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2021 ◽  
Author(s):  
Matthias Schlichting ◽  
Shlesha Richhariya ◽  
Nicholas Herndon ◽  
Dingbang Ma ◽  
Jason Xin ◽  
...  

The metronome-like circadian regulation of sleep timing must still adapt to an uncertain environment. Recent studies in Drosophila indicate that neuromodulation not only plays a key role in clock neuron synchronization but also affects interactions between the clock network and brain sleep centers. We show here that the targets of neuromodulators, G-Protein Coupled Receptors (GPCRs), are highly enriched in the fly brain circadian clock network. Single cell sequencing indicates that they are not only differentially expressed but also define clock neuron identity. We generated a comprehensive guide library to mutagenize individual GPCRs in specific neurons and verified the strategy with a targeted sequencing approach. Combined with a behavioral screen, the mutagenesis strategy revealed a novel role of dopamine in sleep regulation by identifying two dopamine receptors and a clock neuron subpopulation that gate the timing of sleep.


SLEEP ◽  
2021 ◽  
Author(s):  
Emanuela Postiglione ◽  
Lucie Barateau ◽  
Fabio Pizza ◽  
Régis Lopez ◽  
Elena Antelmi ◽  
...  

Abstract Study objectives To describe the phenotype of narcolepsy with intermediate cerebrospinal hypocretin-1 levels (CSF hcrt-1). Methods From 1600 consecutive patients with narcolepsy from Bologna and Montpellier sleep centers we selected patients with intermediate CSF hcrt-1 levels (110-200 pg/ml). Clinical, neurophysiological and biological data were contrasted for the presence of cataplexy, HLA-DQB1*06:02, and median CSF hcrt-1 levels (149.34 pg/mL). Results Forty-five (55% males, aged 35 ± 17 years) patients (2.8% of all cases) were included. Thirty-three (73%) were HLA-DQB1*06:02, 29 (64%) reported cataplexy (21, 72.4% with typical features), and 5 (11%) had presumed secondary etiology. Cataplexy was associated with other core narcolepsy symptoms, increased sleep onset REM periods, and nocturnal sleep disruption. Cataplexy and irrepressible daytime sleep were more frequent in HLA DQB1*06:02 positive patients. Lower CSF hcrt-1 levels were associated with hallucinations. Conclusion Narcolepsy with intermediate CSF hcrt-1 level is a rare condition with heterogeneous phenotype. HLA DQB1*06:02 and lower CSF hcrt-1 were associated with typical narcolepsy features, calling for future research to distinguish incomplete from secondary narcolepsy forms.


SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A208-A208
Author(s):  
John Feemster ◽  
Paul Timm ◽  
Luke Teigen ◽  
Sarah Faber ◽  
Tyler Steele ◽  
...  

Abstract Introduction Idiopathic/isolated REM sleep behavior disorder (iRBD) is a prodromal alpha-synucleinopathy characterized by dream enactment behavior and REM sleep without atonia (RSWA). We sought to define quantitative RSWA diagnostic thresholds in the North American Prodromal Synucleinopathy (NAPS) Consortium cohort. We analyzed RSWA between iRBD patients across participating NAPS sleep centers, compared to normative controls, and hypothesized that previous diagnostic RSWA thresholds were overestimates. Methods All digital polysomnography files were converted to European Data Format and scored at a central laboratory (Mayo Clinic) which standardized display scoring montages, channel sensitivities, and filtering, and scripted computational analyses for visual scoring. RSWA was quantitatively analyzed in the submentalis (SM) and anterior tibialis (AT) muscles in iRBD (n=86) patients and controls (n=118) utilizing well validated visual (Mayo) and automated (RAI) methods. Parametric statistics were used to compare RSWA metrics, and RSWA thresholds were developed using receiver operating characteristic curves. Results RSWA was significantly higher for the RAI and all visual individual and combined muscle activity metrics in iRBD compared to controls (all p<0.001). Average SM phasic measures were: 14.2% (Mayo), 17.9% (McGill), 18.5% (UCLA), and 9.4% (Washington University). Average AT phasic measures at each site were: 26.7% (Mayo), 17.1% (McGill), 23.3% (UCLA), and 17.4% (Washington University). Average SM/AT ‘any’ measures at each site were: 45.4% (Mayo), 35.9% (McGill), 53.4% (UCLA), and 23.5% (Washington University). Overall cohort RBD diagnostic thresholds (AUC, specificity/sensitivity) were: SM phasic 4.9% (90.0, 82.2%/83.7%); AT phasic 7.6% (88.7%, 82.2%/81.4%) and combined SM/AT ‘any’ 13% (94.6, 83.9%/96.5%). Conclusion RSWA thresholds in the NAPS cohort were substantially lower than previously reported, suggesting previously overestimated diagnostic RSWA thresholds due to smaller, enriched patient samples and overfit statistical modeling. Confirmation of these findings in the complete NAPS cohort (n=300 iRBD patients across all 10 NAPS centers) is planned. Support (if any):


Author(s):  
Wojciech Kuczyński ◽  
Aleksandra Kudrycka ◽  
Aleksandra Małolepsza ◽  
Urszula Karwowska ◽  
Piotr Białasiewicz ◽  
...  

The aim of this study is to provide a brief summary of the epidemiological data on obstructive sleep apnea syndrome (OSAS) diagnosis and therapy in different regions of Poland from 2010 to 2019. We performed a retrospective study in the sleep center of the Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Poland. We requested data from the National Health Service concerning the number of new diagnoses of OSAS, the polysomnographies (PSGs) that were performed, and reimbursements of positive airway pressure (PAP) therapy in each region of Poland in the period 2010–2019. The constant increase in the number of polysomnographies performed and PAP reimbursements suggests the need to create a national network between regional sleep centers to provide proper care for patients with OSAS, and PAP therapy.


Author(s):  
Bhanu Prakash Kolla ◽  
Meghna P. Mansukhani
Keyword(s):  

CHEST Journal ◽  
2020 ◽  
Vol 158 (3) ◽  
pp. 1187-1197
Author(s):  
Fabiola G. Rizzatti ◽  
Diego R. Mazzotti ◽  
Jesse Mindel ◽  
Greg Maislin ◽  
Brendan T. Keenan ◽  
...  

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A263-A263
Author(s):  
W Hardy ◽  
J Jasko ◽  
R Bogan

Abstract Introduction There is no universal process for selecting mask style, size, and fit, and there is considerable variance in clinician and patient mask preference and patient anatomy. Poor mask fit may negatively affect adherence. A three-dimensional (3D) facial scanner and proprietary analytical software were developed to bring efficiencies to mask selection. This study explored the impact of that system on initial mask success compared to standard practice. Methods This was an open-label, randomized-controlled study. Participants provided written informed consent. 3D Scanner Arm (3DA): Participants answered questions about sleeping habits then had 3D facial images taken. Proprietary software recommended a hierarchy of up to four Philips Respironics masks and sizes. Traditional Fitting Arm (TFA): A designated clinician selected and fit masks using their standard methods. Mask selection was assessed by applying therapy and soliciting patient and clinician feedback. Mask refits and adherence were tracked through 90 days. Five sleep centers recruited 115 participants into the 3DA (61 males, 51.1±13.4 years, BMI 35.2±7.0, diagnostic AHI 26.2±21.9) and 123 into the TFA (79 males, 51.1±11.9 years, BMI 35±7.9, diagnostic AHI 26.9±22.6). Results A significantly higher percentage of 3DA patients required only one mask fitting (with no refits) compared to TFA during the initial setup (89.6% vs. 54.5%, p<0.001) and through 90 days (62.6% vs 37.4%, p<0.001). 3DA subjectively rated confidence in and satisfaction with the scanner-selected mask significantly higher than TFA. Mask leak was lower in the 3DA compared to TFA (29.4±10.6 vs 32.3±11.4 L/M, p= 0.043). The CMS adherence rate tended to favor 3DA vs. TFA (66.7% vs. 55.3, p=0.083). There were no significant differences in AHI or other adherence metrics. Conclusion The 3D scanner system was successful in mask selection with lower mask leak and greater patient satisfaction and confidence. This tool may bring about operational efficiencies to the mask selection process. Support This study was sponsored by Philips Respironics


SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A166-A167
Author(s):  
W Lin ◽  
P Kuo ◽  
M Liu ◽  
C Li ◽  
C Lin ◽  
...  

Abstract Introduction According to a survey by World Sleep Society, 45% of the population suffered from sleep disorders. The best way to diagnose these patients is to use Polysomnography (PSG), recording their physiological signals throughout the night. Mostly, sleep technologists manually score sleep stages. Manual scoring is quite subjective and time-consuming. Although the technologist’s judgments are based on scoring standards of the American Academy of Sleep Medicine, fine-tuning scoring results because of different considerations in different sleep centers may be happened. In order to assess the consistency of scoring standards in sleep technologists, we tried to establish a cloud sleep scoring system and evaluate its feasibility in 4 sleep centers in southern Taiwan. Methods We constructed a computer-aided cloud sleep scoring system. Each sleep technologist could score the same test data of PSG online without being restricted by places and hardware equipment. After comparing scoring results of all participants, the scoring system could provide the following reports, including an overall agreement, agreement of each sleep stage and each sleep index. Besides, multi-person scoring results of each epoch with displaying physiological signals were analyzed. Results Seven sleep technologists from 4 hospitals in Tainan, Taiwan joined this study. Standard deviations (SDs) of each sleep stage included 2.64 in Wake stage, 6.90 in N1, 8.31 in N2, 6.87 in N3, 1.38 in REM, respectively. SDs of sleep indexes were 2.64 in sleep efficiency, 2.14 in sleep onset time, 8.35 in wake after sleep onset time, 10.03 in total sleep time, individually. The overall agreement was 89.6%. The satisfaction of this scoring system operation was 85.7%. Conclusion With the cloud sleep scoring system assistance, it was feasible to evaluate the scoring consistency among sleep technologists in different sleep centers. Support This work is supported by the Ministry of Science and Technology, Taiwan. (MOST 108-2634-F-006-012)


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