A novel device (SD-101) with high accuracy for screening sleep apnoea-hypopnoea syndrome

Background and objective: The SD-101 is a non-restrictive, sheet-like medical device with an array of pressure sensors, to detect sleep-disordered breathing by sensing gravitational alterations in the body corresponding to respiratory movements. This study evaluated the accuracy of the SD-101 for screening sleep apnoea-hypopnoea syndrome (SAHS) by comparison with polysomnography. Methods: Nocturnal polysomnography and SD-101 monitoring were conducted simultaneously and compared in 201 patients with suspected SAHS (suspected SAHS group) and 165 male employees of a transport company (screening group). Results: Polysomnography revealed an AHI of = 60 events/h in 39, 35, 38, 68 and 21 subjects in the suspected SAHS group and 103, 34, 12, 12 and four subjects in the screening group, respectively. Central SAHS and obstructive SAHS were subsequently diagnosed in 11 (5.5%) and 135 (67.2%) of subjects in the suspected SAHS group and five (3.0%) and 39 (23.6%) of subjects in the screening group, respectively. Significant correlations were apparent between AHI and the respiratory disturbance index (RDI) measured with the SD-101 in both the suspected SAHS group (r = 0.88) and screening group (r = 0.92). Receiver operating characteristic curve analysis revealed 89.5% sensitivity and 85.8% specificity in identifying SAHS, using an RDI of 14.0 events/h. Conclusions: These findings suggest that the SD-101 is a useful device for screening SAHS.ArticleRESPIROLOGY. 14(8):1143-1150 (2009)journal articl

Enhancing the Diagnosis and Management of Obstructive Sleep Apnoea in Atrial Fibrillation Patients

Background: Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia, and significantly increases the risk of stroke and cardiovascular mortality. It is strongly associated with obstructive sleep apnoea (OSA). Aims: 1. Examine the epidemiology of OSA in a hospital cohort with AF. 2. Compare the diagnostic accuracy of clinical screening tools for OSA in patients with AF. 3. Compare cardiac autonomic function in AF patients with and without OSA. 4. Conduct a pilot study of mandibular advancement splint (MAS) therapy for OSA in AF patients. Methods: 107 AF patients were recruited. The diagnostic accuracy of screening tools including a level 3 (portable) sleep study device as compared to polysomnography in AF patients was assessed. Cardiac autonomic function as a potential mechanistic link between OSA and AF was assessed using Heart Rate Variability (HRV). A pilot study of OSA treatment in AF patients using MAS therapy was conducted. Results: 62.6% of patients were newly diagnosed with OSA. Patients with moderate to severe OSA showed an increased BMI, neck circumference and Mallampati score, but were not significantly different in terms of daytime somnolence. Oxygen desaturation index (ODI) derived from a Level 3 portable sleep study device performed best for the diagnosis of moderate to severe and severe OSA, with excellent diagnostic accuracy (AUC 0.899, 95% CI 0.838 – 0.960 and AUC 0.925, 95% CI 0.859 – 0.991 respectively). We found a chronic increase in parasympathetic nervous activity in paroxysmal AF patients with OSA. MAS therapy showed high rates of acceptance, compliance and efficacy in AF patients. Conclusions: This thesis contributes to our understanding of the association between AF and OSA across a spectrum o

Sleep medicine and dentistry

Many health care professionals and patients are unclear of the role that dentists may play in the management of Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAHS.) The dentists’ role is primarily in the construction of appliances for OSAHS but in the United States of America some dentists have practices limited to “Sleep dentistry”. However, in the United Kingdom there is limited training for dentists in this field. This thesis aims to review the relevant literature that pertains to OSAHS and dentistry and then, through three studies, to look at the past, present and future involvement of dentists in OSAHS. Assessing outcome is clearly important and this thesis firstly presents patient-based findings of the long term success of mandibular advancement appliances. Secondly, the experience and views of dentists and sleep specialists, assessed by questionnaire, is presented. Finally, a prospective study of a promising screening tool (the Kushida Index) for the diagnosis of sleep apnoea is carried out

Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review

Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data

Psychometric Properties of Obstructive Sleep Apnea Screening Measures in Patients Referred to a Sleep Clinic

Background: Obstructive Sleep Apnea (OSA) contributes to all-cause and cardiac mortality. There are no current guidelines for OSA screening in outpatient settings. An American Academy of Sleep Medicine task force is focusing on improving detection and categorization of OSA symptoms and severity to promote screening, assessment, and diagnosis of the disorder. The purpose of this study was to identify the psychometric properties of three self-report OSA screening measures (Berlin, Epworth Sleepiness Scale (ESS), STOP Bang) and an objective portable sleep monitor (PSM) compared to apnea-hypopnea index (AHI) levels (≥5, ≥ 15, and ≥ 30) from polysomnogram (PSG). Methods: A methodological design was used. Patients referred to a sleep specialist for an OSA consultation were recruited and enrolled at initial sleep evaluation. Participants completed the three OSA self-report screening measures and those participants who met inclusion criteria were sent home with a PSM for one night measurement. Automatic scoring was used. PSGs were ordered by the physician and AHI results were obtained from the medical record. Results: Participants (N=170) were enrolled (88 male, 82 female; age 54.5, SD 5.0 years). Almost all participants completed the self-report OSA screening measures, approximately half completed PSM measurement, and the majority completed laboratory PSG. The STOP Bang had the highest levels of sensitivity; the ESS had the lowest. The ESS had the highest specificity and reliability level. The PSM measure had the highest positive predictive value (PPV). The PSM measure had the strongest psychometric properties of the screening measures. Conclusions: The STOP Bang was the preferred self-report OSA screening measure because of high sensitivity levels. A positive STOP Bang warrants assessment for OSA. The ESS is the least desirable screening measure. If a patient qualifies, further screening with a PSM is indicated. PSM measurement consistently predicted the presence of OSA but at the expense of low sensitivity at AHI levels ≥ 30. PSM results can guide the referral process from primary or specialty clinicians to sleep specialist

Continuous Positive Airway Pressure Use and Mild Obstructive Sleep Apnea Syndrome (OSAS)

ABSTRACT CONTINUOUS POSITIVE AIRWAY PRESSURE USE AND MILD OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) by Michelle L. Nelson The University of Wisconsin-Milwaukee, 2014 Under the Supervision of Jennifer Doering, PhD, RN Obstructive sleep apnea syndrome (OSAS) is an increasingly recognized sleep disorder that affects an estimated ten percent of middle-aged women and 25 percent of middle-aged men. Continuous positive airway pressure (CPAP) is the standard treatment for individuals with moderate to severe OSAS. However, it is estimated that 80 percent of individuals with OSAS have a milder form of the disease. The use of CPAP therapy in persons with mild OSAS has not been widely researched and whether CPAP is efficacious in this population remains inconclusive. OSAS has both psychological and physiological effects on people. Two common effects of CPAP use in persons with moderate and severe OSAS are reduced excessive daytime sleepiness (EDS) and reduced blood pressure. The purpose of this study was to examine the effectiveness of CPAP use on blood pressure and EDS in persons with mild OSAS. CPAP use was defined as using CPAP for more than 4 hours per night for more than 70 percent of nights recorded by the CPAP machine. The study design was a retrospective chart review of electronic medical records (EMR) from a sleep medicine clinic in the southeastern United States. The sample consisted of 60 participants with mild OSAS who were divided into two groups based upon the amount of CPAP use recorded in the EMR (4 or more hours of nightly use 70% of nights, n = 45 and less than 4 hours of nightly use 70% of nights, n = 15). Blood pressure (systolic and diastolic) and daytime sleepiness (Epworth Sleepiness Scale) data were collected on each participant before the initiation of CPAP therapy and at six weeks follow up. Independent samples t-tests were conducted to examine the differences between the groups from baseline to six-week follow-up on the outcome variables. No statistical significance was found for daytime sleepiness (t [34] = .865, p = .393) or either systolic (t [52] = .911, p = .367) or diastolic (t [52] = 1.002, p = .321) pressures. Sleepiness scores in the group who used CPAP four or more hours a night 70% of nights decreased 6.6 points from baseline to 6 weeks, and decreased 8.1 points in the group who used CPAP less than 4 hours a night 70% of the nights. Both groups experienced clinically significant decreases in daytime sleepiness from nearly excessive daytime sleepiness (ESS score \u3e10) before CPAP initiation to nearly no daytime sleepiness at six weeks follow up. There were significant limitations in data collection around both the EMR and the CPAP machine reporting that have implications for practice, research, and policy. Recommendations include standardization of CPAP use reporting across machine type and improving quality around data entry in the EMR. These results support the continued need to research the effectiveness of CPAP in persons with mild OSAS

All night analysis of time interval between snores in subjects with sleep apnea hypopnea syndrome

Sleep apnea–hypopnea syndrome (SAHS) is a serious sleep disorder, and snoring is one of its earliest and most consistent symptoms. We propose a new methodology for identifying two distinct types of snores: the so-called non-regular and regular snores. Respiratory sound signals from 34 subjects with different ranges of Apnea-Hypopnea Index (AHI = 3.7–109.9 h−1) were acquired. A total number of 74,439 snores were examined. The time interval between regular snores in short segments of the all night recordings was analyzed. Severe SAHS subjects show a shorter time interval between regular snores (p = 0.0036, AHI cp: 30 h−1) and less dispersion on the time interval features during all sleep. Conversely, lower intra-segment variability (p = 0.006, AHI cp: 30 h−1) is seen for less severe SAHS subjects. Features derived from the analysis of time interval between regular snores achieved classification accuracies of 88.2 % (with 90 % sensitivity, 75 % specificity) and 94.1 % (with 94.4 % sensitivity, 93.8 % specificity) for AHI cut-points of severity of 5 and 30 h−1, respectively. The features proved to be reliable predictors of the subjects’ SAHS severity. Our proposed method, the analysis of time interval between snores, provides promising results and puts forward a valuable aid for the early screening of subjects suspected of having SAHS

Stress resilience, sleep and physical activity in older manual workers.

This thesis investigated the relationships between stress resilience, sleep and physical activity (PA) in older manual workers (OMW). The first study aimed to explore latent profiles of individuals at risk of ill health and being based on presenteeism, stress resilience and PA. Profiles of OMW differed on work-related affect and health perceptions, and high levels of PA were associated with lower levels of presenteeism. As such, implementing interventions that focus on high levels of PA may be efficient in the reduction of presenteeism in some groups of OMW and potentially in improving stress resilience. The aim of study two in this thesis was to explore the relationship between perceived psychological resilience and work-related factors (presenteeism and work engagement) and the physiological response to acute psychological stress in a group of OMW. The results indicated that psychological resilience was not associated with work-related factors. In contrast, cardiovascular reactivity was significantly related to work-related factors such that workers with high levels of presenteeism and low work engagement had high heart rate reactivity to stress. Thus, exaggerated cardiac reactivity in workers with high presenteeism may provide a pathway to cardiovascular disease (CVD). Study three examined the association of PA levels, BMI and undiagnosed obstructive sleep apnoea (OSA), which is common in OMW. Preliminary results indicated that undiagnosed OSA was associated with low levels of PA, although BMI was a stronger indicator, implying that PA may be a modifiable risk factor in OSA development. The aim of the fourth and final study of this thesis was to investigate the ability of a 12-week PA intervention to reduce moderate OSA independent of BMI in a group of older workers. The results indicated that the PA intervention was effective in the reduction of OSA independent of BMI and weight-loss and therefore, supports previous research that increasing PA may provide a means of managing OSA and improving cardiovascular health. In summary, increasing levels of PA, decreasing stress and promoting sufficient quality and duration of sleep may well be the pathway to promoting good health and wellbeing in older workers, which will enable them to continue a long and efficient working life