411 REM predominance of OSA: Associated with supine position, but not with CPAP adherence

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A163-A163
Author(s):  
Scott Schecter ◽  
Junjie Liu
Keyword(s):  
Supine Position ◽  
Rem Sleep ◽  
Sleep Stage ◽  
Body Position ◽  
Sleep Time ◽  
The Body ◽  
Cpap Therapy ◽  
Inclusion Criteria ◽  
Cpap Adherence ◽  
Supine Sleep

Abstract Introduction Obstructive sleep apnea (OSA) is a heterogeneous disease dependent on many factors including the sleep stage and the body position. OSA is often more severe during the rapid eye movement (REM) sleep stage, a phenomenon known as REM predominance. Prior studies suggested associations of higher REM predominance of OSA with younger age, higher obesity, and lower adherence to continuous positive airway pressure (CPAP) therapy, but these studies had small cohort sizes. Here we leverage home-based sleep tests (HST) that estimate REM sleep and measure body position to study REM predominance in a larger cohort of OSA patients. Methods We retrospectively reviewed patients who took HST at our clinic using devices based on peripheral arterial tonometry (WatchPAT, Itamar Medical). The HST results included estimated REM sleep periods and measured body positions. Auto-titrating CPAP therapy was prescribed for the majority of OSA patients diagnosed by the HST. Our inclusion criteria were: apnea-hypopnea index (AHI) above 5 /hour, estimated REM sleep time above 30 minutes, oxygen saturation below 90% (T90) for less than 10 minutes, and successful retrieval of CPAP usage data. CPAP adherence was defined as the percentage of nights with CPAP usage above four hours, and REM predominance as the ratio between REM AHI and non-REM AHI. Additionally, the percentage of estimated sleep time in supine position was calculated. Results Among 292 consecutive patients whose HST were reviewed, 113 patients met the inclusion criteria. The 25th-75th percentile ranges of age, body mass index (BMI), AHI, REM predominance, CPAP adherence and supine sleep percentage were 36–56 years, 28.1–38.4 kg/m2, 8.9–25.9 /hour, 1.27–2.89, 40%-97% and 28%-72%, respectively. REM predominance was not associated with CPAP adherence (P > 0.05), but was significantly associated with lower age, higher BMI, and higher supine sleep percentage (all P < 0.01). Conclusion We found that REM-predominant OSA is relatively more prevalent not only in young and obese patients, but in patients who sleep relatively more in the supine position. This association of REM predominance with body position is a novel finding to our knowledge. Contrary to prior studies, we did not find association of REM predominance with adherence to CPAP therapy. Support (if any):

scholarly journals Modulation of the ultradian human nasal cycle by sleep stage and body position

2017 ◽  
Vol 75 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Richard E. Frye ◽  
Deborah F. Rosin ◽  
Adrian R. Morrison ◽  
Fidias E. Leon-Sarmiento ◽  
Richard L. Doty
Keyword(s):  
Rem Sleep ◽  
Sleep Stage ◽  
Body Position ◽  
Video Camera ◽  
Sleep Stages ◽  
Nasal Airflow ◽  
Somatosensory Stimulation ◽  
Nasal Cycle ◽  
Left And Right ◽  
The Right

ABSTRACT Objective: The nasal cycle, which is present in a significant number of people, is an ultradian side-to-side rhythm of nasal engorgement associated with cyclic autonomic activity. We studied the nasal cycle during REM/non-REM sleep stages and examined the potentially confounding influence of body position on lateralized nasal airflow. Methods: Left- and right-side nasal airflow was measured in six subjects during an eight-hour sleep period using nasal thermistors. Polysomnography was performed. Simultaneously, body positions were monitored using a video camera in conjunction with infrared lighting. Results: Significantly greater airflow occurred through the right nasal chamber (relative to the left) during periods of REM sleep than during periods of non-REM sleep (p<0.001). Both body position (p < 0.001) and sleep stage (p < 0.001) influenced nasal airflow lateralization. Conclusions: This study demonstrates that the lateralization of nasal airflow and sleep stage are related. Some types of asymmetrical somatosensory stimulation can alter this relationship.

scholarly journals The Relationship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8960
Author(s):  
Monika Michalek-Zrabkowska ◽  
Mieszko Wieckiewicz ◽  
Piotr Macek ◽  
Pawel Gac ◽  
Joanna Smardz ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Body Position ◽  
Sleep Bruxism ◽  
The Body ◽  
Study Group ◽  
Upper Aerodigestive Tract ◽  
Obstructive Sleep ◽  
Supine Sleep ◽  
The Relationship ◽  
Simple Snoring

Simple snoring is defined as the production of sound in the upper aerodigestive tract during sleep, not accompanied by other pathologies. Sleep bruxism (SB) refers to repetitive phasic, tonic, or mixed masticatory muscle activity during sleep. In this study, we investigated the relationship between simple snoring and SB in patients without obstructive sleep apnea (OSA). A total of 565 snoring subjects underwent polysomnography. After examination, individuals with OSA were excluded from the study group. Finally, 129 individuals were analyzed. The bruxism episode index was positively correlated with maximum snore intensity. Phasic bruxism was positively correlated with snore intensity in all sleep positions. Bruxers had a significantly decreased average and minimum heart rate compared with non-bruxers. Supine sleep position seemed to have a significant impact on snore intensity and SB. In summary, our study showed the relationship between SB, snore intensity, and body position. Phasic bruxism was positively correlated with snore intensity despite the body position, which is an interesting and novel finding.

Decreased Cardiac Responses to Auditory Stimulation During Prone Sleep

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Patricia Franco ◽  
Jose Groswasser ◽  
Martine Sottiaux ◽  
Ema Broadfield ◽  
A. Kahn
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Eye Movement ◽  
Supine Position ◽  
Rem Sleep ◽  
Body Position ◽  
Auditory Stimulation ◽  
Transcutaneous Oxygen ◽  
Cardiac Responses ◽  
Significant Difference

Objective. To evaluate the relationship between body position during sleep and the infants' cardiac responses to auditory stimulation. Methods. Thirty healthy infants with a median age of 11 weeks were studied polygraphically for one night, while sleeping successively prone and supine, or vice versa. Their behavioral and cardiac responses were recorded during rapid eye movement (REM) sleep, both before and after exposure to 90 dB (A) of white-noise. Results. Ten infants were excluded from the study, because they woke up during the challenge. For the 20 infants included in the analysis, no significant difference was seen between the prone and the supine position for total sleep time, sleep efficiency, percent of REM and nonrapid eye movement sleep, number of gross body movements, transcutaneous oxygen saturation levels, mean cardiac rate, heart rate variability, number of heart rate drops; mean respiratory rate, and number or duration of central or obstructive apneas. Auditory challenges induced significantly less overall changes in heart rate, less heart rate drops, less heart rate variability, as well as fewer and shorter central apneas in the prone than in the supine position. Autoregressive power spectral analysis of the heart rate was consistent with a possible increase in orthosympathetic tone in the prone position. Conclusion. Prone sleeping was associated with a decrease in cardiac responses to auditory stimulation and a possible increase in orthosympathetic activity. Prone positioning could favor a reduced reactivity to danger-signaling stimuli during REM sleep.

Videofluoroscopic Investigation of Body Position on Articulatory Positioning

2014 ◽  
Vol 57 (4) ◽  
pp. 1135-1147 ◽  
Author(s):  
Youkyung Bae ◽  
Jamie L. Perry ◽  
David P. Kuehn
Keyword(s):  
Supine Position ◽  
Body Position ◽  
Healthy Adults ◽  
The Body ◽  
Consistent Pattern ◽  
Vowel Formant ◽  
Gravitational Pull ◽  
Anterior Posterior

Purpose To quantitatively examine the effects of body position on the positioning of the epiglottis, tongue, and velum at rest and during speech. Method Videofluoroscopic data were obtained from 12 healthy adults in the supine and upright positions at rest and during speech while the participants produced 12 VCV sequences. The effects of body position, target sounds, and adjacent sounds on structural positioning and vowel formant structure were investigated. Results Velar retropositioning in the supine position was the most consistent pattern observed at rest. During speech, all structures, with varying degrees of adjustment, appeared to work against the gravitational pull, resulting in no significant narrowing in the oro- and nasopharyngeal regions while in the supine position. Minimal differences in the formant data between the body positions were also observed. Overall, structural positioning was significantly dependent on the target and adjacent sounds regardless of body position. Conclusions The present study demonstrated that structural positioning in response to gravity varied across individuals based on the type of activities being performed. With varying degrees of positional adjustment across different structures, fairly consistent articulatory positioning in the anterior–posterior dimension was maintained in different body positions during speech.

scholarly journals Reference values for intracranial pressure and lumbar cerebrospinal fluid pressure: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Nicolas Hernandez Norager ◽  
Markus Harboe Olsen ◽  
Sarah Hornshoej Pedersen ◽  
Casper Schwartz Riedel ◽  
Marek Czosnyka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Reference Values ◽  
Supine Position ◽  
Body Position ◽  
Fluid Pressure ◽  
The Body ◽  
Cerebrospinal Fluid Pressure ◽  
Lumbar Cerebrospinal Fluid

Abstract Background Although widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to the body position of the patient. Despite this, the current reference values do not distinguish between intracranial and lumbar cerebrospinal fluid pressures, and body position-dependent reference values do not exist. In this study, we aim to establish these reference values. Method A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals. Results Thirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were −  5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in the supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. Conclusions This systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure were established, and are in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter.

Cluster headache shows no association with rapid eye movement sleep

Cephalalgia ◽  
2012 ◽  
Vol 32 (4) ◽  
pp. 289-296 ◽  
Author(s):  
Sebastian Zaremba ◽  
Dagny Holle ◽  
Thomas E Wessendorf ◽  
Hans C Diener ◽  
Zaza Katsarava ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Eye Movement ◽  
Rem Sleep ◽  
Sleep Stage ◽  
Sleep Time ◽  
Brain Regions ◽  
Sleep Stages ◽  
Rapid Eye Movement ◽  
Sleep State ◽  
Wake Time

Background: The connection of cluster headache (CH) attacks with rapid eye movement (REM) sleep has been suggested by various studies, while other authors challenge this assumption. We performed serial polysomnography to determine the association of nocturnal CH attacks and sleep. Methods: Five patients diagnosed with CH (two with the episodic and three with the chronic subtype) were included and studied over four consecutive nights to evaluate connections between attacks onset and sleep stage. Results: Twenty typical CH attacks were reported. Thirteen of these attacks arose from sleep. Seven attacks were reported after waking in the morning or shortly before going to sleep. The beginnings of sleep-related attacks were distributed arbitrarily between different non-REM sleep stages. No association of CH attacks with REM or sleep disordered breathing was observed. Increased heart rate temporally associated with transition from one sleep state to another was observed before patients awoke with headache. Total sleep time, total wake time, arousal index and distribution of non-REM sleep stages were different between chronic and episodic CH. Conclusion: CH attacks are not associated with REM sleep. Brain regions involved in sleep stage transition might be involved in pathophysiology of CH. Differences in sleep characteristics between subgroups might indicate adaptation processes or underlying pathophysiology.

Sleep-Related Deglutition in Children

2007 ◽  
Vol 116 (10) ◽  
pp. 747-753 ◽  
Author(s):  
Kiminori Sato ◽  
Tadashi Nakashima
Keyword(s):  
Rem Sleep ◽  
Total Sleep Time ◽  
Sleep Stage ◽  
Sleep Time ◽  
Vital Function ◽  
Stage 4 ◽  
Stage 2 Sleep ◽  
Normal Human ◽  
The Mean ◽  
Stage 1

Objectives: Clearance of the pharynx by deglutition is important in protecting the airway. The pattern of deglutition during sleep was investigated in children. Methods: Ten normal human children (8.6 ± 2.9 years) were examined via time-matched recordings of polysomnography and of surface electromyography (EMG) of the thyrohyoid and suprahyoid muscles. Results: During sleep, deglutition was episodic, and it was absent for long periods. The mean number of swallows per hour (±SD) during the total sleep time was 2.8 ± 1.7 per hour. The mean period of the longest absence of deglutition was 59.7 ± 20.3 minutes. Most deglutition occurred in association with spontaneous electroencephalographic arousal in rapid eye movement (REM) and non-REM sleep. Deglutition was related to sleep stage. The mean number of swallows per hour was 27.4 ± 27.4 during stage 1 sleep, 3.1 ± 3.5 during stage 2 sleep, 2.8 ± 3.3 during stage 3 sleep, and 0.9 ± 0.8 during stage 4 sleep. The deeper the sleep stage became, the lower the mean deglutition frequency became. The mean number of swallows per hour was 2.2 ± 2.1 during REM sleep. The EMG amplitude dropped to the lowest level of recording during REM sleep. Conclusions: Deglutition, a vital function, is infrequent during sleep in children.

scholarly journals Tecnologia X Saúde: Estudo Sobre a Ocorrência de Lesões Musculoesqueléticas em Universitários Usuários de Notebooks

2015 ◽  
Vol 8 (1) ◽  
pp. 63
Author(s):  
Juscelino Francisco Vilela Junio ◽  
Jessica Marques dos Santos ◽  
Rayssa Iracy da Silva ◽  
Juceluce Da Silva Vilela ◽  
Evanisia Assis Goes de Araujo
Keyword(s):  
Body Position ◽  
Intervertebral Discs ◽  
The Body ◽  
Lumbar Pain ◽  
Inclusion Criteria ◽  
Private Institution ◽  
Early 21St Century ◽  
Physical Exercises ◽  
The Right ◽  
Dominant Side

No século XXI, o notebook atingiu o maior auge das criações tecnológicas, tendo-se em vista o fato de ser compacto e poder ser facilmente carregado. Entretanto, o uso excessivo, a má postura e a limitação da ergonomia do notebook podem favorecer a ocorrência de lesões musculoesqueléticas. O estudo teve como objetivo investigar a ocorrência de lesões musculoesqueléticas em universitários que utilizam notebook. Trata-se de um estudo de campo, descritivo, exploratório, transversal, de abordagem quantitativa. A amostra correspondeu a 246 indivíduos de uma instituição privada de ensino. O instrumento utilizado foi um questionário com 17 questões fechadas. Os critérios de inclusão foram a utilização de notebook, com tempo mínimo de 60 min/dia, e a não existência de histórico de lesões em extremidades superiores. Do total de entrevistados, 43% se encontram entre a faixa etária de 18 a 19 anos; 58,9% não realizam atividades físicas; 65,8% não utilizam períodos de pausas e alongamentos; 39,6% utilizam o notebook de uma a duas horas por dia; 40,2% adotam a posição sentada, com o notebook sobre a mesa, gerando desconforto na coluna lombar (42,6%) e cervical (36,17%). Quanto à mão dominante, 84,4% são destros. A alta ocorrência de dores na cervical e lombar pode estar relacionada ao posicionamento mais adotado (computador portátil sobre a mesa), posicionamento que favorece o aumento da flexão cervical. A dor lombar é influenciada pelos longos períodos na posição sentada o que enseja o aumento da compressão nos discos intervertebrais. As dores no punho direito podem ser explicadas pelo excesso de digitação no lado dominante. Technology Versus Health: The Occurrence of Muscle-Skeleton Lesions in Undergraduates Using Notebooks ABSTRACT. The notebook reached the peak of technological inventions in the early 21st century, featuring compactness and portability. However, excessive use, bad body posture and the ergonomic limitations of the notebook may trigger muscle-skeleton lesions. Current paper investigates, through a descriptive, exploratory, transversal and quantitative study, the occurrence of muscle-skeleton lesions in university students using the notebook. Sample comprised 246 students from a private institution for higher education and the questionnaire comprised 17 questions. Inclusion criteria comprised usage of the notebook for at least 60 min/day and the absence of lesions in the higher members of the body. Further, 43% of the students were 18 - 19 years old; 58.9% did not practice any physical exercises; 65.8% ignored periodic pauses and stretching; 39.6% used the notebook for one or two hours per day; 40.2% used it while sitting, with the notebook on a table, with discomfiture for the lumbar (42.6%) and cervical (36.17%) column. Moreover, 84.4% are right-handed. High occurrence of cervical and lumbar pain may be related to body position (portable computer on the table), which increased cervical flexion. Lumbar pain is affected by long periods in a sitting position, increasing the compression of intervertebral discs. Pain in the right hand may be due to excessive typing on the dominant side.

scholarly journals Cardiorespiratory coupling is influenced by body position and slow paced 0.1Hz breathing in a state specific manner

2020 ◽  
Author(s):  
Tijana Bojić ◽  
Zoran Matić ◽  
Mihajlo Stojković ◽  
Mirjana Platiša ◽  
Aleksandar Kalauzi ◽  
...  
Keyword(s):  
Supine Position ◽  
Spontaneous Breathing ◽  
Task Complexity ◽  
Body Position ◽  
Mean Value ◽  
The Body ◽  
Wilcoxon Test ◽  
Cardiorespiratory System ◽  
Healthy Human ◽  
Cardiorespiratory Coupling

Cardiorespiratory coupling (CRC), a set of cardiac and respiratory rhythms that optimise the body oxygenation and the adaptability of the cardiorespiratory system to the external and internal environment, is represented in the linear domain by coefficient Qpr, the number of heartbeats per respiratory cycle (1, 2). Slow 0.1Hz breathing in supine position (Supin01) and active standing (Stand) represent the states of maximal RRI vagal and sympathetic modulation, respectively, in physiological quiescence; standing with 0.1Hz breathing (stand01) is characterized by qualitatively specific pattern of CRC(3). The aim of our work was to investigate the Qpr in 4 states: supine position with spontaneous breathing (supin), stand, supin01and stand01. Methods: The ECG (RRI) and respiration signals were simultaneously recorded in 20 healthy human subjects in four conditions. Data acquisition and processing was performed as in (3). Results: Parameter Supin (mean95%CI) Stand (mean95%CI) Supin01 (mean95%CI) Stand01 (mean95%CI) RRI [s] 0.980.13 0.720.10 1.060.13 0.750.09 sd RRI [s] 0.060.02 0.040.02 0.090.03 0.070.02 BBI [s] 4.681.53 4.581.80 9.850.71 9.950.20 sdBBI [s] 1.110.69 1.351.29 1.440.94 1.060.44 Qpr 4.811.67 6.392.43 9.411.20 13.481.66 sdQpr 1.140.67 1.931.73 1.390.71 1.540.53 Table 1. Mean value and 95%CI of RRI, BBI and Qpr for 20 healthy subjects in four physiological states: Supin-supine position with spontaneous breathing, Stand- standing with spontaneous breathing, Supin01-supine position with 0.1Hz breathing, Stand01-standing with slow 0.1Hz breathing. Parameter Supin-Stand Supin-Supin01 Supin-Stand01 Supin01-Stand01 RRI 0.000 0.0 04 0.000 0.000 sd RRI 0.0 04 0.00 0 0.351 0.0 10 BBI 0.391 0.000 0.000 0.313 sdBBI 0.232 0.433 0.911 0.135 Qpr 0.0 00 0.000 0.000 0.000 sdQpr 0.0 06 0.370 0.0 33 0.191 Table 2. Probability values ​​(p) of statistically significant differences between different physiological states. Wilcoxon test on a sample of 20 subjects. Color-indicated statistically significant changes in values ​​(p <0.05) whose changes were related and discussed. - increase of mean value, -decrease of mean value. Our results show that Qpr is state dependent and that it increases with the behavioral task complexity. Postural change tunes Qpr by RRI modulation, while 0.1Hz breathing dominantly by the increase of BBI. Stand01 is characterized by concomitant adjustment of both RRI and BBI. These data imply that Qpr regulation is "loosely" and selectively coordinated in stand and supin01("dual control") while integrated in stand01 ("unitary control"(4)). Analogously to nonlinear CRC(3), Qpr is probably operated by hierarchically higher diencephalo-telencephalic autonomic networks. References: 1. Moser M et al, Biol Rhythm Res 1995;26(1):100-111. 2. Scholkmann F et al, Front Physiol 2019;10:371. 3. Matić Z et al, Front Physiol 2020;11:24. 4. Feldman JL et al, Annu Rev Physiol 1988;50,593606.

scholarly journals Overnight variation in tidal expiratory flow limitation in COPD patients and its correction: an observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
J. McKenzie ◽  
P. Nisha ◽  
S. Cannon-Bailey ◽  
C. Cain ◽  
M. Kissel ◽  
...  
Keyword(s):  
Sleep Stage ◽  
Body Position ◽  
Sleep Time ◽  
Flow Limitation ◽  
Expiratory Flow Limitation ◽  
Home Ventilation ◽  
Copd Patients ◽  
Expiratory Flow ◽  
Single Night ◽  
Mean Time

Abstract Background Tidal expiratory flow limitation (EFLT) is common among COPD patients. Whether EFLT changes during sleep and can be abolished during home ventilation is not known. Methods COPD patients considered for noninvasive ventilation used a ventilator which measured within-breath reactance change at 5 Hz (∆Xrs) and adjusted EPAP settings to abolish EFLT. Participants flow limited (∆Xrs > 2.8) when supine underwent polysomnography (PSG) and were offered home ventilation for 2 weeks. The EPAP pressure that abolished EFLT was measured and compared to that during supine wakefulness. Ventilator adherence and subjective patient perceptions were obtained after home use. Results Of 26 patients with supine EFLT, 15 completed overnight PSG and 10 the home study. In single night and 2-week home studies, EFLT within and between participants was highly variable. This was unrelated to sleep stage or body position with only 14.6% of sleep time spent within 1 cmH2O of the awake screening pressure. Over 2 weeks, mean EPAP was almost half the mean maximum EPAP (11.7 vs 6.4 cmH2O respectively). Group mean ∆Xrs was ≤ 2.8 for 77.3% of their home use with a mean time to abolish new EFLT of 5.91 min. Adherence to the ventilator varied between 71 and 100% in prior NIV users and 36–100% for naïve users with most users rating therapy as comfortable. Conclusions Tidal expiratory flow limitation varies significant during sleep in COPD patients. This can be controlled by auto-titrating the amount of EPAP delivered. This approach appears to be practical and well tolerated by patients. Trial registration: The trial was retrospectively registered at CT.gov NCT04725500.

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