scholarly journals Sleep position, patient comfort, and technical performance with two established procedures for home sleep testing

2021 ◽  
Author(s):  
C. Emika Mueller ◽  
Hansen Li ◽  
Sophia M. Begasse ◽  
J. Ulrich Sommer ◽  
Boris A. Stuck ◽  
...  
Keyword(s):  
Patient Comfort ◽  
Sleep Position ◽  
Technical Failure ◽  
Failure Rates ◽  
Peripheral Arterial Tonometry ◽  
Technical Performance ◽  
Home Sleep Testing ◽  
Obstructive Sleep ◽  
Falling Asleep ◽  
Technical Failures

Abstract Purpose In patients with a high pre-test probability of suffering from obstructive sleep apnea (OSA), (cardio)-respiratory polygraphy (RP; level 3) is commonly used for home sleep testing (HST); however, testing based on peripheral arterial tonometry (PAT) is increasingly recognized as an alternative method. The aim of the study was to compare sleep position, patients’ comfort, and technical failure rates of HST with RP and PAT in patients with suspected OSA. Methods Sleep position, patients’ comfort, and technical failure rates of RP and PAT were compared in 56 patients receiving two nights of HST with either RP or PAT in a randomized fashion. Results Time in supine position with PAT was significantly lower (173.7±88 min) compared to RP (181.7±103.7 min; p < 0.001), although the absolute mean difference was not clinically significant. Patients reported to sleep better, feeling less disturbed when falling asleep, losing less sensors, and fewer nightly awakenings with PAT, but experienced more pain at the side of the finger probe. Forty-five out of 56 patients (80%) rated PAT as being the superior sleep test and 49 out of 56 (88%) would prefer PAT for further investigations (p<0.001). PAT testing was associated with less technical failures. Conclusion The results demonstrate that HST with PAT leads to less time in supine sleep positioning, which may be clinically relevant in selected patients. Moreover, PAT is associated with less technical failures and is perceived with less discomfort during testing and a reduced number of nocturnal awakenings in patient self-reports.

scholarly journals 1253 Multiple sleep onset REM episodes in middle age woman with excessive daytime sleepiness – Is this automatically assumed narcolepsy?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A477-A477
Author(s):  
Kamal Patel ◽  
Bianca J Lang
Keyword(s):  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Sleep Onset ◽  
Sleep Time ◽  
Multiple Sleep Latency Test ◽  
Sleep Onset Latency ◽  
Onset Latency ◽  
Obstructive Sleep ◽  
Falling Asleep ◽  
Multiple Sleep Latency

Abstract Introduction Presence of sleep onset REM episodes often raises concerns of narcolepsy. However other conditions have shown to have presence of sleep on REM episodes which include but not limited to obstructive sleep apnea, sleep wake schedule disturbance, alcoholism, neurodegenerative disorders, depression and anxiety Report of Case Here we present a case of 30 year old female with history of asthma, patent foraman ovale, migraine headache, and anxiety who presented with daytime sleepiness, falling asleep while at work, occasional scheduled naps, non-restorative sleep, sleep paralysis, and hypnopompic hallucination. Pertinent physical exam included; mallampati score of 4/4, retrognathia, high arched hard palate, crowded posterior oropharynx. She had a score of 16 on Epworth sleepiness scale. Patient previously had multiple sleep latency test at outside facility which revealed 4/5 SOREM, with mean sleep onset latency of 11.5 minutes. She however was diagnosed with narcolepsy and tried on modafinil which she failed to tolerate. She was tried on sertraline as well which was discontinued due to lack of benefit. She had repeat multiple sleep latency test work up which revealed 2/5 SOREM, with mean sleep onset latency was 13.1 minutes. Her overnight polysomnogram prior to repeat MSLT showed SOREM with sleep onset latency of 10 minutes. Actigraphy showed consistent sleep pattern overall with sufficient sleep time but was taking hydroxyzine and herbal medication. Patient did not meet criteria for hypersomnolence disorder and sleep disordered breathing. Conclusion There is possibility her medication may have played pivotal role with her daytime symptoms. We also emphasize SOREMs can be present in other disorders such as anxiety in this case and not solely in narcolepsy

scholarly journals Sleep Disorders and Symptoms in Blacks with Metabolic Syndrome: the Metabolic Syndrome Outcome Study (MetSO)

2018 ◽  
Vol 28 (3) ◽  
pp. 193 ◽  
Author(s):  
Natasha J. Williams ◽  
Chimene Castor ◽  
Azizi Seixas ◽  
Joseph Ravenell ◽  
Girardin Jean-Louis
Keyword(s):  
Metabolic Syndrome ◽  
Sleep Disturbance ◽  
Daytime Sleepiness ◽  
Evaluation System ◽  
Early Morning ◽  
Public Health Issue ◽  
Outcome Study ◽  
The Metabolic Syndrome ◽  
Obstructive Sleep ◽  
Falling Asleep

<p class="Pa7"><strong>Introduction: </strong>Sleep disturbance is a major public health issue and is comorbid with the cluster of conditions associated with meta­bolic syndrome (MetS). Our study explored the presence of sleep disturbance, including daytime sleepiness, the risk for obstructive sleep apnea (OSA), and insomnia symp­toms, in a cohort of adult Black men and women with MetS.</p><p class="Pa7"><strong>Methods: </strong>Patients (n=1,013) from the Met­abolic Syndrome Outcome Study (MetSO), 2009-2012, met criteria for MetS based on guidelines from the National Cholesterol Education Program’s Adult Treatment Panel and provided sociodemographic data and the Apnea Risk Evaluation System (ARES) questionnaire to assess OSA risk, sleep char­acteristics, and physician-reported diagnosis of a sleep disorder.</p><p class="Pa7"><strong>Results: </strong>Prevalence of the components of MetS included: diabetes (60%); obesity (67%); hypertension (94%); and dyslip­idemia (74%). Based on the ARES, 49% were at risk for OSA. Of all study patients, slightly more than half (53%) reported feel­ing sleepy during the day, and 10% reported an insomnia diagnosis. The most common sleep disturbance reported by 46% of the patients was early morning awakenings (EMA). This was closely followed by 42% who reported difficulty staying asleep (DSA) and 38% reporting difficulty falling asleep (DFA). Seventy percent reported short sleep (≤ 6 hours), whereas a minority (19%) reported long sleep (≥ 9 hours). Only 12% used sleep aids. Women, compared with men, reported greater daytime sleepiness, greater DFA, and greater DSA (57% vs 45%; 41% vs 32.4%; 45% vs 37%), respectively.</p><p class="Default"><strong>Conclusion: </strong>Blacks with MetS reported insomnia symptoms and insomnia disor­der, use of sleep aids, feeling sleepy during the day, and inadequate sleep durations. The presence of these sleep characteristics suggests that patients with MetS should be referred for further sleep assessment. <em></em></p><p class="Default"><em>Ethn Dis. </em>2018;28(3):193-200; doi:10.18865/ ed.28.3.193</p>

Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants

2021 ◽  
pp. archdischild-2020-320527
Author(s):  
Hanna-Leena Kristiina Kukkola ◽  
Pia Vuola ◽  
Maija Seppä-Moilanen ◽  
Päivi Salminen ◽  
Turkka Kirjavainen
Keyword(s):  
Eye Movement ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Sleep Position ◽  
Pierre Robin Sequence ◽  
Rapid Eye Movement ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Sleep Positioning ◽  
Pierre Robin

IntroductionObstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated.DesignTo complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position.ResultsOne-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient.ConclusionsThe incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.

scholarly journals Varicocele surgery or embolization: Which is better?

2013 ◽  
Vol 6 (4) ◽  
pp. 266 ◽  
Author(s):  
Darby Cassidy ◽  
Keith Jarvi ◽  
Ethan Grober ◽  
Kirk Lo
Keyword(s):  
Failure Rate ◽  
Attractive Alternative ◽  
Published Data ◽  
Technical Failure ◽  
Failure Rates ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Gonadal Vein ◽  
Microsurgical Approach ◽  
The Right

Introduction: Varicocele remains the most commonly identifiedcorrectable cause of male factor infertility. Surgical correction isthe most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series.Methods: We reviewed a total of 158 patients. These patientsunderwent embolization for clinical varicoceles and male factorinfertility between 2004 and 2008. Of these, 56% underwentattempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization.Results: Of these patients who underwent attempted bilateralembolization, 19.3% did not experience a successful obliterationof the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed.Conclusion: This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men withunilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.

scholarly journals Effect of sleep position on obstructive sleep apnea.

1988 ◽  
Vol 156 (Suppl) ◽  
pp. 143-149 ◽  
Author(s):  
HIROSHI MIKI ◽  
WATARU HIDA ◽  
YOSHIHIRO KIKUCHI ◽  
TAMOTSU TAKISHIMA
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Position ◽  
Obstructive Sleep

scholarly journals 0377 A Strengths-Based Approach to Examine Obstructive Sleep Apnea in Black and White Patients

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A144-A145
Author(s):  
N J Williams ◽  
M Butler ◽  
J Roseus ◽  
J Blanc ◽  
A Barnes ◽  
...  
Keyword(s):  
Social Support ◽  
Ethnic Differences ◽  
Ethnic Disparities ◽  
Sleep Diary ◽  
Newly Diagnosed ◽  
Linear Regression Models ◽  
Obstructive Sleep ◽  
Falling Asleep ◽  
Race Ethnicity ◽  
Insomnia Complaints

Abstract Introduction The majority of studies on race/ethnic disparities in OSA are derived from a deficit-based perspective (i.e. &gt;BMI, non-adherence to PAP). It would prove useful to identify which aspects are protective to inform potential treatment approaches. We focused on two potential factors: resilience and social support, in patients newly diagnosed with OSA. Given the high prevalence of insomnia complaints in patients with OSA, insomnia was our outcome of interest. Methods 91 patients newly diagnosed with OSA provided demographic and socioeconomic status, sleep measures (Epworth, DBAS), resilience (Connor Davidson Resiliency Scale), social support (MOS Social Support Scale) and completed the Insomnia Severity Index. The cross-sectional associations between ISI, race/ethnicity, resilience, social support and their interaction effects were examined using linear regression models with covariate adjustment for participant age, sex and BMI. We ascertained total ISI score and individual items. Results The sample was 34.1% black (n=31), mean age of 57.6 years, SD=13.6, 64.8% male (n=59), and mean BMI of 32.4, SD=7.04. Mean sleep duration (as reported by sleep diary) was 6.64, SD=1.35. Black, white differences were not observed for sleepiness (M=8.60; 10.43, p=0.11) or DBAS (M=4.61; M=5.04, p=0.30). Blacks, reported clinically significant insomnia (M=15.00, SD=7.17) compared to whites (M=12.02, SD=6.83, p=0.05). On the individual ISI items, blacks were significantly more likely to endorse difficulty falling asleep (M=1.58, SD=1.54; M=0.75, SD=0.93,p=0.002) and waking up too early (M=2.09, SD=1.26; M=1.45, SD=0.93,p=0.021) compared to whites. Resilience (M=30.04, SD=6.42) and social support scores (M=74.13, SD=21.36) did not differ by race/ethnicity. In adjusted linear analysis, resilience had significant effect on ISI score (b=-0.36, SE=0.12, p=0.003) but not social support (b=-0.06, SE=0.08, p=0.31). Conclusion In this study we did not observe race/ethnic differences for sleepiness and dysfunctional beliefs about sleep. With respect to the protective factors, race/ethnic differences were not observed. Resilience, not social support, was related to insomnia complaints. Future studies should examine a variety of factors that may serve black and other racial/ethnic groups with OSA, and help elucidate protective processes. Support K23HL125939

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