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Turner AD, Ong JC, Jones AL, Tu A, Salanitro M, Crawford MR. Neurocognitive functioning in comorbid insomnia and sleep apnea patients is better after positive airway pressure therapy, but worse after cognitive behavioral therapy for insomnia: exploratory analysis of cognitive outcomes from the Multidisciplinary Approach to the Treatment of Insomnia and Comorbid Sleep Apnea study. Sleep 2023; 46:zsad128. [PMID: 37148183 PMCID: PMC10424173 DOI: 10.1093/sleep/zsad128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/11/2023] [Indexed: 05/08/2023] Open
Abstract
STUDY OBJECTIVES Neurocognitive impairments in comorbid insomnia and sleep apnea (COMISA) are not well documented. We explored neurocognitive functioning and treatment effects in individuals with COMISA as an ancillary study to a randomized clinical trial. METHODS Participants with COMISA (n = 45; 51.1% female; mean age = 52.07 ± 13.29 years), from a 3-arm randomized clinical trial combining cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) concurrently (CBT-I+PAP) or sequentially, completed neurocognitive testing at baseline, and post-treatment. Using Bayesian linear mixed models, we estimated effects of CBT-I, PAP, or CBT-I+PAP, compared to baseline, and CBT-I+PAP compared to PAP on 12 metrics across five cognitive domains. RESULTS This COMISA sample had worse neurocognitive performance at baseline than reported for insomnia, sleep apnea, and controls in the literature, though short-term memory and psychomotor speed performance appears intact. When comparing PAP to baseline, performance on all measures was better after treatment. Performance after CBT-I was worse compared to baseline, and only performance in attention/vigilance, executive functioning via Stroop interference and verbal memory was better with moderate-high effect sizes and moderate probability of superiority (61-83). Comparisons of CBT-I+PAP to baseline generated results similar to PAP and comparing CBT-I+PAP to PAP revealed superior performance in only attention/vigilance via psychomotor vigilance task lapses and verbal memory for PAP. CONCLUSIONS Treatment combinations involving CBT-I were associated with poorer neurocognitive performance. These potentially temporary effects may stem from sleep restriction, a component of CBT-I often accompanied by initially reduced total sleep time. Future studies should examine long-term effects of individual and combined COMISA treatment pathways to inform treatment recommendations. CLINICAL TRIAL This was an ancillary study from a clinical trial (Multidisciplinary Approach to the Treatment of Insomnia and Comorbid Sleep Apnea (MATRICS), which was preregistered at www.clinicaltrials.gov (NCT01785303)).
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Affiliation(s)
- Arlener D Turner
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Nox Health, Inc, Suwanee, GA, USA
| | - Alex L Jones
- Department of Psychology, Swansea University, Swansea, UK
| | - Alice Tu
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center at Charité-Universitätsmedizin Berlin, Germany and
| | - Megan R Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Lu M, Yu W, Wang Z, Huang Z, Salanitro M, Penzel T. Daytime sleepiness is associated with increased coronary plaque burden among patients with obstructive sleep apnea. Sleep Breath 2023; 27:1455-1463. [PMID: 36472730 DOI: 10.1007/s11325-022-02758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the cross-sectional associations of daytime sleepiness with coronary plaque volume and composition in patients with obstructive sleep apnea (OSA), and whether or not these associations are modified by age, gender, and obesity. METHODS Patients who were confirmed with OSA through respiratory polygraphy and also underwent coronary CTA at a tertiary hospital were consecutively enrolled. The interval between the sleep monitoring and coronary CTA scan was < 3 months. Every patient completed the Epworth sleepiness scale (ESS) to assess daytime sleepiness, and an ESS score of ≥ 11 was recognized as excessive daytime sleepiness (EDS). Coronary plaque volume and composition were measured using semi-automatic software. RESULTS Of the 394 patients with OSA (median [IQR] age, 56.0 [49.0-64.0] years; median [IQR] body mass index, 27.9 [25.5-30.2] kg/m2; median [IQR] apnea-hypopnea index, 21.3 [11.7, 36.3] events/h), a total of 200 patients had EDS. In the overall participants, a significant dose-response relationship between ESS scores and low-attenuation plaque volume was found in the fully adjusted model (P = 0.019). Further analysis demonstrated that there was a significant interactive effect of ESS levels and obesity on coronary plaque volume (all P values for interaction analysis < 0.05). Specifically, ESS levels were associated with total plaque volume, volumes of noncalcified, low-attenuation, and calcified plaque (P = 0.008, 0.006, 0.005, and 0.043 respectively) in obese patients with OSA. CONCLUSION Daytime sleepiness is significantly correlated with increased coronary plaque burden among patients with OSA. Thus, clinicians should recognize that patients with OSA reporting high ESS scores, especially those with obesity, are more prone to experience adverse coronary events.
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Affiliation(s)
- Mi Lu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Yu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhenjia Wang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Matthew Salanitro
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin,, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin,, Charitéplatz 1, 10117, Berlin, Germany
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Wang Y, Fietze I, Salanitro M, Penzel T. Comparison of the value of the STOP-BANG questionnaire with oxygen desaturation index in screening obstructive sleep apnea in Germany. Sleep Breath 2023; 27:1315-1323. [PMID: 36269514 PMCID: PMC10427704 DOI: 10.1007/s11325-022-02727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been developed to increase the speed of diagnosis. However, most questionnaires such as the STOP-BANG questionnaire (SBQ) are limited due to low specificity. This study evaluated the value of SBQ to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. METHODS This retrospective study included patients who completed the SBQ and underwent a night at the sleep lab or home sleep testing. The ODI was extracted from these sleep study reports. The combination of SBQ with ODI and their individual scores were compared with apnea-hypopnea index (AHI) in terms of their accuracy in diagnosing OSA. Sensitivity, specificity, and area under the curve (AUC) for different severities of OSA were calculated and compared. RESULTS Among 132 patients, SBQ showed a sensitivity of 0.9 and a specificity of 0.3 to screen for OSA. As the severity of OSA increased, the sensitivity increased whilst specificity decreased for both measurements. ODI achieved an increased specificity of 0.8 and could correctly diagnose OSA 86% of the time which was better than SBQ's 60%. For all severities of OSA, ODI alone displayed a larger AUC than SBQ and similar AUC to their combination. CONCLUSION ODI produced a higher specificity and AUC than SBQ. Furthermore, ODI combined with SBQ failed to increase diagnostic value. Therefore, ODI may be the preferred way to initially screen patients for OSA as an easy-to-use alternative compared to SBQ.
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Affiliation(s)
- Yan Wang
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
- 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
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
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Wang Y, Huang Y, Xia M, Salanitro M, Kraemer JF, Toncar T, Fietze I, Schöbel C, Penzel T. Effect of phrenic nerve stimulation on patients with central sleep apnea: A meta-analysis. Sleep Med Rev 2023; 70:101819. [PMID: 37467524 DOI: 10.1016/j.smrv.2023.101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
Patients with central sleep apnea (CSA) have a lower quality of life and higher morbidity and mortality. Phrenic nerve stimulation (PNS) is a novel treatment for CSA that has been shown to be safe. However, the effects of PNS on sleep changes are still under debate. This meta-analysis was performed to evaluate the efficacy of PNS in patients with CSA. PubMed, Scopus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science databases were searched for relevant studies published. We performed random-effects meta-analyses of the changes in apnea-hypopnea index (AHI), central apnea index (CAI), Arousal Index, percent of sleep with O2 saturation <90% (T90), Epworth Sleepiness Scale (ESS) and sleep efficiency. Ten studies with a total of 580 subjects were analyzed. Overall meta-analysis showed AHI [SMD: -2.24, 95% confidence interval (CI): was -3.11 to -1.36(p<0.00001)], CAI [SMD: -2.32, 95% CI: -3.17 to -1.47 (p<0.00001)] and Arousal Index (p = 0.0002, SMD (95% CI) -1.79 (-2.74 to -0.85)) significantly reduced after PNS. No significant changes were observed in T90, ESS and sleep efficiency (p > 0.05). Meta-analysis of observational studies demonstrated AHI, CAI and Arousal Index had a decreasing trend between before and after PNS (all, p<0.05). However, ESS and T90 did not change significantly after PNS (p > 0.05). Meta-analysis of RCTs showed that CSA patients had trends of a lower AHI (I2 = 0%), CAI (I2 = 74%), Arousal Index (I2 = 0%), T90 (I2 = 0%) and ESS (I2 = 0%) after PNS (all, p<0.05). The use of PNS appears to be safe and feasible in patients with CSA. However, larger, independent RCTs are required to investigate the efficacy and long-term effect of PNS and more attention should be paid to T90 and ESS.
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Affiliation(s)
- Youmeng Wang
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ying Huang
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mengdi Xia
- Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital) and Nanchong Key Laboratory of Basic Science & Clinical Research on Chronic Kidney Disease, Nanchong, 637000, Sichuan Province, China.
| | - Matthew Salanitro
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Theresa Toncar
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ingo Fietze
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Schöbel
- Universitätsmedizin Essen, Ruhrlandklinik - Westdeutsches Lungenzentrum, am Universitätsklinikum Essen GmbH, Tüschener Weg 40, 45239, Essen, Germany
| | - Thomas Penzel
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
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Lu M, Brenzinger L, Rosenblum L, Salanitro M, Fietze I, Glos M, Fico G, Penzel T. Comparative study of the SleepImage ring device and polysomnography for diagnosing obstructive sleep apnea. Biomed Eng Lett 2023; 13:343-352. [PMID: 37519866 PMCID: PMC10382437 DOI: 10.1007/s13534-023-00304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose We aim to evaluate the diagnostic performance of the SleepImage Ring device in identifying obstructive sleep apnea (OSA) across different severity in comparison to standard polysomnography (PSG). Methods Thirty-nine patients (mean age, 56.8 ± 15.0 years; 29 [74.3%] males) were measured with the SleepImage Ring and PSG study simultaneously in order to evaluate the diagnostic performance of the SleepImage device for diagnosing OSA. Variables such as sensitivity, specificity, positive and negative likelihood ratio, positive and negative predictive value, and accuracy were calculated with PSG-AHI thresholds of 5, 15, and 30 events/h. Receiver operating characteristic curves were also built according to the above PSG-AHI thresholds. In addition, we analyzed the correlation and agreement between the apnea-hypopnea index (AHI) obtained from the two measurement devices. Results There was a strong correlation (r = 0.89, P < 0.001 and high agreement in AHI between the SleepImage Ring and standard PSG. Also, the SleepImage Ring showed reliable diagnostic capability, with areas under the receiver operating characteristic curve of 1.00 (95% CI, 0.91, 1.00), 0.90 (95% CI, 0.77, 0.97), and 0.98 (95% CI, 0.88, 1.000) for corresponding PSG-AHI of 5, 15 and 30 events/h, respectively. Conclusion The SleepImage Ring could be a clinically reliable and cheaper alternative to the gold standard PSG when aiming to diagnose OSA in adults. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-023-00304-9.
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Affiliation(s)
- Mi Lu
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lisa Brenzinger
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Lisa Rosenblum
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthew Salanitro
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Giuseppe Fico
- Department of Biomedical Engineering, Polytechnic University of Madrid, Madrid, Spain
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Fietze I, Rosenblum L, Salanitro M, Ibatov AD, Eliseeva MV, Penzel T, Brand D, Westermayer G. The Interplay Between Poor Sleep and Work-Related Health. Front Public Health 2022; 10:866750. [PMID: 35875041 PMCID: PMC9301247 DOI: 10.3389/fpubh.2022.866750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Sleep disorders can arise from work. Employees who experience work overload are more likely to develop sleep problems. Poor sleep leads to decreased performance, sick leave, and accidents. Therefore, sleep disorders may be linked to workplace hazards as well as decreased occupational health, however, the relationship remains unknown. Methods This relationship was examined using secondary data analysis of aggregated survey data from 97 companies based in Germany between 2003 and 2020 as part of Workplace Health Management project. Two extreme groups with respect to sleep problems were analyzed (N = 4,865 + 9,795). The survey “Diagnosis of corporate health” contained 137 individual questions which recorded all relevant working conditions, aspects of health, and one question relating to insomnia traits. A one-way analysis of variance was used to examine whether and to what extent the potentials, hazards, and health aspects differed between employees depending on their perceived sleep problems. In addition, multiple linear regressions were used to determine whether and to what extent work characteristics affect various health aspects for both good and poor sleepers. Results In total, 49.7% of staff reported moderate difficulty falling and/or remaining asleep. These poor sleepers perceived all health potentials worse than good sleepers, especially on scales such as fair assessment, work climate, and learning at work. Furthermore, poor sleepers perceived health hazards (physical environmental stress, job insecurity, and time pressure) more whilst positive health indicators (joy of work and confidence) were perceived less. Conclusion Overall, the determination of sleep difficulties could be used as a substantial health indicator. Also, these sleep problems are reported more frequently in certain occupations compared to others, which could mean that the perception of sleep health varies between professions. Therefore, it is important to implement specific recommendations for each industry in order to improve working conditions for poor sleepers which in turn, improves their health.
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Affiliation(s)
- Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
- 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
- *Correspondence: Ingo Fietze
| | - Lisa Rosenblum
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexey Danilovich Ibatov
- 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
| | - Marina Vladimirovna Eliseeva
- 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
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Désirée Brand
- BGF Gesellschaft für Betriebliche Gesundheitsförderung mbH, Berlin, Germany
| | - Gerhard Westermayer
- 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
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Salanitro M, Wrigley T, Ghabra H, de Haan E, Hill CM, Solmi M, Cortese S. Efficacy on sleep parameters and tolerability of melatonin in individuals with sleep or mental disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 139:104723. [PMID: 35691474 DOI: 10.1016/j.neubiorev.2022.104723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/20/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
We conducted the first systematic review and series of meta-analyses to assess the efficacy and tolerability of melatonin in children/adolescents or adults with sleep or mental health disorders, using the same set of criteria across disorders and ages. Based on a pre-registered protocol (PROPSPERO: CRD42021289827), we searched a broad range of electronic databases up to 02.02.2021 for randomized control trials (RCTs) of melatonin. We assessed study quality using the Risk of Bias tool, v2. We included a total of 34 RCTs (21 in children/adolescents: N = 984; 13 in adults: N = 1014). We found evidence that melatonin significantly improved sleep onset latency and total sleep time, but not sleep awaking, in children and adolescents with a variety of neurodevelopmental disorders, and sleep onset latency (measured by diary) as well as total sleep time (measured with polysomnography) in adults with delayed sleep phase disorder. No evidence of significant differences between melatonin and placebo was found in terms of tolerability. We discuss clinical and research implications of our findings.
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Affiliation(s)
| | | | | | - Edward de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, Amsterdam, the Netherland
| | - Catherine M Hill
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Sleep Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
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Wang Y, Penzel T, Salanitro M, Arens P. Persistent Treatment-Emergent Central Sleep Apnea (TECSA) Following Hypoglossal Nerve Stimulation. Nat Sci Sleep 2022; 14:2227-2236. [PMID: 36578670 PMCID: PMC9791954 DOI: 10.2147/nss.s382710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Since 2001, hypoglossal nerve stimulators (HNS) have been used worldwide to treat patients with obstructive sleep apnea (OSA). Recently, a few studies reported treatment-emergent central sleep apnea (TECSA) with spontaneous resolution following HNS. However, the evidence of persistent development of TECSA during long-term care visits was lacking. As a result, this study first report two patients with persistent TECSA and describe their development phenotype during more than two years of follow-up visits to help explore the influencing factors and underlying mechanisms. PATIENTS AND METHODS This retrospective study included twenty-seven patients who underwent HNS implantation from 2016 to 2021. Their demographic data, pre- and postoperative sleep study characteristics, and device use settings were collected. The possible factors associated with post-operative elevated CSA (central apnea index ≥5) were evaluated. Moreover, the development phenotype of the TECSA was observed and followed up with a titration trial study. RESULTS Among overall 27 patients with OSA, 3 patients with an increased preoperative Epworth Sleepiness Score (ESS) got an elevated CSA (CAI ≥ 5). Two of these 3 patients developed a persistent TECSA with a significant negative correlation between obstructive apnea index (OAI) and central and mixed sleep apnea index (CMAI) (R = -0.745, P = 0.021). These development phenotypes might be associated with different stimulation amplitudes of the HNS device. Furthermore, the following titration trial study also suggested that different amplitudes would influence the development of TECSA following HNS. CONCLUSION OSA patients with severe daytime sleepiness are more likely to have elevated CSA following HNS. An inappropriate stimulation amplitude might influence the development course of TECSA in such patients.
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Affiliation(s)
- Yan Wang
- Interdisciplinary Sleep Medicine Center Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
| | - Philipp Arens
- Department of Otorhinolaryngology, Campus Virchow Klinikum Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Crawford M, Salanitro M, Vallières A, Carr M, Rees H, Norris E, Bradshaw C, Blagrove M. Both good and poor sleepers overestimate wakefulness after waking from a nap: impact of sleep inertia. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pietro SD, Salanitro M, Rapisarda F. OHP-077 The Role of Pharmacists in an Italian Model of Economic Sustainability and Innovative Treatments. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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