High‑Performance Flexible Microneedle Array as a Low‑Impedance Surface Biopotential Dry Electrode for Wearable Electrophysiological Recording and Polysomnography

Microneedle array(MNA)electrodes are an effective solution to achieve high-quality surface biopotential recording without the coordination of conductive gel and are thus very suitable for long-term wearable applications.Existing schemes are limited by flexibility,biosafety,and manufacturing costs,which create large barriers for wider applications.Here,we present a novel flexible MNA electrode that can simultaneously achieve flexibility of the substrate to fit a curved body surface,robustness of microneedles to penetrate the skin without fracture,and a simplified process to allow mass production.The compatibility with wearable wireless systems and the short preparation time of the electrodes significantly improves the comfort and convenience of electrophysiological recording.The normalized electrode–skin contact impedance reaches 0.98 kΩcm^(2)at 1 kHz and 1.50 kΩcm^(2)at 10 Hz,a record low value compared to previous reports and approximately 1/250 of the standard electrodes.The morphology,biosafety,and electrical/mechanical properties are fully characterized,and wearable recordings with a high signal-to-noise ratio and low motion artifacts are realized.The first reported clinical study of microneedle electrodes for surface electrophysiological monitoring was conducted in tens of healthy and sleep-disordered subjects with 44 nights of recording(over 8 h per night),providing substantial evidence that the electrodes can be leveraged to substitute for clinical standard electrodes.

Software Tool Development and Application Focusing in EDF Signal Readings and Polysomnography

The EDF+ (European Data Format Plus) is a flexible and open source data format created in order to store and exchange biomedical signals. It is known worldwide and used by a large variety of specialists in the area. EDF+ signals have been subjected to many researches of clinical interest amongst diagnosing and for treatment of diseases related to sleeping disorders. Nevertheless, more complete and user-friendly tools, which use these signals, are yet too few in the market. This paper presents a new tool developed in order to read and analyze EDF+ signals, focusing in the area of sleep disorders. It includes several features, such as organizing signal channels through previous montage customizations, sleep stage bars and graphics for analyzing the quality of sleep (hypnograms). It provides easiness in the whole process of interpretation and scoring of sleep events in polysomnography exams. The software development used the C++ language, due to its great versatility and efficiency, using Visual Studio Community 2013? as the Integrated Development Environment (IDE). Moreover, it implements many Digital Signal Processing (DSP) techniques, for instance, its own set of digital filters. This paper presents an application of Polysomnography analysis software and suggests a modification on the way to interpret the EDF+ standard and its usage.

Effect of nocturia in patients with different severity of obstructive sleep apnea on polysomnography: A retrospective observational study

Patients with suspected OSA were examined using PSG.They were divided into two groups based on the presence of nocturia.Nocturia was defined as a patient who needed to void at least once.Apneaehypopnea index(AHI)was employed to classify patients according to degrees of severity:AHI<5 events/h,5 events/h
AHI<15 events/h,15 events/h
AHI<30 events/h,and AHI30 events/h,defined as normal,mild OSA,moderate OSA,and severe OSA,respectively.Demographic variables,PSG parameters,International Prostate Symptom Scores(IPSSs),and quality of life scores due to urinary symptoms were analyzed.Results:In total 140 patients,114 patients had OSA(48 had mild OSA;34 had moderate OSA;and 32 had severe OSA)and 107 patients had nocturia.The total IPSS was significantly higher in nocturia patients in all groups except the group of severe OSA patients.With the increasing severity of OSA,more correlated factors related to nocturia were determined.In mild OSA patients,nocturia related to increased age(p=0.025),minimum arterial blood oxygenation saturation(p=0.046),and decreased AHI of non-rapid eye movement(p=0.047),AHI of total sleep time(p=0.010),and desaturation index(p=0.012).In moderate OSA patients,nocturia related to increased age(p<0.001),awake time(p=0.025),stage 1 sleep(p=0.033),and sleep latency(p=0.033),and decreased height(p=0.044),weight(p=0.025),and sleep efficiency(p=0.003).In severe OSA patients,nocturia related to increased weight(p=0.011),body mass index(p=0.009),awake time(p=0.008),stage 1 sleep(p=0.040),arousal number(p=0.030),arousal index(p=0.013),periodic limb movement number(p=0.013),and periodic limb movement index(p=0.004),and decreased baseline arterial blood oxygenation saturation(p=0.046).Conclusion:Our study revealed that there were more correlated factors related to nocturia with increasing severity of OSA.This study helps in clinical education and treatment for OSA patients with different severity.

Stubborn Hypoxia in Neonates with D-Transposition of the Great Arteries after Arterial Switch Operation: Central Sleep Apnea as the Cause and Potential Indicator of Brain Immaturity

D-transposition of the great arteries(d-TGA)is surgically repaired with the arterial switch operation(ASO)with excellent results,however short and long-term morbidities still develop including neurocognitive delay.Clinically significant central sleep apnea is uncommon in non-premature infants,but when present indicates immature autonomic control of respiration likely due to a neurologic disorder.We report the unanticipatedfinding of central sleep apnea in four-term neonates with d-TGA after uncomplicated ASO,with the short-term complication of delayed hospital discharge and long-term concerns regarding this early marker of brain immaturity and its hindrance to normal development.Within this report,we will review each patient’s clinical course and then examine the literature on pediatric central sleep apnea,neurodevelopmental outcomes after ASO,and the important overlap of these entities in the care of patients going forward.

A Nomogram for Predicting the Likelihood of Obstructive Sleep Apnea to Reduce the Unnecessary Polysomnography Examinations

Background：The currently available polysomnography （PSG） equipments and operating personnel are facing increasing pressure,such situation may result in the problem that a large number of obstructive sleep apnea （OSA） patients cannot receive timely diagnosis and treatment,we sought to develop a nomogram quantifying the risk of OSA for a better decision of using PSG,based on the clinical syndromes and the demographic and anthropometric characteristics.Methods：The nomogram was constructed through an ordinal logistic regression procedure.Predictive accuracy and performance characteristics were assessed with the area under the curve （AUC） of the receiver operating characteristics and calibration plots,respectively.Decision curve analyses were applied to assess the net benefit of the nomogram.Results：Among the 401 patients,73 （18.2%） were diagnosed and grouped as the none OSA （apnea-hypopnea index [AHI] 〈5）,67 （16.7%） the mild OSA （5 ≤ AHI 〈 15）,82 （20.4%） the moderate OSA （15 ≤ AHI 〈 30）,and 179 （44.6%） the severe OSA （AHI ≥ 30）.The multivariable analysis suggested the significant factors were duration of disease,smoking status,difficulty of falling asleep,lack of energy,and waist circumference.A nomogram was created for the prediction of OSA using these clinical parameters and was internally validated using bootstrapping method.The discrimination accuracies of the nomogram for any OSA,moderate-severe OSA,and severe OSA were 83.8%,79.9%,and 80.5%,respectively,which indicated good calibration.Decision curve analysis showed that using nomogram could reduce the unnecessary polysomnography （PSG） by 10% without increasing the false negatives.Conclusions：The established clinical nomogram provides high accuracy in predicting the individual risk of OSA.This tool may help physicians better make decisions on PSG arrangement for the patients referred to sleep centers.

A Polysomnography Study of Kleine-Levin Syndrome in a Single Center

Background： Kleine-Levin syndrome （KLS） is a rare sleep disorder characterized by recurrent episodes of hypersomnia. Polysomnographic （PSG） researches of KLS have been reported only in few publications in the past decades. This study aimed to investigate the characteristics of PSG of KLS. Methods： This study, which was conducted from March 2010 to July 2014, included seven patients diagnosed with KLS in the Sleep and Wake Disorder Center of Huashan Hospital, Fudan University （Shanghai, China）. PSG and multiple sleep latency tests （MSLT） were performed during their episodes and the results were evaluated. Results： Five of the seven patients were males, The mean age at KLS onset was 15.6 ：k 3.6 years. The number of episodes ranged from 2 to 7. The duration of episodes lasted from 4 to 11 days. The sleep architecture and proportion were normal in most of the patients. The average value of mean sleep latency was 6.9 4- 4.1 min. No sleep-onset rapid eye movement （SOREM） was detected in three of the patients, whereas one patient experienced one period of SOREM, and such episodes occurred twice in other two patients. Conclusions： We found that sleep architecture and proportion were normal in most KLS patients. However, the results of PSG and MSLT had no specificity for KLS patients.

Outcomes of upper airway reconstructive surgery for obstructive sleep apnea syndrome based on polysomnography after nasopharyngeal tube insertion

Background The most common obstruction sites for obstructive sleep apnea hypopnea syndrome （OSAHS） are the oropharynx and the glossopharyx. The diagnosis of glossopharyngeal airway obstruction is difficult. The study aimed to assess the effect of upper airway reconstructive surgery for OSAHS based on polysomnography （PSG） after nasopharyngeal tube insertion （NPT-PSG）, and to evaluate the clinical value of NPT-PSG in localizing the obstructive sites. Methods Seventy-nine OSAHS patients diagnosed with PSG were included in the study. PSG was repeated with a nasopharyngeal tube in place （NP＇r-PSG）. Results of the two PSGs were compared. A NPT-PSG apnea hypopnea index （AHI） greater than 15 times per hour was used as a threshold for glossopharyngeal surgery. The cause of glossopharyngeal airway obstruction was taken into consideration in planning glossopharyngeal surgery. Assessment of efficacy was followed-up. Results After NPT-PSG, patients＇ AHI significantly decreased and lowest oxygen saturation （LaSO2） significantly increased. Of the 79 patients, 47 were treated with uvulopalatopharyngoplasty （UPPP） alone and 32 with UPPP ＋ glossopharyngeal surgery. Thirty-two patients were considered cured, 33 markedly improved, and 14 failed. The overall surgery success rate was 82.3%. Conclusions NPT-PSG can be used as a diagnosis tool for localizing airway obstruction in OSAHS patients. Surgical treatment based on NPT-PSG results in good treatment efficacy.

Effects of sleep deprivation on polysomnography and executive function in patients with depression

Anumber of therapies have been developed in the past decades.About two thirds of patients can be seizure free with antiepileptic drugs.1 Other patients are drug resistant,some of whom are good candidates for epileptic focus resection and become seizure free after surgery.2 The treatment for drug-resistant patients who are not eligible for resection is still challenging.Traditionally,these patients can receive palliative surgery such as callosotomy and multiple subpial transection,3,4 but the long-term outcomes of these procedures are not satisfactory.5-7 In the past decades,neuromodulation techniques have been applied in the treatment of epilepsy.Much evidence has been accumulated about the therapeutic effects of vagus nerve stimulation for epilepsy.In contrast to peripheral nerve stimulation,brain stimulation techniques have also been developed for patients with epilepsy recently.

Neural Cryptography with Fog Computing Network for Health Monitoring Using IoMT

Sleep apnea syndrome(SAS)is a breathing disorder while a person is asleep.The traditional method for examining SAS is Polysomnography(PSG).The standard procedure of PSG requires complete overnight observation in a laboratory.PSG typically provides accurate results,but it is expensive and time consuming.However,for people with Sleep apnea(SA),available beds and laboratories are limited.Resultantly,it may produce inaccurate diagnosis.Thus,this paper proposes the Internet of Medical Things(IoMT)framework with a machine learning concept of fully connected neural network(FCNN)with k-near-est neighbor(k-NN)classifier.This paper describes smart monitoring of a patient’s sleeping habit and diagnosis of SA using FCNN-KNN+average square error(ASE).For diagnosing SA,the Oxygen saturation(SpO2)sensor device is popularly used for monitoring the heart rate and blood oxygen level.This diagnosis information is securely stored in the IoMT fog computing network.Doctors can care-fully monitor the SA patient remotely on the basis of sensor values,which are efficiently stored in the fog computing network.The proposed technique takes less than 0.2 s with an accuracy of 95%,which is higher than existing models.

Sleep during and following critical illness:A narrative review

Sleep is a complex process influenced by biological and environmental factors.Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo.Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment.This review will outline the predisposing and precipitating factors for sleep disturbance,categorised into patient,environmental and treatment-related factors.The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed.While polysomnography remains the gold-standard,its use in the critical care setting still presents many barriers.Other methodologies are needed to better understand the pathophysiology,epidemiology and treatment of sleep disturbance in this population.Subjective outcome measures,including the Richards-Campbell Sleep Questionnaire,are still required for trials involving a greater number of patients and provide valuable insight into patients’experiences of disturbed sleep.Finally,sleep optimisation strategies are reviewed,including intervention bundles,ambient noise and light reduction,quiet time,and the use of ear plugs and eye masks.While drugs to improve sleep are frequently prescribed to patients in the ICU,evidence supporting their effectiveness is lacking.

Effects and Predictions of Oral Appliances in Obstructive Sleep Apnea

Since April 2004, the Asahi University Medical and Dental Center (hereinafter referred to as our center) has been providing oral appliances (hereinafter referred to as OA) to treat patients diagnosed with obstructive sleep apnea. The effects of using the OA and progress of 71 patients who received treatment at our center by wearing OA from March 2005 to the end of March 2016 were examined through questionnaires sent by physical mail. In 21 of 24 patients who underwent polysomnography after wearing OA, the apnea-hypopnea index (hereinafter referred to as AHI) significantly decreased after wearing OA (9.44 ± 10.37) compared to that before wearing OA (24.02 ± 13.57) (p = 8.7 × 10-8). The results showed that for patients who continuously use OA, it is necessary to have sound sleep/sleep soundly;further, the patients experienced a decrease in snoring when wearing OA, with only a few side effects on the temporomandibular joints and teeth. In addition, the closer the distance from the plane of the lower margin of the mandible to the hyoid bone after wearing OA, the more likely it was for the AHI to decrease, which suggests that wearing OA contributes to the prediction of therapeutic effects.

儿童重度阻塞性睡眠呼吸暂停低通气综合征致抽动症1例

1临床资料患儿,男,6岁,因"鼻塞、睡眠打鼾3个月余"就诊。患儿于入院前3个月因受凉感冒出现鼻腔通气不畅,夜间张口呼吸,睡眠不安,打鼾,有呼吸暂停,偶有睡眠中憋醒;同时伴有白天频繁眨眼、缩鼻、咧嘴、抬额,反复清嗓,清醒时喉部频繁发声类似鼾声,注意力不集中、多动。发病以来无明显嗜睡,神志清,无发热等症。查体:外鼻(-)鼻腔可见较多黏液样涕;咽腔无明显狭窄。

睡眠呼吸监测

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种比较常见的睡眠疾病，由于可以引发多种全身性疾病，尤其是中重度OSAHS患者心脑血管并发症的危险性及死亡率均显著提高，是目前睡眠障碍的研究热点。

儿童阻塞性睡眠呼吸暂停低通气综合征诊断方法

儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)是儿童常见疾病之一,可引起一系列不良后果。早期、准确的诊断是一切治疗和预防并发症发生的基础。目前,各种诊断方法都有各自的优点和不足,本文将就各种诊断方法在儿童OSAHS方面的应用做一综述。

OSAHS患者血液流变学变化的临床研究

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）是由于睡眠时上气道部分或完全阻塞，引起的呼吸暂停和通气不足，伴有打鼾、睡眠结构紊乱，频繁发生血氧饱和度下降、白天嗜睡等症状。它是一种具有潜在危险的常见病症，长期患病易诱发心脑血管方面的疾病。本研究观察55例OSAHS患者和36例正常人血流动力学的改变，探讨OSAHS患者病理生理改变的规律，进一步认识其影响全身情况的机制。

Epworth嗜睡量表联合鼾声量表在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是最常见的睡眠障碍形式,伴有打鼾、睡眠结构紊乱、白天嗜睡等病症,其发病率在西方国家报道约为2%～5%,可发生在任何年龄阶段,随着研究的深入,OSAHS作为许多疾病的源头已得到共识，它不仅严重影响患者的生活质量和工作效率，而且易并发心脑血管疾病，具有潜在的危险性。

Continuous Positive Airway Pressure Effectively Alleviates Arrhythmias in Patients with Obstructive Sleep Apnea:Possible Relationship with Counteracting Oxidative Stress

This work is aimed at exploring the clinical efficacy of continuous positive airway pressuie(CPAP)in treatment of patients with arrhythmias combined with obstructive sleep apnea(OSA).Through evaluating serum native thiol,malonaldehyde(MDA)and nicotinamide adenine dinucleotide phosphate oxidase(NADPH oxidase)in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months,we confirmed the impact of oxidative stress on arrhythmias.A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information.Patients were divided into two groups(paired experiment design):32 patients in group A(control group),who received unchanged anti-arrhythmia treatment and 32 patients in group B,who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP.OSA related parameters were compared between the two groups after 3-month therapy.And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy.After 3 months of CPAP therapy,compared with the control group,the percentage of sage N3(NREM 3)and stage R(REM)in total sleep time was significantly increased,while apnea-hypopnea index(AHI)and the Epworth Sleepiness Scale(ESS)score were evidently decreased.Meanwhile,the lowest oxygen saturation(LSpCh)was also elevated after CPAP treatment for 3 months.The CPAP therapy significantly prevented the occurrence of arrhythmias(P<0.05).Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A(P<0.05).But serum native thiol was improved by CPAP treatment(P<0.05).In conclusion,proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.

Reliability and Validity of Simplified Chinese STOP-BANG Questionnaire in Diagnosing and Screening Obstructive Sleep Apnea Hypopnea Syndrome

The main purpose of this study was to assess the reliability and validity of the simplified Chinese STOP-BANG Questionnaire(SBQ)as a diagnosing and screening tool for obstructive sleep apnea hypopnea syndrome(OSAHS).Two hundred and ten patients with suspected OSAHS were recruited in this study.The simplified Chinese SBQ was completed twice before and after polysomnography(PSG)monitoring.SPSS 20.0 was used to analyze the test-retest reliability,discriminant validity,comparative validity and predictive validity of the SBQ.Fourteen patients were excluded on account of fragmentary data,and valid 196 were divided into four groups:non-OSAHS group(n=28,14.29%),mild OSAHS group(n=28,14.29%),moderate OSAHS group(n=31,15.81%)and severe OSAHS group(n=109,55.61%).The test-retest coefficient tor the first four items was 0.810,0.679,0.775,0.963 respectively and the total score of the STOP questionnaire was 0.854.The analysis of discriminant validity revealed that there were significant differences among four groups in the total score of the SBQ and scores of item 1,3,7 and 8,which were also validated between patients with normal blood oxygen saturation and different degrees of hypoxemia.The SBQ evaluation showed low consistency with diagnostic gold standard PSG(k=0.3O3,P<0.05).When taking apnea hypopnea index(AHI)≥5/h,≥15/h and≥30/h as cut-offs to evaluate the SBQ predictive value,the areas under ROC curve were 0.77,0.81 and 0.78,the sensitivity was 90.48%,93.57%and 93.33%,and corresponding negative predictive values were 40.74%,66.67%and 85.19%,respectively.It was suggested that the simplified Chinese version of SBQ had good reliability,and could distinguish the severity of OSAHS.Despite its limited diagnostic accuracy,the SBQ can be considered as an ideal tool for screening OSAHS with superior predictive validity.

Polysomnographic assessment of respiratory disturbance during deep propofol sedation for endoscopic submucosal dissection of gastric tumors

AIM To investigate that polysomnographic monitoring can accurately evaluate respiratory disturbance incidence during sedation for gastrointestinal endoscopy compare to pulse oximetry alone.METHODS This prospective observational study included 10 elderly patients with early gastric cancer undergoing endoscopic submucosal dissection(ESD) under propofol sedation. Apart from routine cardiorespiratory monitoring, polysomnography measurements were acquired. The primary hypothesis was tested by comparing the apnea hypopnea index(AHI), defined as the number of apnea and hypopnea instances per hour during sedation, with and without hypoxemia; hypoxemia was defined as the reduction in oxygen saturation by ≥ 3% from baseline.RESULTS Polysomnography(PSG) detected 207 respiratory disturbances in the 10 patients. PSG yielded a significantly greater AHI(10.44 ± 5.68/h) compared with pulse oximetry(1.54 ± 1.81/h, P < 0.001), thus supporting our hypothesis. Obstructive AHI(9.26 ± 5.44/h) was significantly greater than central AHI(1.19 ± 0.90/h, P < 0.001). Compared with pulse oximetry, PSG detected the 25 instances of respiratory disturbances with hypoxemia 107.4 s earlier on average.CONCLUSION Compared with pulse oximetry, PSG can better detect respiratory irregularities and thus provide superior AHI values, leading to avoidance of fatal respiratory complications during ESD under propofol-induced sedation.

Polysomnographic sleep aspects in liver cirrhosis: A case control study

AIM: To study sleep aspects and parameters in cirrhotic patients and assess the role of liver dysfunction severity in polysomnographic results. METHODS: This was a case-control study. Patients with a diagnosis of liver cirrhosis were consecutively enrolled in the study. Clinical examinations and laboratory liver tests were performed in all patients, and disease severity was assessed using the Child-Pugh score. The control group consisted of ageand gender-matched healthy volunteers. All individuals answered a questionnaire about habits, behaviors, and complaints related to sleep and were submitted to polysomnography. Sleep parameters were compared between the two groups, and separate analyses were performed among classesof Child-Pugh classification in the cirrhotic group. RESULTS: Forty-two cirrhotic patients and forty-two controls were enrolled. Compared to the control group, the cirrhotic group exhibited lower sleep efficiency (mean ± SD: 73.89% ± 14.99% vs 84.43% ± 8.55%, P < 0.01), increased latency (151.27 ± 93.24 min vs 90.62 ± 54.74 min, P < 0.01) and a lower percentage of rapid eye movement (REM) sleep (14.04% ± 5.64% vs 20.71% ± 6.77%, P < 0.05) as well as a higher frequency of periodic limb movements (10.56 ± 2.85/h vs 2.79 ± 0.61/h, P < 0.01). The comparison of sleep parameters among Child A, B and C cirrhotic patients revealed a significant reduction of REM sleep stage occurrence in individuals with severe liver disease (Child C patients) compared to Child A/B patients (polysomnography percentage of REM sleep stage of patients Child A: 16.1% ± 1.2%; Child B: 14.9% ± 1.2%; Child C: 8.6% ± 1.6%, P < 0.05). CONCLUSION: Cirrhosis was associated with shorter sleep time, reduced sleep efficiency, increased sleep latency, increased REM latency and reduced REM sleep. Additionally, disease severity influences sleep parameters.