Gender Differences in Rapid Eye Movement-Related Sleep Disordered Breathing

Sleep disordered breathing (SDB) is an independent risk factor for cardiovascular disease. It is known to be associated more frequently with men than women, particularly in the premenopausal age range. The goal of this study is to evaluate gender differences among Korean patients diagnosed with SBD. This study included 309 patients who visited our Sleep Clinic due to sleep-related symptoms and were diagnosed with SDB by overnight polysomnography (PSG). We analyzed age, gender, body mass index, various PSG indices including sleep stages, apnea-hypopnea index (AHI) and AHI ratio in rapid eye movement (REM) versus non-REM (NREM) sleep stages (R:N ratio). Of those 309 patients diagnosed with obstructive sleep apnea, 217 (70.2%) were men (mean age 51.05 ± 12.64 years) and 92 (29.8%) were women (mean age 64.53 ± 10.43 years). The mean AHI during total sleep time was 30.34 ± 21.17 in men and 21.47 ± 17.14 in women (P P P = 0.402). REM SDB with R:N ratio higher than 2.0 was more frequently observed in women than in men, 34.8% (32/92) of women, compared with 11.9% (26/217) in men (P 60 years old. These findings suggest the possibility of different pathophysiologic mechanisms of SDB between genders and also between NREM versus REM sleep, which can be partly explained by the influence of female sex hormones.

Prevalence of sleep-disordered breathing in elderly patients with cardiac pacemaker: a case-control study

Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients' sleep apnea-hypopnea index.Methods Forty-four elderly patients (＞60 years) with cardiac pacemaker and their 44 controls matched for gender, age, body mass index and cardiovascular morbidity were studied using polysomnography or portable sleep monitoring device. Results Prevalence of sleep-disordered breathing (apnea-hypopnea index ≥5/h) was 44.7% and the mean apnea-hypopnea index was 8.2 ±4.1/h in the cardiac pacemaker group, which were significantly higher than those in control subjects (25% and 4.6±2.4/h, respectively, P＜0.01 and P＜0.05). The mean apnea-hypopnea index of patients with DDD or AAI pacemaker was significantly lower than that of patients with VVI pacemaker. Conclusions Sleep-disordered breathing was more common in patients who had their cardiac pacemaker implanted due to bradyarrhythmias than in their matched controls. Compared with VVI pacing, DDD or AAI pacing may be more beneficial to patients with bradyarrhythmias and sleep-disordered breathing.

Sleep-disordered breathing and stroke:A relation to be considered

Stroke is a leading cause of death and disability.Despite expensive and elaborative research in finding out mechanisms of interrelation between sleep-disordered breathing(SDB)and stroke,there is yet much attention to be given in stroke units worldwide to the prompt diagnosis and treatment of SDB in order to improve morbidity and mortality rates related with stroke.The preventive diagnosis and treatment of SDB reduce stroke rate and improves penumbra area in case of ischemic stroke.Stroke itself predispose to SDB,making the interrelationship more complicated.The review by Parra O and Arboix A reflects the results from carefully selected reviews reported in the literature so far.This review of the literature and presentation of the original study of the Authors based on their patients’data,enhances the conviction that there exists a direct relation between SDB and stroke.Diagnosis of SDB in new stroke cases should be sought and treated carefully whenever present.

Effect of continuous positive airway pressure ventilation on nocturnal ST-segment changes in patients with sleep-disordered breathing

Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.

Nocturnal myocardial ischemic events and sleep-disordered breathing in patients with coronary artery disease

Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 % of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients. This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions, more frequently in men (P<0.05) and more frequently in those with severe disordered breathing (P<0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)

Immune function in Japanese schoolchildren with sleep-disordered breathing: a preliminary study with analyses of salivary markers

The aim of this study was to assess the prevalence of sleep-disordered breathing (SDB) symptoms among primary schoolchildren, and to objectively determine the influence of SDB on the intra-oral environment through the analysis of saliva. A questionnaire survey was conducted among approximately 400 children from a primary school in Hiroshima. Parents were asked to complete the questionnaire and provide their contact information if they allowed the collection of saliva samples from their children. Thirty-eight chil- dren agreed to participate in the saliva study. Habit- ual snoring and cessation of breathing during sleep were found in approximately 8% and 1% of children, respectively. The present results showed significant correlations between snoring and mouth breathing. A significant association between excessive daytime sle- epiness (EDS) and learning problems was found. Fur- thermore, among children between the ages of 7 and 12 years, those with EDS and learning problems tended to be older. SDB symptom scores were statisti- cally significant only in relation to EDS. The present study also demonstrated significantly higher levels of salivary IgA and cortisol in children with sleep-re- lated disorders. The present study determined the pre- valence and characteristics of SDB among Japanese primary schoolchildren and their effects on the oral environment. Approximately 8% of primary school- children with habitual snoring might need to be care- fully monitored for SDB symptoms and immune sta- tus to ensure proper psychological and physical deve- lopment.

Sleep disordered breathing in interstitial lung disease: A review

Patients with interstitial lung disease commonly exhibit abnormal sleep architecture and increased sleep fragmentation on polysomnography. Fatigue is a frequent complaint, and it is likely that poor sleep quality is a significant contributor. A number of studies have shown that sleep disordered breathing is prevalent in this population, particularly in the idiopathic pulmonary fibrosis subgroup. The factors that predispose these patients to obstructive sleep apnoea are not well understood, however it is believed that reduced caudal traction on the upper airway can enhance collapsibility. Ventilatory control system instability may also be an important factor, particularly in those with increased chemo-responsiveness, and in hypoxic conditions. Transient, repetitive nocturnal oxygen desaturation is frequently observed in interstitial lung disease, both with and without associated obstructive apnoeas. There is increasing evidence that sleep-desaturation is associated with increased mortality, and may be important in the pathogenesis of pulmonary hypertension in this population.

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.

Enuresis and sleep disordered breathing:An old and new link

The causes of nocturnal enuresis(NE) are likely multifactorial.It has been related to several(urologicalnephrological-hormonal) reasons but clear and univocal pathogenesis remains mostly undetermined.Sleep disordered breathing(SDB) is a syndrome of upper airway dysfunction that occurs during sleep and is characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility.Adenotonsillar hypertrophy is the main cause of SDB in children.To date,several studies have associated childhood NE with coexistent SDB.Adenotonsillectomy was successful for both SDB and NE in about half of patients.Unfortunately,practical consensus guidelines for the management of primary NE do not mention,or marginally concern,SDB in these children,particularly in those who have treatment resistance and comorbidities.The concerns regard the concomitant presence of two relatively frequent sleep disorders,raising the question whether they are really coincidental problems of childhood.

Vertebro-basilar ischemic attacks and sleep-related breathing disorders

Objective To study the relationship between vertebro basilar ischemic attacks (VBI) and sleep related breathing disorders (SRBD). Methods Polysomnographic examinations were performed on 45 VBI patients. The incidence and characteristics of SRBD, and its relationship with various clinical factors were analyzed. Results Eighteen cases (40%) were complicated with SRBD, among which 2/3 was obstructive and 1/3 was central types. They were correlated with obesity and prone to be suffered with cardiovascular disorders.Conclusions Brain stem dysfunction caused by long term repeated ischemias probably is the pathogenesis of SRBD, especially it’s central type, in VBI. The arrhythmia and hypertension secondary to SRBD may aggravate VBI. VBI and SRBD may be reciprocal and form a vicious circle which should draw attention in the prevention and treatment of SRBD in VBI.

Sleep disorders in Alzheimer’s disease:the predictive roles and potential mechanisms

Sleep disorders are common in patients with Alzheimer’s disease,and can even occur in patients with amnestic mild cognitive impairment,which appears before Alzheimer’s disease.Sleep disorders further impair cognitive function and accelerate the accumulation of amyloid-βand tau in patients with Alzheimer’s disease.At present,sleep disorders are considered as a risk factor for,and may be a predictor of,Alzheimer’s disease development.Given that sleep disorders are encountered in other types of dementia and psychiatric conditions,sleep-related biomarkers to predict Alzheimer’s disease need to have high specificity and sensitivity.Here,we summarize the major Alzheimer’s disease-specific sleep changes,including abnormal non-rapid eye movement sleep,sleep fragmentation,and sleep-disordered breathing,and describe their ability to predict the onset of Alzheimer’s disease at its earliest stages.Understanding the mechanisms underlying these sleep changes is also crucial if we are to clarify the role of sleep in Alzheimer’s disease.This paper therefore explores some potential mechanisms that may contribute to sleep disorders,including dysregulation of the orexinergic,glutamatergic,andγ-aminobutyric acid systems and the circadian rhythm,together with amyloid-βaccumulation.This review could provide a theoretical basis for the development of drugs to treat Alzheimer’s disease based on sleep disorders in future work.

Characteristics of Electroencephalogram Arousals of Sleep- disordered Breathing Children at Different Sleep Stages

Sleep-disordered breathing （SDB） is the most common sleep- related disorder, and it can seriously affect sleep conditions, growth, and neurocognitive function. Recent research even demonstrates that hypertensive patients with SDB are at an increased risk of developing resistant hypertension.

Sleep disordered breathing in children with achondroplasia

Background:Children with achondrOplasia often have breathing problems,especially during sleep.The most important treatments are adenotonsillectomy(for treating upper obstruction)and/or neurosurgery(for resolving cervicomedullar junction stenosis).Data SOlirces:We reviewed the seientitle literature on polysomnographic investigations which assessed the severity of respiratory disorders during sleep.

Subjective sleepiness in heart failure patients with sleep-related breathing disorder

Background Previous studies show that sleep-related breathing disorder （SRBD） is common in patients with heart failure （HF） and is associated with increased mortality. This study aimed to determine whether there was significant difference of subjective daytime sleepiness between HF patients with and without SRBD. Methods We enrolled, prospectively, 195 consecutive HF patients with left ventricular ejection fractions （LVEF） ≤45% and all subjects underwent polysomnography to measure the sleep structure between 2005 and 2008. Patients were then assigned to those with SRBD including obstructive and central sleep apnea （apnea-hypopnea index （AHI） ≥5/hour of sleep） and those without SRBD （AHI 〈5/hour） according to the sleep study. The subjective sleepiness was assessed with Epworth sleepiness scale （ESS）. Results Among 195 HF patients, the prevalence of obstructive sleep apnea （OSA） was 53% and of central sleep apnea （CSA） was 27%. There was no significant difference of ESS scores between patients without SRBD （NSA） and with SRBD （NSA vs OSA： 6.7±0.6 vs 7.6±0.4, P=0.105 and NSA vs CSA： 6.7±0.6 vs 7.4±K）.5, P=0.235, respectively）, indicating that SRBD patients had no more subjective daytime sleepiness. Compared with NSA, patients with SRBD had increased arousal index （Arl） （NSA vs OSA： 14.1±1.4 vs 26.3 ±1.5, P〈0.001 and NSAvs CSA： 14.1±1.4 vs 31.3±3.5, P 〈0.001, respectively）, more awake number after sleep onset （NSA vs OSA： 19.2±1.5 vs 26.2±1.4, P=0.01 and NSA vs CSA： 19.2±1.5 vs 36.9±4.4, P 〈0.001, respectively）, and reduced proportion of slow-wave sleep （SWS） （NSA vs OSA： 13.8±1.7 vs 9.3±0.7, P=0.024 and NSA vs CSA： 13.8±1.7 vs 8.9±0.9, P=0.024, respectively）. Conclusions OSA and CSA remain common in patients with HF on optimal contemporary therapy. Patients with both HF and SRBD have no significant subjective daytime sleepiness compared with patients without SRBD, despite of significantly increased awake number, arousal and decreased proportion of deep sleep stages. It is not a credible way and means to exclude SRBD in patients with HF according to the absence of subjective daytime sleepiness.

椎-基底动脉缺血发作与睡眠呼吸障碍

对 45例椎 基底动脉缺血发作 (VBI)患者进行了多导睡眠图检查 ,了解其发病率和性质 ,并分析其与临床各因素的关系。结果表明 :18例 (4 0 % )并发睡眠呼吸障碍 (SRBD) ,2 / 3为阻塞性者 ,1/ 3为中枢性者 ,与肥胖有关 ,且易并发心血管病变。提示 :长期反复缺血导致的脑干功能障碍 ,有可能是VBI中SRBD ,特别是中枢性者发生的机制。SRBD继发的心律改变和高血压可加重VBI。VBI与SRBD可以互为因果 ,造成恶性循环 ,应该引起重视 ,加强SRBD的防治措施。

OSA-18调查表法对儿童阻塞性睡眠呼吸障碍患者生活质量评估的临床意义

目的利用儿童阻塞性睡眠呼吸暂停疾病特异性生活质量调查表（disease-specific quality of life for chidren with obstructive sleep apnea 1 8 items survey,OSA-1 8）,对手术治疗前后儿童阻塞性睡眠呼吸障碍（obstructive sleep disordered breathing,OSDB）患者的生活质量进行评估,探讨OSA-18的临床应用意义。方法对30例因扁桃体和（或）腺样体肥大的OSDB患者,采用OSA-18法在术前和术后6个月进行调查,评价手术治疗对OSDB患者生活质量的影响,并对评估结果以及相关问题进行讨论。结果OSDB患儿术后生活质量总分及各维度总评分较术前明显下降（P均〈0.0 1）,改善明显。其中睡眠障碍、身体症状、病情对患儿监护人的影响3个维度的变化值〉1.50,达到显著改善;情绪不佳、白天功能两个维度的变化值在0.50~0.99,为轻度改善。在所有的18个条目中,手术前后平均积分的比较,其差别均具有统计学意义（P〈0.05）。结论OSA-18调查表法可以全面反映儿童OSDB患者的生活质量,OSA-18调查在儿童OSDB的临床诊断、治疗选择和疗效评估均有较好的实用价值,是儿童OSDB疗效评价的可靠方法。

心力衰竭合并陈-施呼吸研究进展

陈-施呼吸(CSR)是中枢性睡眠呼吸紊乱的一种形式,以潮气量周期性渐进性减弱-消失-增强为特征。CSR最多见于心力衰竭患者,但也可见于急性肺水肿恢复期、进展性肾衰、中枢性神经系统损伤患者。重度心力衰竭可能是CSR最重要的危险因素,而CSR反过来也会增加心力衰竭患者的发病率和死亡率。

Pierre-Robin综合征儿童临床特征及睡眠呼吸紊乱分析

目的:探讨Pierre-Robin综合征(PRS)儿童的临床特征和睡眠呼吸紊乱(SDB)情况,为合理诊治提供依据。方法:收集2014年12月至2016年6月温州医科大学附属第二医院育英儿童医院收治的PRS儿童15例,回顾性分析临床资料,总结临床特征,并随访转归。8例和7例PRS儿童分别在3月龄和12月龄时完成睡眠问卷调查。1例行多导睡眠监测(PSG)。结果:15例均有小下颌畸形、舌后坠及高腭弓,其中3例伴腭裂。13例有呼吸困难,8例合并肺部感染或吸入性肺炎,6例有喂养困难。睡眠问卷调查显示3月龄时8例有SDB,12月龄时5例有SDB。1例PSG结果示中度阻塞性睡眠呼吸暂停低通气综合征。1例4月龄时行下颌牵引成骨术,12例保守治疗,2例失访。13例随访儿童中,5例死亡。8例于12月龄时平均体质量为(8.0±1.5)kg,平均身高为(72.0±3.0)cm。结论:PRS儿童是SDB的高发人群,临床上需提高对该病的认识,选择合适的时机和方法及早治疗。

中药穴位贴敷联合缩唇-腹式呼吸训练对慢性顽固性心力衰竭伴睡眠障碍患者睡眠质量、心功能及负性情绪的影响

目的探讨中药穴位贴敷联合缩唇-腹式呼吸训练对慢性顽固性心力衰竭伴睡眠障碍患者睡眠质量、心功能及负性情绪的影响。方法选取我院2018年1月至2019年11月老年病科收治的86例慢性顽固性心力衰竭伴睡眠障碍患者作为研究对象,采用随机数字表法将其分为对照组(42例)和观察组(44例)。对照组给予规范抗心衰治疗及护理干预,观察组在对照组基础上给予中药穴位贴敷联合缩唇-腹式呼吸训练。比较两组干预前、后的睡眠质量、心功能指标、焦虑、抑郁状态及护理满意度。结果干预后,观察组睡眠质量Ⅰ级患者占比高于对照组,Ⅳ级患者占比低于对照组,差异具有统计学意义(P<0.05)。干预后,两组患者的LVSD、LVDD均较干预前降低,LVEF均较干预前升高,且观察组优于对照组,差异具有统计学意义(P<0.05)。干预后,两组患者的HAMA、HAMD评分均较干预前降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。观察组患者的护理满意度为88.64%,高于对照组的61.90%,差异具有统计学意义(P<0.05)。结论中药穴位贴敷联合缩唇-腹式呼吸训练可显著改善慢性顽固性心力衰竭伴睡眠障碍患者的睡眠质量及心功能,缓解负性情绪,提高护理满意度。

中药穴位贴敷联合缩唇-腹式呼吸训练干预慢性顽固性心力衰竭伴睡眠障碍的临床观察

目的:观察中药穴位贴敷联合缩唇-腹式呼吸训练对慢性顽固性心力衰竭伴睡眠障碍患者心功能、匹兹堡睡眠质量指数、生存质量及护理满意度的影响。方法:将86例慢性顽固性心力衰竭伴睡眠障碍患者随机分为观察组44例和对照组42例,对照组患者给予慢性心力衰竭规范治疗与护理方案,观察组在对照组基础上给予自制中药穴位贴敷联合缩唇-腹式呼吸训练的综合干预方案,2组患者均连续干预4周,比较2组干预前后美国纽约心脏协会(NYHA)心功能分级、匹兹堡睡眠质量指数量表(PSQI)、明尼苏达心力衰竭生活质量调查量表(MLHFQ)评分,干预后评价2组患者临床护理满意度。结果:经综合方案干预后2组患者NYHA心功能分级较干预前均显著改善,差异均有统计学意义(P<0.05);观察组患者干预后的NYHA心功能分级显著优于对照组,差异均有统计学意义(P<0.05)。2组患者睡眠潜伏期、睡眠持续性、主观睡眠质量、睡眠效率、睡眠紊乱、日间功能紊乱、使用睡眠药物评分及PSQI总分均显著低于干预前,差异有统计学意义(P<0.05);观察组以上项目评分均显著低于对照组,差异有统计学意义(P<0.05)。2组患者经干预后MLHFQ量表各维度评分及总分均较干预前显著降低,差异有统计学意义(P<0.05);观察组各维度评分及总分均显著低于对照组,差异有统计学意义(P<0.05)。2组患者干预后进行护理满意度调查,观察组非常满意率及总满意率显著高于对照组,差异有统计学意义(P<0.05)。结论:中药穴位贴敷联合缩唇-腹式呼吸训练的综合干预方案可显著改善慢性顽固性心力衰竭伴睡眠障碍患者心功能、睡眠质量,提高患者生存质量和护理满意度。