSIONS In hospitalized COVID-19 patients, prior OSA treated with home CPAP is not independently associated with worse outcomes.
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Affiliation(s)
- Júlia Sampol
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sáez
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Martí
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Pallero
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Miriam Barrecheguren
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jaume Ferrer
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel Sampol
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Multidisciplinary Sleep Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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14
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Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy. SENSORS 2022; 22:s22072782. [PMID: 35408395 PMCID: PMC9002933 DOI: 10.3390/s22072782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022]
Abstract
Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies.
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15
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Abstract
This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, and touches upon pandemic-related considerations for obstructive sleep apnea and continuous positive airway pressure treatment. Treatment strategies and management approaches are also briefly discussed.
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Affiliation(s)
- Sushanth Bhat
- Hackensack Meridian-Health JFK University Medical Center, 65 James Street, Edison, NJ, 08818, USA.
| | - Sudhansu Chokroverty
- Sleep Medicine Research, and Co-Chair Emeritus of Neurology, Hackensack Meridian-Health JFK University Medical Center, 65 James Street, Edison, NJ, 08818, USA.
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16
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Romero HE, Ma N, Brown GJ, Hill EA. Acoustic Screening for Obstructive Sleep Apnea in Home Environments Based on Deep Neural Networks. IEEE J Biomed Health Inform 2022; 26:2941-2950. [PMID: 35213321 DOI: 10.1109/jbhi.2022.3154719] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obstructive sleep apnea (OSA) is a chronic and prevalent condition with well-established comorbidities. However, many severe cases remain undiagnosed due to poor access to polysomnography (PSG), the gold standard for OSA diagnosis. Accurate home-based methods to screen for OSA are needed, which can be applied inexpensively to high-risk subjects to identify those that require PSG to fully assess their condition. A number of methods that analyse speech or breathing sounds to screen for OSA have been previously investigated. However, these methods have constraints that limit their use in home environments (e.g., they require specialised equipment, are not robust to background noise, are obtrusive or depend on tightly controlled conditions). This paper proposes a novel method to screen for OSA, which analyses sleep breathing sounds recorded with a smartphone at home. Audio recordings made over a whole night are divided into segments, each of which is classified for the presence or absence of OSA by a deep neural network. The percentage of segments predicted as containing evidence of OSA is then used to screen for the condition. Audio recordings made during home sleep apnea testing from 103 participants for 1 or 2 nights were used to develop and evaluate the proposed system. When screening for moderate OSA the acoustics based system achieved a sensitivity of 0.79 and a specificity of 0.80. The sensitivity and specificity when screening for severe OSA were 0.78 and 0.93, respectively. The system is suitable for implementation on consumer smartphones.
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Sunkonkit K, Selvadurai S, Voutsas G, Benzon D, Baker A, Trinh M, Narang I. To Wear or Not Wear the Mask: Decline in Positive Airway Pressure Usage in Children with Sleep Disordered Breathing During the COVID-19 Pandemic. Nat Sci Sleep 2022; 14:621-633. [PMID: 35431590 PMCID: PMC9012305 DOI: 10.2147/nss.s348978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/25/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Positive airway pressure (PAP) therapy is an effective treatment prescribed to children with sleep disordered breathing (SDB); however, PAP adherence remains challenging. Given that COVID-19 pandemic continues to impact sleep and daily life, the aim of this study was to evaluate longitudinal trajectory of PAP usage in children during the COVID-19 pandemic. PATIENTS AND METHODS This was a retrospective study. Children aged 1-18 years with SDB prescribed PAP at The Hospital for Sick Children (Toronto, Canada) were evaluated for PAP adherence. Demographics, medical history and PAP adherence data during four consecutive 3-month time periods from December 2019 to December 2020 were collected. These four time periods included i) prior to COVID-19 lockdown, ii) during the first three months of lockdown, iii) summer and iv) return to school period. Percentage of days where PAP was used for ≥4 hours and average nightly usage of PAP were primary outcomes. RESULTS A total of 149 children (61.7% male, mean (±SD) age=12.8 ± 4.1 years, BMI (±SD) z-score=1.45±1.43) were enrolled. Compared to prior to lockdown, the median (IQR) of percentage of PAP usage ≥4 hours and average nightly usage of PAP declined significantly during the summer and return to school periods (p<0.001 for all). By the end of the return to school period, only 69/149 (46%) showed sustained PAP usage and 80/149 (54%) had decreased PAP usage. Obesity was a risk factor for a decline in PAP usage after returning to school (β=-15.36, p=0.03). CONCLUSION Compared to COVID-19 pre-pandemic PAP usage, there was a significant decline in PAP usage across COVID-19 pandemic. There is critical under usage of PAP in children diagnosed with SDB, resulting in an urgent need to address barriers to mitigate poor adherence to PAP long-term. Targeted strategies are required to optimize PAP adherence in children with SDB.
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Affiliation(s)
- Kanokkarn Sunkonkit
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarah Selvadurai
- Translational Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Giorge Voutsas
- Translational Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David Benzon
- Translational Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adele Baker
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Melissa Trinh
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Translational Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Kim SW, Kim HH, Kim KY, Lee SH, Kang HH. Impacts of the COVID-19 pandemic on sleep center operations and sleep apnea treatment in Korea: A multicenter survey. Medicine (Baltimore) 2021; 100:e28461. [PMID: 34941202 PMCID: PMC10545019 DOI: 10.1097/md.0000000000028461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The coronavirus disease-2019 (COVID-19) pandemic has not only changed the lives of people around the world but also affected all areas of the healthcare system, including sleep medicine. However, no studies in Korea have investigated the status of domestic sleep centers and their challenges during the pandemic.An online survey was performed from December 2020 to January 2021. Hospitals that belonged to sleep-related academic societies and were considered well managed were included in this survey. The questionnaire focused on changes in sleep center operations, infection control policies, and patient treatment since the start of the COVID-19 pandemic. Telemedicine and future directions for sleep medicine services were also investigated.Of the 20 sleep centers that responded, 80% were at university hospitals with more than 500 inpatient beds. During the third wave of the COVID-19 pandemic in Korea (November-December 2020), the routine operating schedule of the sleep study room was reduced in 30% of the sleep centers compared to November-December 2019 (before COVID-19). The number of type 1 polysomnographies performed decreased in 85% of the sleep centers. In contrast, in-lab positive airway pressure (PAP) titrations decreased in 40%, remained unchanged in 35%, and increased in 25%. With respect to prescriptions, 30% of the sleep centers increased the number of prescriptions for auto-titrating continuous PAP. However, 60% of the sleep centers reported no change in the rate of fixed continuous PAP and auto-titrating continuous PAP prescriptions. All sleep centers that participated in this survey agreed that the need for documented infection control regulations will continue after the COVID-19 pandemic. Since the beginning of the pandemic, 30% of the centers have tried telemedicine. However, respondents expressed concern about telemedicine, citing a number of practical issues.Compared to countries where the COVID-19 pandemic was severe, Korea had less impact of COVID-19 on the sleep center operations and sleep apnea treatment. Infection and quality control in the sleep study room are important and inevitable issues, and regulation within each institution is necessary. Further research and discussion are needed regarding telemedicine and home sleep apnea test in Korea.
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Affiliation(s)
- Sei Won Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Hee Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Yean Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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19
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Kapoor P, Chowdhry A, Sengar P, Mehta A. Development, testing, and feasibility of a customized mobile application for obstructive sleep apnea (OSA) risk assessment: A hospital-based pilot study. J Oral Biol Craniofac Res 2021; 12:109-115. [PMID: 34840941 DOI: 10.1016/j.jobcr.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstructive Sleep Apnea (OSA), the most prevalent form of sleep-related breathing disorder has practical and financial limitations in diagnosis by polysomnography, hence OSA risk-assessment can identify OSA-related symptoms early. Objectives To develop a mobile application for OSA-risk assessment and tests its validity, feasibility, and application in a hospital-based pilot sample. Study design and methods The study comprised of two parts. Part i Development of a mobile application "OSA-Risk Assessment Tool" using automated questionnaires. Part ii A pilot study to screen OSA-risk in 200 patients (100 adults,100 children) from the orthodontic OPD of a Govt. Dental Hospital, using the mobile application. Internal validation by manual and mobile-based methods was done on 30 random patients. Non-parametric tests assessed the statistical differences between OSA-risk and nonOSA-risk variables. Results The prevalence of OSA-risk was 21.4% in adults and 8% in children. In adults, OSA-risk showed significantly greater neck circumference (p = 0.0001), waist circumference(p = 0.001), body mass index(p = 0.008), daytime sleepiness, headache, and mouth breathing(p = 0.0001). In children, OSA-risk is associated with a dry mouth on awakening, daytime sleepiness, and mouth breathing, and nocturnal enuresis. The low OSA-risk patients were suggested standardized preventive management counseling and orthodontic interventions while medium to high-risk underwent sleep-specialist referrals. Conclusions This study supports the feasibility and usability of the mobile application "OSA-risk assessment tool" in a hospital setup. This cost-effective tool can be advocated for self-evaluation, early detection, and awareness in pandemic times. The future upgraded versions may include preventive modules and real-time coordination with the nearest sleep clinics and specialists.
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Affiliation(s)
- Priyanka Kapoor
- Orthodontics & Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Aman Chowdhry
- Oral Pathology & Microbiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Poonam Sengar
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Abhishek Mehta
- Public Health Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
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Neagos A, Vrinceanu D, Dumitru M, Costache A, Cergan R. Demographic, anthropometric, and metabolic characteristics of obstructive sleep apnea patients from Romania before the COVID-19 pandemic. Exp Ther Med 2021; 22:1487. [PMID: 34765028 DOI: 10.3892/etm.2021.10922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 01/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is one of the major pathologies of modern life, with multiple etiologies intertwining: the increase in life expectancy, facial and dental changes, metabolic syndrome, and others. The current diagnosis is based on sleep studies, flexible endoscopy, imaging studies and a complete differential diagnosis from other possible pathologies. We present a retrospective study of 80 cases with OSA managed in 2019 prior to the beginning of the COVID-19 pandemic. We analyzed various demographic, anthropometric and metabolic data recorded in our study group. Some of the results, such as high levels of cholesterol and triglycerides, were consistent with worldwide literature. However, regarding the anthropometric data, we underline a general decrease in height in the Romanian population. In addition, demographic data have changed in the last decade due to the work immigration in the European Union. This data will be used in a future analysis for comparison with variables recorded from cases with OSA during the COVID-19 pandemic. Current cases with OSA are not a priority for healthcare systems, and patients avoid referral to a specialist as much as possible.
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Affiliation(s)
- Adriana Neagos
- ENT Department, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540139 Targu Mures, Romania.,ENT Department, 'Galenus' Medical Center, 540342 Targu Mures, Romania
| | - Daniela Vrinceanu
- ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania
| | - Mihai Dumitru
- ENT Department, Bucharest Emergency University Hospital, 010271 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Romica Cergan
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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21
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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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Spicuzza L, Sanna A. Continuum of care for patients with obstructive sleep apnea after one year from the COVID-19 pandemic onset: no time for further delays: practical issues for a safe and effective management. Sleep Med 2021; 84:98-106. [PMID: 34144451 PMCID: PMC8166158 DOI: 10.1016/j.sleep.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
Since the SARS-CoV-2 pandemic onset, many routine medical activities have been put on hold and this has deeply affected the management of patients with chronic diseases such as obstructive sleep apnea. Untreated OSA is associated with increased mortality and difficulties in social functioning. A delay in initiating treatment may therefore have harmful consequences. Between February and April 2020, the so-called first wave of the pandemic, the overall activity of sleep centers in Europe was reduced by 80%. As the international infection control authorities released guidelines for SARS-CoV-2 outbreak control, many of the national sleep societies provided strategies for a gradual re-opening of sleep facilities. Most of these strategies were not evidences-based and, in a climate of general concern, worldwide it was strongly advised to post-pone any non-urgent sleep-related procedure. Despite the initial idea that the outbreak could be transient, after one year it is still ongoing and the price we are paying, not only includes deaths caused by COVID-19, but also deaths caused by missed or late diagnosis. As further delays in diagnosing and treating patients with sleep apnea are no more acceptable, a new arrangement of sleep facilities and resources, in order to operate safely and effectively, is now mandatory. In this article, we review most recent literature and guidelines in order to provide practical advice for a new arrangement of sleep laboratories and the care of patients with obstructive sleep apnea after one year from the onset of the COVID-19 pandemic.
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Affiliation(s)
- Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Antonio Sanna
- Azienda USL Toscana Centro - Pneumology and Bronchial Endoscopy Unit, San Giuseppe Hospital, Empoli, FI, Italy
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23
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Wu D, Yang T, Hall DL, Jiao G, Huang L, Jiao C. COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak. BMC Psychiatry 2021; 21:306. [PMID: 34126958 PMCID: PMC8200549 DOI: 10.1186/s12888-021-03310-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status. METHODS A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status. RESULTS The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (β = 0.015, 95%C.I. = 0.009-0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (β = 0.009, 95%C.I. = - 0.002-0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (β = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress. CONCLUSIONS These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.
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Affiliation(s)
- Dan Wu
- grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, 518060 Guangdong China
| | - Tingzhong Yang
- grid.13402.340000 0004 1759 700XWomen’ s Hospital/Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, 310058 Zhejiang China
| | - Daniel L. Hall
- grid.38142.3c000000041936754XMassachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Guihua Jiao
- grid.410560.60000 0004 1760 3078Department of Psychology/Research Center on Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, 523808 Guangdong China
| | - Lixin Huang
- grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, 518060 Guangdong China
| | - Can Jiao
- School of Psychology, Shenzhen University, Shenzhen, 518060, Guangdong, China.
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Ehsan Z. The management of pediatric obstructive sleep apnea in the COVID-19 era: to PAP or not to PAP? J Clin Sleep Med 2021; 17:1323-1324. [PMID: 33583490 DOI: 10.5664/jcsm.9146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, Missouri
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25
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Prediction of obstructive sleep apnea using Fast Fourier Transform of overnight breath recordings. MACHINE LEARNING WITH APPLICATIONS 2021. [DOI: 10.1016/j.mlwa.2021.100022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Lipert A, Kozłowski R, Timler D, Marczak M, Musiał K, Rasmus P, Kamecka K, Jegier A. Physical Activity as a Predictor of the Level of Stress and Quality of Sleep during COVID-19 Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115811. [PMID: 34071446 PMCID: PMC8198542 DOI: 10.3390/ijerph18115811] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023]
Abstract
Background: The coronavirus pandemic and the government restrictions significantly disturbed the daily functioning of people, thereby influencing healthy behaviors, such as physical activity—the core indicator of well-being. This study evaluates the associations between physical activity (PA), the level of stress and quality of sleep during the COVID-19 pandemic lockdown. Methods: An online survey was distributed during the governmental lockdown in April 2020 and included measures for assessing physical activity, stress and sleep. The surveyed participants included all adults aged 18 years and over. The final data were collected from the 1959 respondents using: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI). Findings: Almost half of the respondents indicated a low level of PA, performing only 60 min of PA daily. Most of the participants reported a moderate or high level of stress (57% and 29%, respectively) and 64% of them reported poor quality of sleep. People with low levels of stress performed on average 85.1 min/day of walking (WPA), 40.9 min/day of moderate PA (MPA) or 52.6 min/day of vigorous PA (VPA). People with good quality of sleep performed 82.9 min/day of WPA, 43.6 min/day MPA and 40.5 min/day VPA. Interpretation: The results from the study indicate that the volume of daily PA may be a predictor of the level of stress and sleep quality in adults during the COVID-19 pandemic lockdown. To retain a low level of stress and good quality of sleep, a lifestyle that allows to achieve a moderate level of physical activity should be maintained. The optimal daily dose of PA is at least 70 min per day, involving different intensities.
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Affiliation(s)
- Anna Lipert
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland; (K.M.); (A.J.)
- Correspondence:
| | - Remigiusz Kozłowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.K.)
| | - Kamila Musiał
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland; (K.M.); (A.J.)
| | - Paweł Rasmus
- Department of Medical Psychology, Medical University of Lodz, 90-131 Lodz, Poland;
| | - Karolina Kamecka
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.K.)
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland; (K.M.); (A.J.)
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Dimitrievski A, Zdravevski E, Lameski P, Villasana MV, Miguel Pires I, Garcia NM, Flórez-Revuelta F, Trajkovik V. Towards Detecting Pneumonia Progression in COVID-19 Patients by Monitoring Sleep Disturbance Using Data Streams of Non-Invasive Sensor Networks. SENSORS (BASEL, SWITZERLAND) 2021; 21:3030. [PMID: 33925869 PMCID: PMC8123511 DOI: 10.3390/s21093030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
Pneumonia caused by COVID-19 is a severe health risk that sometimes leads to fatal outcomes. Due to constraints in medical care systems, technological solutions should be applied to diagnose, monitor, and alert about the disease's progress for patients receiving care at home. Some sleep disturbances, such as obstructive sleep apnea syndrome, can increase the risk for COVID-19 patients. This paper proposes an approach to evaluating patients' sleep quality with the aim of detecting sleep disturbances caused by pneumonia and other COVID-19-related pathologies. We describe a non-invasive sensor network that is used for sleep monitoring and evaluate the feasibility of an approach for training a machine learning model to detect possible COVID-19-related sleep disturbances. We also discuss a cloud-based approach for the implementation of the proposed system for processing the data streams. Based on the preliminary results, we conclude that sleep disturbances are detectable with affordable and non-invasive sensors.
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Affiliation(s)
- Ace Dimitrievski
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, 1000 Skopje, Macedonia; (E.Z.); (P.L.); (V.T.)
| | - Eftim Zdravevski
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, 1000 Skopje, Macedonia; (E.Z.); (P.L.); (V.T.)
| | - Petre Lameski
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, 1000 Skopje, Macedonia; (E.Z.); (P.L.); (V.T.)
| | | | - Ivan Miguel Pires
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal; (I.M.P.); (N.M.G.)
- Computer Science Department, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
- UICISA:E Research Centre, School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Nuno M. Garcia
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal; (I.M.P.); (N.M.G.)
| | | | - Vladimir Trajkovik
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, 1000 Skopje, Macedonia; (E.Z.); (P.L.); (V.T.)
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Abstract
The sleep of millions has suffered during the global COVID-19 pandemic. Prevalence rates of 20-45% are reported globally for insomnia symptoms during the pandemic. Affected populations include the public and health care workers. A sleep deprived society faces the increased burden of COVID-related economic disruption, psychosocial problems, substance abuse, and suicide. Disordered sleep is not expected to disappear with control of infection, making interventions acutely necessary. The question becomes how to manage the sleep dysfunction during and after the pandemic. Depression and anxiety are prominent complaints during pandemic restrictions. Insomnia symptoms and fatigue continue even as mood improves in those who are in recovery from COVID-19 infection. Management of disturbed sleep and mental health is particularly needed in frontline health care workers. This overview describes 53 publications, as of February 2021, on disturbed sleep during the pandemic, treatment studies on COVID-related sleep disturbance, and need to rely on current treatment guidelines for common sleep disorders. The available research during the first year of COVID-19 has generally described symptoms of poor sleep rather than addressing treatment strategies. It covers digital cognitive behavioral therapy for insomnia (CBT-i) for the public and frontline workers, recognizing the need of greater acceptance and efficacy of controlled trials of CBT for affected groups. Recommendations based on a tiered public health model are discussed.
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Voulgaris A, Ferini-Strambi L, Economou NT, Nena E, Steiropoulos P. Sleep Telemedicine Practices: Checkpoint List and Practical Considerations in the COVID-19 Era. Front Neurol 2021; 12:664274. [PMID: 33959092 PMCID: PMC8093381 DOI: 10.3389/fneur.2021.664274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | | | - Evangelia Nena
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Kendzerska T, Zhu DT, Gershon AS, Edwards JD, Peixoto C, Robillard R, Kendall CE. The Effects of the Health System Response to the COVID-19 Pandemic on Chronic Disease Management: A Narrative Review. Risk Manag Healthc Policy 2021; 14:575-584. [PMID: 33623448 PMCID: PMC7894869 DOI: 10.2147/rmhp.s293471] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Individuals with chronic conditions require ongoing disease management to reduce risks of adverse health outcomes. During the COVID-19 pandemic, health care for non-COVID-19 cases was affected due to the reallocation of resources towards urgent care for COVID-19 patients, resulting in inadequate ongoing care for chronic conditions. METHODS A keyword search was conducted in PubMed, Google Scholar, Science Direct, and Scopus for English language articles published between January 2020 and January 2021. FINDINGS During the COVID-19 pandemic, in-person care for individuals with chronic conditions have decreased due to government restriction of elective and non-urgent healthcare visits, greater instilled fear over potential COVID-19 exposure during in-person visits, and higher utilization rates of telemedicine compared to the pre-COVID-19 period. Potential benefits of a virtual-care framework during the pandemic include more effective routine disease monitoring, improved patient satisfaction, and increased treatment compliance and follow-up rates. However, more needs to be done to ensure timely and effective access to telemedicine, particularly for individuals with lower digital literacy. Capitation primary care models have been proposed as a more financially-robust approach during the COVID-19 pandemic than fee-for-service primary care models; however, the interplay between different primary models and the health outcomes is still poorly understood and warrants further investigation. Shortages of medication used to manage chronic conditions were also observed at the beginning of the COVID-19 pandemic due to global supply chain disruptions. Finally, patients with chronic conditions faced lifestyle disruptions due to the COVID-19 pandemic, specifically in physical activity, sleep, stress, and mental health, which need to be better addressed. INTERPRETATION Overall, this review elucidates the disproportionately greater barriers to primary and specialty care that patients with chronic diseases face during the COVID-19 pandemic and emphasizes the urgent need for better chronic disease management strategies moving forward.
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Affiliation(s)
- Tetyana Kendzerska
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David T Zhu
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Science, Western University, London, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre/University of Toronto, Toronto, Ontario, Canada
| | - Jodi D Edwards
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cayden Peixoto
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
| | - Rebecca Robillard
- The Royal’s Institute of Mental Health Research/University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada
- The Institut Du Savoir Montfort, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Kapoor P, Sengar P, Chowdhry A. Prototype of Customized Mobile Application for Obstructive Sleep Apnea (OSA) Risk Assessment During the COVID-19 Pandemic. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2021. [DOI: 10.1177/0301574220982735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA), the most prevalent form of sleep-related breathing disorder (SRBD), is associated with cardiovascular, neurocognitive, and metabolic complications. Evidence suggests that these comorbidities are also risk factors for enhanced severity in COVID-19 patients. Hence, initial diagnosis or screening of OSA-risk is a major requirement of current times, which can be fulfilled by a noncommercial, easily accessible mobile application for self-assessment of OSA-risk. The current article mentions a prototype of an “OSA-Risk Assessment Tool,” a mobile application developed after prior testing of needs analysis and comprising various interfaces for OSA-risk assessment in all age groups, and further refined for user applicability through a cognitive, pluralistic walkthrough and heuristic evaluation by the authors and four volunteers. It has huge scope of application in orthodontic clinics, primary healthcare centers in middle and low-income strata of developing countries, and multiple educational and licensing institutions for the larger benefit of the society.
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Affiliation(s)
- Priyanka Kapoor
- Professor, Department of Orthodontics & Dentofacial Orthopedics, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| | - Poonam Sengar
- BDS Student, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| | - Aman Chowdhry
- Professor, Department of Oral Pathology & Microbiology, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
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St Louis EK, Videnovic A. Sleep Neurology's Toolkit at the Crossroads: Challenges and Opportunities in Neurotherapeutics Lost and Found in Translation. Neurotherapeutics 2021; 18:1-5. [PMID: 33821447 PMCID: PMC8020828 DOI: 10.1007/s13311-021-01032-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
We find ourselves at our present crossroads with a well-traveled toolkit, perhaps too well worn but with aspirational hopes and dreams for the field of sleep neurotherapeutics. This volume is organized thematically into six topical domains that parallel the major subspecialty areas of contemporary clinical sleep neurology practice, as well as novel directions and opportunities. The issue begins with an overview of the central disorders of hypersomnolence, including narcolepsy, idiopathic hypersomnia and other hypersomnia disorders, and the related use of the entire broad range of stimulant and wake-promoting pharmacotherapies. Next, the range of behavioral therapies, application of light and light restriction and melatonin therapies, and hypnotic pharmacotherapies useful in insomnia and circadian sleep-wake rhythm disorders are reviewed, followed by an overview of treatment options for sleep-related breathing disorders including positive airway pressure and the novel approach of hypoglossal neurostimulation for obstructive sleep apnea. The parasomnias and sleep-related movement disorders, including NREM disorders of arousal, REM parasomnias (nightmares and isolated sleep paralysis and idiopathic/isolated REM sleep behavior disorder, and restless legs syndrome are then discussed, and the applications of sleep neurotherapeutics in sleep and neurological disease are reviewed, including neurodevelopmental, epileptic, autoimmune encephalopathies, and neurodegenerative diseases. Last, the novel directions and opportunities in sleep neurology offered by cannabinoid therapies and machine learning/artificial intelligence methodology conclude this comprehensive survey of contemporary sleep neurology. We hope that you find this volume to be a useful and inspirational support tool for the work that matters most, your care of all our sleep neurology patients in the clinics.
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Affiliation(s)
- Erik K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Clinical and Translational Research, Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA.
| | - Aleksandar Videnovic
- Divisions of Sleep Medicine and Movement Disorders, Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Mutti C, Azzi N, Soglia M, Pollara I, Alessandrini F, Parrino L. Obstructive sleep apnea, cpap and COVID-19: a brief review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020196. [PMID: 33525235 PMCID: PMC7927548 DOI: 10.23750/abm.v91i4.10941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a broadly diffused curable chronic low-grade inflammatory disease sharing impressive clinical and pathogenetic features with Covid-19. Moreover, a potential role of OSA as a detrimental factor for Covid-19 severity has been hypothesized. Continuous positive airway pressure (CPAP) is the mainstay treatment for moderate-severe OSA, but the beneficial effects of ventilation strongly depend on medical expertise and on the patient's adherence and compliance. Although several papers have analyzed the overlaps and outcomes of OSA and Covid-19, limited attention has been dedicated to ventilatory adherence and management of OSA cohorts exposed to Covid-19. We briefly review the literature data, pointing out the main risks and benefits of CPAP for OSA patients in the pandemic setting.
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Affiliation(s)
| | - Nicoletta Azzi
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Margherita Soglia
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Irene Pollara
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Francesca Alessandrini
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Liborio Parrino
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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