Exclusion of EEG-based arousals in wake epochs of polysomnography leads to underestimation of the arousal index

AbstractBackgroundAccumulating evidence suggests a relationship between sleep alterations and overweight/obesity in children. Our aim was to investigate the association of sleep measures other than obstructive sleep apnea or sleep duration with overweight/obesity and metabolic function in children.MethodsWe conducted a prospective cohort study in school- aged children (aged 5 to 8 years, prepubertal, and 12 to 15 years, pubertal) with overweight/obesity and normal-weight children. All children underwent a standardized in-laboratory polysomnography followed by a fasting blood assessment for glucose and metabolic testing. Subjective sleep measures were investigated by a 7-day sleep diary and questionnaire. We analyzed prepubertal and pubertal groups separately using logistic regression and partial correlation analyses.ResultsA total of 151 participants were analyzed. Overweight/obese children had significantly higher odds for arousal index (prepubertal children: 1.28, Confidence interval (CI): 1.06, 1.67; pubertal children: 1.65, CI: 1.19, 2.29) than normal-weight children, independent of age and gender. In prepubertal children, arousal-index was positively associated with C-peptide (r=0.30, p=0.01), whereas Minimum O2 saturation was negatively associated with triglycerides (r=−0.34, p=0.005), adjusting for age and sex. However, associations were attenuated by further adjustment for body mass index standard deviation scores (BMI-SDS). In pubertal children, higher level of apnea-hypopnea-index and pCO2 predicted increased lipoprotein (a) levels (r=0.35, p=0.03 and r=0.40, p=0.01, respectively), independent of age, sex, and BMI-SDS. A negative association was found between pCO2 and high-density lipoprotein (HDL)-cholesterol (r=−0.40, p=0.01).ConclusionsOverall, we report that sleep quality as measured by arousal index may be compromised by overweight and obesity in children and warrants attention in future intervention programs.

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The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

The Scientific World JOURNAL ◽

10.1100/2012/757283 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Pi-Chang Lee ◽

Betau Hwang ◽

Wen-Jue Soong ◽

C. C. Laura Meng

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pediatric Patients ◽

Pediatric Population ◽

Clinical Manifestations ◽

Cor Pulmonale ◽

Arousal Index ◽

Obstructive Sleep ◽

Hemodynamic Characteristics ◽

Pulmonary Arterial

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

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391 Upper Airway Resistance Syndrome is associated with high Cyclic Alternating Pattern

SLEEP ◽

10.1093/sleep/zsab072.390 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A155-A156

Author(s):

Luciana Godoy ◽

Letícia Soster ◽

Clarissa Bueno ◽

Sonia Togeiro ◽

Dalva Poyares ◽

...

Keyword(s):

Airway Resistance ◽

Upper Airway ◽

Sleep Fragmentation ◽

Control Group ◽

Flow Limitation ◽

Upper Airway Resistance Syndrome ◽

Arousal Index ◽

Upper Airway Resistance ◽

Cyclic Alternating Pattern ◽

Cap Rate

Abstract Introduction Upper Airway Resistance Syndrome (UARS) is suspected in individuals with excessive daytime sleepiness, fatigue, and sleep fragmentation associated with increased respiratory effort. UARS can negatively impact daytime function. Conventional polysomnography parameters do not demonstrate significant abnormalities in UARS patients but increase in RERAs and arousal index. Cyclic alternating pattern (CAP) is a periodic electroencephalogram activity of non-REM sleep that expresses a condition of sleep instability. The objective of the study was to compare CAP components between UARS patients and health individuals. Methods Fifteen subjects with UARS and 15 age- and sex- matched controls had their sleep study blinded analyzed. UARS criteria were the presence of sleepiness (Epworth Sleepiness Scale – ESS - ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. Control group criteria were AHI < 5 events/hour, RDI ≤ 5 events/hour and < 30% of TST with flow limitation and ESS < 10, without sleep, clinical, neurological, or psychiatric disorder. CAP electroencephalogram of both groups was analyzed. Results We found higher CAP rate (p = 0.05) and CAP index in N1 stage (p < 0.001) and in N3 stage (p < 0.001) in UARS patients compared to control group. Considering only CAP phase A1 analysis, UARS patients presented higher CAP rate (p = 0.05) and CAP index in N1 stage (p < 0.001) as well as CAP index in N3 stage (p < 0.001) compared to control group. Considering only CAP phase A2 analysis, UARS patients also presented higher number of CAP in N1 stage (p = 0.05). There was no significant difference for CAP phase A3 between groups. Conclusion Although UARS is associated with high arousal index, we found increase in CAP phase A1 and A2, which do not include necessarily AASM arousals, suggesting not only sleep fragmentation but also sleep instability. Support (if any) Associação Fundo de Incentivo à Pesquisa (AFIP) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).

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Predicting Polysomnography Parameters from Anthropometric Features and Breathing Sounds Recorded during Wakefulness

Diagnostics ◽

10.3390/diagnostics11050905 ◽

2021 ◽

Vol 11 (5) ◽

pp. 905

Author(s):

Ahmed Elwali ◽

Zahra Moussavi

Keyword(s):

Primary Outcome ◽

Screening Tool ◽

Correlation Coefficients ◽

Random Forest Classifier ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Bilinear Model ◽

Arousal Index ◽

Obstructive Sleep ◽

Anthropometric Features

Background: The apnea/hypopnea index (AHI) is the primary outcome of a polysomnography assessment (PSG) for determining obstructive sleep apnea (OSA) severity. However, other OSA severity parameters (i.e., total arousal index, mean oxygen saturation (SpO2%), etc.) are crucial for a full diagnosis of OSA and deciding on a treatment option. PSG assessments and home sleep tests measure these parameters, but there is no screening tool to estimate or predict the OSA severity parameters other than the AHI. In this study, we investigated whether a combination of breathing sounds recorded during wakefulness and anthropometric features could be predictive of PSG parameters. Methods: Anthropometric information and five tracheal breathing sound cycles were recorded during wakefulness from 145 individuals referred to an overnight PSG study. The dataset was divided into training, validation, and blind testing datasets. Spectral and bispectral features of the sounds were evaluated to run correlation and classification analyses with the PSG parameters collected from the PSG sleep reports. Results: Many sound and anthropometric features had significant correlations (up to 0.56) with PSG parameters. Using combinations of sound and anthropometric features in a bilinear model for each PSG parameter resulted in correlation coefficients up to 0.84. Using the evaluated models for classification with a two-class random-forest classifier resulted in a blind testing classification accuracy up to 88.8% for predicting the key PSG parameters such as arousal index. Conclusions: These results add new value to the current OSA screening tools and provide a new promising possibility for predicting PSG parameters using only a few seconds of breathing sounds recorded during wakefulness without conducting an overnight PSG study.

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Bone Mineral Density Attenuation in Obstructive Sleep Apnea by Derived Computed Tomography Screening

10.21203/rs.3.rs-1049040/v1 ◽

2021 ◽

Author(s):

Sharon Daniel ◽

Yafit Cohen-Freud ◽

Ilan Shelef ◽

Ariel Tarasiuk

Keyword(s):

Computed Tomography ◽

Bone Mineral Density ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Bone Mineral ◽

Clinical Information ◽

Mineral Density ◽

Peak Voltage ◽

Arousal Index ◽

Obstructive Sleep

Abstract The association between obstructive sleep apnea (OSA) and bone mineral density (BMD) is poorly elucidated with contradictory findings. We retrospectively explored the association between OSA and BMD by examining abdominal computed tomography (CT) vertebrae images using clinical information. We included 315 subjects (174 with OSA and 141 without OSA) who performed at least two CT scans (peak voltage of 120 kV). Bone mineral density was attenuated in those with OSA and increased age. BMD attenuation was not associated with the apnea–hypopnea score, nocturnal oxygen saturation, or arousal index. A multivariate linear regression indicated that OSA is associated with BMD attenuation after controlling for age, gender, and cardiovascular diseases. Here, we report that OSA is associated with BMD attenuation. Further studies are required to untangle the complex affect of OSA on BMD loss and possible clinical implication of vertebra depressed fracture or femoral neck fracture.

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Saccadic velocity as an arousal index in naturalistic tasks

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2013.03.011 ◽

2013 ◽

Vol 37 (5) ◽

pp. 968-975 ◽

Cited By ~ 90

Author(s):

Leandro L. Di Stasi ◽

Andrés Catena ◽

José J. Cañas ◽

Stephen L. Macknik ◽

Susana Martinez-Conde

Keyword(s):

Arousal Index ◽

Saccadic Velocity

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0892 Sleep Abnormalities in Cornelia De Lange Syndrome

SLEEP ◽

10.1093/sleep/zsaa056.888 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A339-A340

Author(s):

R Villalobos ◽

A P Villalobos ◽

R Villalobos ◽

I A Villarreal ◽

D Grimaldo ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Sleep Onset ◽

Clinical Information ◽

Sleep Apnea Syndromes ◽

Autosomal Dominant Disorder ◽

Arousal Index ◽

Increased Risk ◽

Cornelia De Lange ◽

Severe Degree ◽

Disordered Breathing

Abstract Introduction Cornelia de lange is an autosomal dominant disorder (when associated with NIPBL, RAD21, or SMC3 genes) with an incidence of 1:10,000 to 1:50,000 live births, patients affected are known to have a wide variety of sleep disorders, those range from insomnia and abnormal circadian cycle to sleep disordered breathing and hypoventilation. The exact etiology of increased risk of sleep-disordered breathing in patients affected is not fully understood. It is possible that some facial features in these patients expose them to a higher risk (micrognathia, high arched palate, and short neck). We wanted to analyze the sleep related problems in CDLS. Methods We included 3 patients with the disorder, age range from 15 months to 16 years old. All patients met criteria for CDLS diagnosis, all had intellectual disability and behavioral associated symptoms. The somnology evaluation included questionnaires of diurnal behavior and sleep focused logs. We performed nocturnal polysomnography in only 2 patients due to inability to tolerate the test in one case. Results Sleep clinical information was abnormal in all the cases. Overnight behavioral video evaluation was done. The behavioral abnormalities were evident in all subjects and severe in one. Overnight polysomnography demonstrated a moderate to severe degree of OSA, delayed sleep onset suggestive of insomnia, sleep-wake transition disorder with elevated WASO time, and arousal disorder with elevated spontaneous arousal index. It is of interest the finding of sleep related hypoxemia with limited evidence of obstructive component in one patient. Conclusion The abnormalities in sleep are frequent in CDLS, there are wide and present in the sleep architecture and the sleep ventilation, sleep apnea syndromes are frequent but are not the only major sleep-related abnormalities. When CDLS is caused by mutations in the HDAC8 or SMC1A gene, the condition has an X-linked dominant pattern inheritance. Most cases result from new mutations in the HDAC8 or SMC1A gene and occur in people with no history of the condition in their family, likely our cases are related to this mode of transmission and potential different patters of sleep disruption are dependent on different genes involved. Support None

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Clinical and PSG Characteristics of Children with Mild OSA and Respiratory Events Terminated Predominantly with Arousal

Canadian Respiratory Journal ◽

10.1155/2021/5549423 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Yunxiao Wu ◽

Li Zheng ◽

Panting Wu ◽

Yufen Tang ◽

Zhifei Xu ◽

...

Keyword(s):

Life Questionnaire ◽

Sleep Related Breathing Disorders ◽

Arousal Index ◽

Respiratory Events ◽

Younger Age ◽

Obstructive Sleep ◽

Respiratory Event ◽

Mild Obstructive Sleep Apnea ◽

Stage 1

Objective. To analyze the clinical and polysomnographic characteristics in children with mild OSA and respiratory events terminated predominantly with arousal. Methods. Children aged 3–10 yrs who had mild obstructive sleep apnea (OSA) were enrolled. All children underwent polysomnography, and patients’ data were collected by using sleep-related breathing disorders (SRBD) questionnaire and OSA-18 quality of life questionnaire. Results. In total, five hundred and seventy-seven children were eligible. Children in arousal predominant group were younger and showed a lower rate of male and obesity. Compared with that of the nonarousal predominant group, the total arousal index, arousal index related to respiratory event, the percentage of NREM stage 1 (N1%), the fraction of respiratory events that were hypopnea, and the mean and minimum oxygen saturation in the arousal predominant group were significantly greater. The percentage of NREM stage 3 (N%), index of obstructive, central, mixed apnea, the fraction of respiratory events that were obstructive, and central and mixed apnea were significantly lower in arousal predominant group. Conclusion. Children with mild OSA in the arousal predominant group had specific characteristics, including younger age, lower rate of male and obesity, worse sleep architecture, higher rates of hypopnea events, and better oxygenation. This trial is registered with NCT02447614.

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Non breathing-related sleep fragmentation and imaging markers in patients with atherosclerotic cerebral small vessel disease (CSVD), a cross-sectional case-control study

10.21203/rs.2.15917/v1 ◽

2019 ◽

Author(s):

Jihui Wang ◽

Xiaodong Chen ◽

Jinchi Liao ◽

Li Zhou ◽

Hongying Han ◽

...

Keyword(s):

Small Vessel Disease ◽

Sleep Onset ◽

Cerebral Small Vessel Disease ◽

Sleep Fragmentation ◽

Small Vessel ◽

Arousal Index ◽

Vessel Disease ◽

Imaging Markers ◽

The Relationship ◽

Normal Controls

Abstract Objective Evidence of a relationship between non breathing-related sleep fragmentation and imaging markers of the brain in cerebral small vessel disease (CSVD) patients is scarce. The purpose of the present study was to investigate the relationship in CSVD patients living in China, where CSVD is a major pathogenesis underlying stroke. Methods A group of 84 CSVD patients were prospectively recruited along with 24 age and sex matched normal controls. 3.0 T superconducting magnetic resonance imaging and overnight polysomnography were conducted in all the participants. Polysomnography parameters including sleep onset latency, total sleep time; sleep efficiency, wake after sleep onset, percentage of each sleep stage (N1, N2, N3 and REM) and arousal index were compared between the CSVD patients and normal controls, and the relationship between arousal index and CSVD markers was explored in the CSVD group. Results Polysomnography measures showed that CSVD patients had significantly higher arousal index and wake after sleep onset, lower sleep efficiency and N-3 ratio compared to normal controls ( p < 0.05). The results of ordinal logistic regression showed that higher arousal index was positively associated with the severity of periventricular white matter hyperintensity (OR 1.177, 95% CI 0.170 to 2.295) and perivascular space (OR 1.245, 95% CI 0.485 to 2.124) in CSVD patients, after adjusting for all the independent variables. Conclusions These preliminary results indicate that non breathing-related sleep fragmentation is common and related to the pathological markers of CSVD patients. Future prospective research is invited to establish the causal relationship between sleep parameters and CSVD pathology.

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601 Comparison of Sleep Parameters in Children with Achondroplasia and Trisomy 21

SLEEP ◽

10.1093/sleep/zsab072.599 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A236-A237

Author(s):

Jodi Gustave ◽

Kaelyn Gaza ◽

Jennifer Marriner ◽

Seema Rani ◽

Abigail Strang ◽

...

Keyword(s):

Sleep Quality ◽

Rem Sleep ◽

Trisomy 21 ◽

Sleep Disturbances ◽

Sleep Latency ◽

Sleep Efficiency ◽

Sleep Architecture ◽

Poor Sleep ◽

Arousal Index ◽

Sleep Parameters

Abstract Introduction Children with achondroplasia and Trisomy 21 (T21) have increased incidence of sleep disturbances including sleep disordered breathing. Abnormal sleep architecture has been documented in children with T21. It is important to continue to analyze sleep parameters in both groups since poor sleep quality is associated with neurocognitive impairment. Methods Following IRB approval, we performed a retrospective chart review of patients at Nemours/A.I. duPont Hospital for Children in Wilmington, DE with achondroplasia and T21 who underwent an initial polysomnogram (PSG) between 2015 and 2020. We compared sleep architecture parameters between the groups including sleep efficiency, total sleep time (TST), sleep latency, arousal index and concentration of N3 and REM sleep. Results In patients with achondroplasia (n=49, mean age 5.8 months and 63.3% male), 12% reported restless sleep. PSG data revealed TST of 392 minutes, mean sleep efficiency of 82%, mean sleep latency of 9.4 min, mean arousal index of 40, 22% REM sleep and 32% N3 sleep. In the patients with T21 (n=32, mean age 17.8 months and 50% male), 59% reported restless sleep. PSG data revealed TST of 393 minutes, mean sleep efficiency of 82%, mean sleep latency of 14 minutes, arousal index of 35, 15% REM sleep and 40% N3 sleep. The differences in REM and N3 sleep between the two groups were statistically significant (p-values of 0.001 and 0.04, respectively), but the differences in arousal index, TST and sleep efficiency were not. Conclusion Our study showed that children with T21 subjectively noted more restless sleep compared to patients with achondroplasia although TST and sleep efficiency were similar. Patients with achondroplasia had a higher arousal index that was not statistically significant. Children with achondroplasia had a shorter sleep latency and more robust REM concentration, likely due to their younger age. There was a higher concentration of N3 sleep in patients with T21. This is likely due to the decrease in REM concentration. In conclusion, it is important to establish expected sleep parameters in patients with achondroplasia and T21 to maximize sleep quality and mitigate negative neurocognitive effects of poor sleep. Support (if any):

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