scholarly journals Management of insomnia in sleep disordered breathing

2019 ◽  
Vol 28 (153) ◽  
pp. 190080 ◽  
Author(s):  
Hennie C.J.P. Janssen ◽  
Lisette N. Venekamp ◽  
Geert A.M. Peeters ◽  
Angelique Pijpers ◽  
Dirk A.A. Pevernagie
Keyword(s):  
General Population ◽  
Sleep Disorder ◽  
Clinical Features ◽  
Sleep Disordered Breathing ◽  
Multidisciplinary Approach ◽  
Sleep Apnoea ◽  
Current Data ◽  
Chronic Insomnia ◽  
Insomnia Disorder ◽  
Obstructive Sleep

Both obstructive sleep apnoea (OSA) and chronic insomnia disorder are highly prevalent in the general population. Whilst both disorders may occur together by mere coincidence, it appears that they share clinical features and that they may aggravate each other as a result of reciprocally adverse pathogenetic mechanisms. Comorbidity between chronic insomnia disorder and OSA is a clinically relevant condition that may confront practitioners with serious diagnostic and therapeutic challenges. Current data, while still scarce, advocate an integrated and multidisciplinary approach that seems superior over the isolated treatment of each sleep disorder alone.

scholarly journals Insomnia – A Heterogenic Disorder Often Comorbid With Psychological and Somatic Disorders and Diseases: A Narrative Review With Focus on Diagnostic and Treatment Challenges

2021 ◽  
Vol 12 ◽  
Author(s):  
Bjørn Bjorvatn ◽  
Susanna Jernelöv ◽  
Ståle Pallesen
Keyword(s):  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Sleep Onset ◽  
Chronic Insomnia ◽  
Diagnostic Challenge ◽  
Insomnia Disorder ◽  
Obstructive Sleep ◽  
Somatic Disorders ◽  
Insomnia Symptoms

Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea (COMISA). In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases.

scholarly journals Pre-operative screening for obstructive sleep apnoea

2017 ◽  
Vol 26 (143) ◽  
pp. 160012 ◽  
Author(s):  
Johan Verbraecken ◽  
Jan Hedner ◽  
Thomas Penzel
Keyword(s):  
Risk Factor ◽  
Cardiovascular Risk ◽  
General Population ◽  
Obstructive Sleep Apnoea ◽  
Cardiovascular Risk Factor ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Surgical Interventions ◽  
Medical Interventions ◽  
Obstructive Sleep

Sleep disordered breathing, especially obstructive sleep apnoea (OSA), has a high and increasing prevalence. Depending on the apnoea and hypopnoea scoring criteria used, and depending on the sex and age of the subjects investigated, prevalence varies between 3% and 49% of the general population. These varying prevalences need to be reflected when considering screening for OSA. OSA is a cardiovascular risk factor and patients are at risk when undergoing medical interventions such as surgery. Screening for OSA before anaesthesia and surgical interventions is increasingly considered. Therefore, methods for screening and the rationale for screening for OSA are reviewed in this study.

The Triad Nocturia, Smoking and Obstructive Sleep APnea

2019 ◽  
Vol 70 (5) ◽  
pp. 1839-1842 ◽  
Author(s):  
Mihaela Trenchea ◽  
Ioan Anton Arghir ◽  
Gilda Georgeta Popescu ◽  
Stefan Rascu ◽  
Edwin Sever Bechir ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Sleep Apnoea ◽  
Obstructive Pulmonary Disease ◽  
Sleep Breathing Disorders ◽  
Smoking Exposure ◽  
Obstructive Sleep ◽  
Spss Software ◽  
The Relationship ◽  
Transversal Study

In patients with obstructive sleep apnoea (OSA), a consequence of the intermittent hypoxia is nocturia. The frequency of nocturia related OSA is increased because many pathological pathways are present simultaneously. The aim was to assess the prevalence of nocturia among OSA patients and to identify the relationship with OSA and its comorbidities. A transversal study determining the prevalence of OSA�s comorbidities and nocturia related OSA and smoking was assessed, from 2011 to 2015, in 2 Romanian centres of Somnology, in Constanta county. All patients suspected of sleep breathing disorders were investigated by polygraphy and all patients diagnosed with OSA were recruited. Demographic and clinical characteristics were assessed, including the onset of nocturia. The comparison between groups with and without nocturia was performed using SPSS software, using Anova for numerical outcomes and c2 test for the categorical ones. Nocturia was highly prevalent (62.75 %) among 204 OSA patients, especially in elderly (p [ 0.00001). High blood pressure (hypertension), obstructive pulmonary disease (COPD), smoking exposure were more frequently reported in the OSA patients presenting nocturia (p[0.05). Type 2 diabetes and cardiac failure were also frequent, but did not reach a significant threshold of 95%. In conclusion, the nocturia is a frequent symptom and it is influenced by the OSA severity and comorbidities as hypertension and COPD. A further multidisciplinary approach in these patients is justified, especially in smokers.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy

2010 ◽  
Vol 125 (2) ◽  
pp. 193-198 ◽  
Author(s):  
S M Powell ◽  
M Tremlett ◽  
D A Bosman
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Life Assessment ◽  
Effect Sizes ◽  
Obstructive Sleep ◽  
Disordered Breathing

AbstractObjective:To assess the quality of life of UK children with sleep-disordered breathing undergoing adenotonsillectomy, by using the Obstructive Sleep Apnoea 18 questionnaire and determining score changes and effect sizes.Design:Prospective, longitudinal study.Setting:The otolaryngology department of a university teaching hospital in Northern England.Participants:Twenty-eight children for whom adenotonsillectomy was planned as treatment for sleep-disordered breathing, and who had either a clinical history consistent with obstructive sleep apnoea or a polysomnographic diagnosis.Main outcome measure:The Obstructive Sleep Apnoea 18 questionnaire, a previously validated, disease-specific quality of life assessment tool; changes in questionnaire scores and effect sizes were assessed.Methods:The Obstructive Sleep Apnoea 18 questionnaire was administered to each child's parent pre-operatively, then again at the follow-up appointment. Questionnaire scores ranged from 1 to 7. Score changes were analysed using the paired t-test; effect sizes were calculated using 95 per cent confidence intervals.Results:Complete data were obtained for 22 children (mean age, 61 months). Ten had undergone pre-operative polysomnography. Twenty-one children underwent adenotonsillectomy (one underwent tonsillectomy). Median follow up was eight weeks (interquartile range, six to 11 weeks). Following surgery, the overall mean score improvement was 2.6 (p < 0.0001) and the mean effect size 2.4 (95 per cent confidence interval 1.9 to 2.8). There were significant improvements in each of the individual questionnaire domains, i.e. sleep disturbance (mean score change 3.9, p < 0.0001), physical suffering (2.2, p < 0.0001), emotional distress (2.0, p = 0.0001), daytime problems (1.8, p = 0.0001) and caregiver concerns (2.6, p < 0.0001).Conclusion:In these children with sleep-disordered breathing treated by adenotonsillectomy, Obstructive Sleep Apnoea 18 questionnaire results indicated significantly improved mean score changes and effect sizes across all questionnaire domains, comparing pre- and post-operative data.

scholarly journals MinimallyInvasive Radiofrequency Surgery in Sleep-Disordered Breathing

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 97
Author(s):  
Ankit Patel ◽  
Bhik Kotecha
Keyword(s):  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Long Term Outcomes ◽  
Sustained Improvement ◽  
Radiofrequency Surgery ◽  
Obstructive Sleep ◽  
Good Quality Research ◽  
Disordered Breathing

Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed.

Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study

2018 ◽  
Vol 26 (6) ◽  
pp. 600-603 ◽  
Author(s):  
Hannah Myles ◽  
Andrew Vincent ◽  
Nicholas Myles ◽  
Robert Adams ◽  
Madhu Chandratilleke ◽  
...  
Keyword(s):  
Relative Risk ◽  
General Population ◽  
Obstructive Sleep Apnoea ◽  
Population Group ◽  
Sleep Apnoea ◽  
General Population Study ◽  
Obstructive Sleep ◽  
General Population Group ◽  
Relative Prevalence ◽  
Population Controls

Objectives: Obstructive sleep apnoea (OSA) may be more common in people with schizophrenia compared to the general population, but the relative prevalence is unknown. Here, we determine the relative prevalence of severe OSA in a cohort of men with schizophrenia compared to representative general population controls, and investigate the contribution of age and body mass index (BMI) to differences in prevalence. Methods: Rates of severe OSA (apnoea–hypopnoea index > 30) were compared between male patients with schizophrenia and controls from a representative general population study of OSA. Results: The prevalence of severe OSA was 25% in the schizophrenia group and 12.3% in the general population group. In subgroups matched by age, the relative risk of severe OSA was 2.9 ( p = 0.05) in the schizophrenia subjects, but when adjusted for age and BMI, the relative risk dropped to 1.7 and became non-significant ( p = 0.17). Conclusions: OSA is prevalent in men with schizophrenia. Obesity may be an important contributing factor to the increased rate of OSA.

Sleep disordered breathing

2007 ◽  
pp. 253-256
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Face Mask ◽  
Sleep Apnoea ◽  
Respiratory Medicine ◽  
Respiratory Support ◽  
Obstructive Sleep ◽  
Disordered Breathing

Sleep disordered breathing 254 Sleep disordered breathing is a relatively new area of respiratory medicine. It encompasses two broad and sometimes overlapping groups: the first and largest is obstructive sleep apnoea (OSA), and the second is the nocturnal hypoventilatory disorders. Both require nocturnal respiratory support, usually via a nasal or face mask, although sometimes via a tracheostomy. The on-call acute physician will be consulted about patients who have sleep disordered breathing and hence should be aware of the diagnoses and the therapies....

scholarly journals Obesity hypoventilation syndrome

2019 ◽  
Vol 28 (151) ◽  
pp. 180097 ◽  
Author(s):  
Juan F. Masa ◽  
Jean-Louis Pépin ◽  
Jean-Christian Borel ◽  
Babak Mokhlesi ◽  
Patrick B. Murphy ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Obesity Hypoventilation Syndrome ◽  
Hypercapnic Respiratory Failure ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation ◽  
Disordered Breathing

Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ≥30 kg·m−2), daytime hypercapnia (arterial carbon dioxide tension ≥45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. OHS prevalence has been estimated to be ∼0.4% of the adult population. OHS is typically diagnosed during an episode of acute-on-chronic hypercapnic respiratory failure or when symptoms lead to pulmonary or sleep consultation in stable conditions. The diagnosis is firmly established after arterial blood gases and a sleep study. The presence of daytime hypercapnia is explained by several co-existing mechanisms such as obesity-related changes in the respiratory system, alterations in respiratory drive and breathing abnormalities during sleep. The most frequent comorbidities are metabolic and cardiovascular, mainly heart failure, coronary disease and pulmonary hypertension. Both continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) improve clinical symptoms, quality of life, gas exchange, and sleep disordered breathing. CPAP is considered the first-line treatment modality for OHS phenotype with concomitant severe obstructive sleep apnoea, whereas NIV is preferred in the minority of OHS patients with hypoventilation during sleep with no or milder forms of obstructive sleep apnoea (approximately <30% of OHS patients). Acute-on-chronic hypercapnic respiratory failure is habitually treated with NIV. Appropriate management of comorbidities including medications and rehabilitation programmes are key issues for improving prognosis.

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