Special Issue:Sleep
A Study on the Diurnal Variation of Ventricular Repolarization Parameters in Patients with Obstructive Sleep Apnea
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep breathing disorder. More and more studies have shown that OSAHS has a significant correlation with cardiovascular disease. It is an independent risk factor for arrhythmia, hypertension, coronary heart disease and other cardiovascular diseases, but the specific mechanism is still not completely clear. Relevant evidence indicates that ventricular repolarization parameters such as Tp-e interval, QT interval and Tp-e/QT ratio may be related to arrhythmia and even sudden cardiac death. However, up to now, there are relatively few studies on OSAHS-related arrhythmias and changes in cardiac electrical parameters.
To study the diurnal variation of ventricular repolarization parameters in patients with obstructive sleep apnea.
A total of 159 OSAHS patients who met the inclusion criteria and received polysomnography monitoring in the First Affiliated Hospital of Zhengzhou University from June 2020 to July 2021 were selected as the observation group, further divided into mild-moderate OSAHS group (n=78) and severe OSAHS group (n=81) according to the severity. Fifty-one healthy people without disease were selected as the control group. Daytime and nocturnal Tp-e interval, QT interval, Tp-e/QT ratio were measured and calculated for all participants.
There were significant differences in daytime Tp-e interval, nocturnal Tp-e interval, daytime Tp-e/QT ratio, nocturnal Tp-e/QT ratio among the control group、the mild-moderate OSAHS group and the severe OSAHS group (P<0.001) . In addition, the daytime Tp-e interval, nocturnal Tp-e interval, daytime Tp-e/QT ratio and nocturnal Tp-e/QT ratio have a gradually increasing trend among the three groups (P<0.05) . There were no significant differences in daytime QT interval and nocturnal QT interval among the three groups (P>0.05) .Tp-e interval, QT interval, Tp-e/QT ratiosin the observation group were statistically different between daytime resting state and nocturnal obstructive state (P<0.05) ; The Tp-e interval, QT interval, and Tp-e/QT ratio in nocturnal obstructive state were significantly longer than those in daytime resting state (P<0.05) .The nocturnal Tp-e interval (rs=0.221, P=0.005) and nocturnal Tp-e /QT (rs=0.298, P<0.001) of OSAHS patients were positively correlated with AHI.
Ventricular repolarization parameters in OSAHS patients during nocturnal obstructive apnea are longer than those in daytime resting state, and the diurnal variation is significant, which provides a new idea for the future study of OSAHS with arrhythmia.
Characteristics of Attention Deficit and Hyperactivity Disorder in Children with Sleep-disordered Breathing
Children with sleep-disordered breathing (SDB) are more prone to attention deficit, and hyperactivity disorder, which seriously impairs their learning ability and long-term intellectual development. However, there is a lack of comprehensive analysis of attention deficit, and hyperactivity disorder in SDB children.
To investigate the characteristics of attention deficit, and hyperactivity disorder in children with SDB, so as to provide a basis for making clinical decisions for such patients.
Children aged 4-10 years with snoring or mouth breathing, who were admitted to the Sleep Center, Beijing Children's Hospital, Capital Medical University from May 2020 to June 2021 were selected. Physiologic parameters during sleep were measured by polysomnography. Attention deficit and hyperactivity disorder symptoms were assessed by parent-rated attention deficit and hyperactivity disorder Symptoms Scale (PASS) . The severity of obstructive sleep apnea (OSA) was classified by obstructive apnea-hypopnea index (OAHI) : OAHI≤1 event/hour, 1<OAHI≤5 events/hour and OAHI>5 events/hour were defined as primary snoring, mild OSA, and moderate to severe OSA, respectively. Polysomnographic parameters〔total sleep time, sleep efficiency, non-rapid eye movement (NREM) sleep stage 1 (N1%) , stage 2 (N2%) , and stage 3 (N3%) and REM sleep percentage of total sleep time (R%) , OAHI, arousal index (ArI) , oxygen desaturation index (ODI) , average oxygen saturation (SpO2) and SpO2 nadir〕 were compared by the severity of OSA. The prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS were compared by the severity of OSA, sex and age.
Seventy-six cases of primary snoring, 86 cases of mild OSA and 77 cases of moderate to severe OSA were included. Moderate to severe OSA children had greater N1%, OAHI, ArI, and ODI, and lower average SpO2 and SpO2 nadir than other two groups (P<0.05) . The R% of moderate to severe OSA group was lower than that of primary snoring group (P< 0.05) . OAHI, ArI and ODI were higher and SpO2 nadir was lower in children with mild OSA than those with primary snoring (P<0.05) . The prevalence of attention deficit, and attention deficit and hyperactivity disorder diagnosed by the PASS in moderate to severe OSA group was statistically higher than that in primary snoring group (P '<0.016 7) . Male children had higher prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS than female children (P<0.05) . Compared with preschoolers, school-age children have higher prevalence of attention deficit and attention deficit and hyperactivity disorder diagnosed by the PASS (P<0.05) .
The prevalence of attention deficit and hyperactivity disorder in children with SDB was higher than that in the general population. Male children had higher prevalence of attention deficit and hyperactivity disorder than female children. And the prevalence of attention deficit in school-age children was higher than that in preschoolers.
The Value of Abdominal Visceral Adipose Tissue Area and Homeostasis Model Assessment of Insulin Resistance in Predicting Essential Hypertension Complicated with Obstructive Sleep Apnea Syndrome
The prevalence of essential hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) has been increasing year by year. However, due to the differences in medical conditions and lack of clinical understanding in different regions of China, the diagnosis of hypertension complicated with OSAHS is still insufficient. Relevant studies have shown that the pathogenesis of hypertension complicated with OSAHS is closely related to the ectopic accumulation of fat and insulin resistance.
This study attempted to analyze the relationship between OSAHS and abdominal visceral adipose tissue (VAT) and homeostasis model assessment of insulin resistance (HOMA-IR) , and their predictive value for hypertension complicated with OSAHS.
Two hundred and thirty-four patients with essential hypertension treated at hypertension center of Yan'an Hospital of Kunming Medical University from January 2019 to July 2020 were enrolled in the study. The HOMA-IR of the enrolled patients was calculated by polysomnography, VAT measurement, parallel glucose tolerance and insulin release experiments. According to the AHI level, 27 patients were divided into hypertension group (AHI<5 times/h) , and 207 patients were divided into hypertension complicated with OSAHS group (AHI≥5 times/h) . The levels of VAT and HOMA-IR were compared between 2 groups. The receiver operating characteristic (ROC) curve of screening hypertension patients complicated with OSAHS were determined by HOMA-IR and VAT, and the diagnosis value of area under AUC and different cut-off value were calculated. Logistic regression modeling was used to determine ROC curve with the saved probability as a separate variable to analyze the AUC of the two combined diagnosis of hypertension and OSAHS.
The VAT, HOMA-IR and BMI of hypertension complicated with OSAHS group were significantly higher than the hypertension group, while LSaO2 was significantly lower than the hypertension group. VAT, HOMA-IR and BMI were positively correlated with AHI (P<0.05) , and LSaO2 was negatively correlated with AHI (P<0.05) . The AUC of ROC curve for the diagnosis of hypertension complicated with OSAHS by VAT was 0.905 〔95%CI (0.861, 0.949) 〕, and the sensitivity and specificity were 0.763 and 0.926 when the diagnostic cut-off point was 100.5 cm2. The ROC curve AUC of HOMA-IR in the diagnosis of hypertension complicated with OSAHS was 0.813 〔95%CI (0.725, 0.900) 〕, when the diagnostic cut-off point was 2.015, the sensitivity and specificity were 0.797 and 0.778, respectively, and the AUC of ROC curve for combined factor diagnosis of hypertension complicated with OSAHS was 0.917 〔95%CI (0.871, 0.963) 〕, the diagnostic cut-off point was 2.045, the sensitivity and specificity were 0.831 and 0.963, respectively.
VAT and HOMA-IR in hypertension patients complicated with OSAHS are significantly higher than those in patients with hypertension. VAT and HOMA-IR have a certain predictive value for hypertension complicated with OSAHS, and can be applied to medical institutions that unconditionally carry out polysomnography, in order to intervene as early as possible to reduce the risk of serious complications of cardiovascular and cerebrovascular diseases.
Recent Advances in the Pathogenesis of Glucolipid Metabolism Disorder in Obstructive Sleep Apnea-hypopnea Syndrome
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a disease marked by apnea, hypopnea, decreased oxygen saturation, and disordered sleep structure, which is a major risk for cardiovascular disease. Recent studies have found that OSAHS patients have an increased risk of hypertension, coronary atherosclerotic heart disease, insulin resistance, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, etc. And these patients have a high prevalence of obvious glucolipid metabolism disorder (GMD) , which plays an important role in cardiovascular morbidity and mortality in OSAHS. We reviewed the latest advances in the association of GMD and OSAHS, and the potential pathogenesis of OSAHS-induced GMD and insulin resistance, aiming at providing new ideas for clinical treatment of GMD in OSAHS.
Role of Light Therapy in Circadian Rhythm Sleep-wake Disorders
Circadian rhythm sleep-wake disorder (CRSWD) affects people's health and well-being.Current treatments mainly include exogenous melatonin therapy and light therapy, among which light therapy plays an important role in the treatment of CRSWDas a non-drug treatment.We conducted a review on recent studies about CRSWD, covering the pathogenesis of CRSWD, principle and efficacy of light therapy in CRSWD, aiming to offer new ideas for clinical treatment of CRSWD.
Subjective cognitive decline (SCD) usually predicts the risk of future cognitive decline, and sleep disturbances are very common in patients with SCD and often precede detectable cognitive changes. Although there is a lack of clarity regarding the relationship between sleep and SCD and the underlying mechanisms of sleep-related cognitive deterioration, studies in recent years have shown a strong link between sleep and cognitive decline. Cognitive decline may be triggered by either sleep deprivation or decreased sleep quality. Therefore, the aim of this review is to provide a comprehensive overview of the research progress on sleep and subjective cognitive decline, and to explore in depth the mechanism of their interaction, with a view to providing new ideas and methods for preventing and delaying cognitive decline, and providing useful references for research and practice in related fields.
Patients with stroke often experience sleep disturbances and imbalances, which are easily overlooked in clinical treatment. Moreover, there is currently limited research on whether sleep status affects the prognosis of such diseases.
Exploration of factors influencing sleep state changes and prognosis in patients with acute posterior circulation ischemic stroke.
A total of 60 patients with acute posterior circulation ischemic stroke, admitted to Kailuan General Hospital Affiliated to North China University of Science and Technology, from December 2019 to December 2023, were selected as the case group. Based on the modified Rankin Scale (mRS) score at discharge, the case group was divided into a good prognosis subgroup (45 cases) and a poor prognosis subgroup (15 cases) . Additionally, 52 patients without cerebral vascular stenosis and acute ischemic stroke during the same period were selected as the control group. General and clinical data of the patients were collected to compare the circadian sleep-wake rhythms, daytime sleep-wake rhythms, nighttime sleep-wake rhythms, and the distribution of infarcted brain regions between the good prognosis subgroup and the poor prognosis subgroup. Multivariate Logistic regression analysis was used to identify the prognostic factors influencing the outcomes of patients with acute posterior circulation ischemic stroke.
The apnea-hypopnea index (AHI) in the case group was higher than in the control group (P<0.05) . The proportions of patients in the case group with reversed sleep cycles, increased daytime sleep, and difficulty falling asleep were higher than those in the control group, with statistically significant differences (P<0.05) . The case group showed higher total daytime sleep time, wake time after sleep onset, light sleep duration, deep sleep duration, NREM sleep duration, REM sleep duration, REM sleep proportion, and deep sleep proportion compared to the control group, whereas the proportions of NREM sleep and light sleep were lower, all with statistically significant differences (P<0.05) . The case group also exhibited longer total nighttime sleep time, light sleep duration, and NREM sleep duration than the control group, with statistically significant differences (P<0.05) . The proportion of pontine infarction in the poor prognosis subgroup was higher than in the good prognosis subgroup, with a statistically significant difference (P<0.05) . Multivariate Logistic regression analysis showed that daytime deep sleep duration (OR=1.203, 95%CI=1.032-1.401) and pontine infarction (OR=16.497, 95%CI=1.142-238.391) were influencing factors for the prognosis of acute posterior circulation ischemic stroke (P<0.05) .
Patients with acute posterior circulation ischemic stroke exhibit an increased AHI and present with sleep characteristics such as reversed sleep cycles, increased daytime sleep, and difficulty falling asleep at night. Additionally, daytime deep sleep duration and pontine infarction are factors that adversely affect the prognosis of these patients.
Insomnia not only decreases the quality of life and working efficiency, but also relates to other deceases. Suitable exercises may be useful to improve sleep quality. However, comparative studies on the effects of different types of exercise on sleep outcomes are currently lacked.
To compare the effects of different exercise types on sleep in insomnia patients and to provide insights for developing exercise prescriptions to improve sleep in this population.
Randomized controlled trials (RCT) investigating the effects of different types of exercises on the sleep of people with insomnia were retrieved from the PubMed, Web of Science, EBSCO, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform from database inception to December 2023. The quality of the literatures was assessed using the Jadad scale. A network meta-analysis was performed using the random-effects model of the frequency framework in Stata 17.0 software, and publication bias was observed using a funnel plot.
A total of 36 articles representing 2 706 participants were included in this study. Exercise interventions were categorized into five types, including the aerobic exercise (AE), resistance training (RT), mind-body exercise (ME), prolonged time of exercise (PTE), and AE combined with RT (AE+RT). The results of the network meta-analysis showed that there was a significant difference in the total score of the subjective evaluation tools between AE group and blank control group (SMD=2.20, 95%CI=0.35-4.05, P<0.05). The maximum surface under the cumulative ranking curve (SUCRA) of the total score of the subjective evaluation tools was detected in AE group (82.2%), followed by ME (71.1%), AE+RT (54.2%), RT (38.9%), controlled trial (CT) (29.2%) and PTE groups (24.4%). There was a significant difference in sleep latency (SL) between PTE group versus AE+RT group (SMD=-14.66, 95%CI=-28.60 to -0.72), between AE+RT group versus RT group (SMD=21.32, 95%CI=6.24-36.40), and between AE+RT group versus AE group (SMD=11.19, 95%CI=1.56-20.81) (all P<0.05). The maximum SUCRA of SL was detected in AE+RT group (96.7%), followed by CT (77.1%), ME (49.5%), AE (42.6%), PTE (27.9%) and RT groups (6.1%). There was a significant difference in sleep efficacy (SE) between AE group versus CT group (SMD=4.59, 95%CI=1.59-7.58, P<0.05). The maximum SUCRA of SE was detected in the AE group (83.1%), followed by AE+RT (59.9%), RT (50.7%), ME (46.9%), PTE (35.5%) and CT groups (23.9%). There was a significant difference in wake time after sleep onset (WASO) between PTE group versus RT group (SMD=23.39, 95%CI=14.67-32.02), between PTE group versus AE group (SMD=14.86, 95%CI=4.64-36.40), between PTE group versus CT group (SMD=12.11, 95%CI=7.62-16.59), between RT group versus ME group (SMD=-27.61, 95%CI=-40.49 to -14.73), between RT group versus CT group (SMD=-11.28, 95%CI=-20.86 to -1.70), between ME group versus AE group (SMD=19.08, 95%CI=5.18-32.98), and between ME group versus CT group (SMD=16.33, 95%CI=7.26-25.40) (all P<0.05). The maximum SUCRA of WASO was detected in the RT group (94.7%), followed by CT (80.2%), AE (41.8%), ME (31.5%) and PTE groups (1.7%). There was a significant difference in the total sleep time (TST) between RT group versus AE group (SMD=-20.84, 95%CI=-38.46 to -3.23), between AE group versus CT group (SMD=12.02, 95%CI=2.96-21.08) (all P<0.05). The maximum SUCRA of TST was detected in the AE group (87.2%), followed by AE+CT (71.6%), PTE (53.8%), ME (40.6%), CT (35.9%) and RT groups (10.8%). There was no significant difference in the sleep quality (SQ) among groups (P>0.05). The maximum SUCRA of SQ was detected in the AE group (84.2%), followed by AE+CT (75.5%), ME (24.9%) and CT groups (15.4%). Publication bias analysis of the total score of subjective evaluation tools, SL, SE, WASO, TST, and SQ revealed some asymmetry in all six outcome indicators, indicating a certain risk of publication bias.
Given the favorable effects of AE on multiple sleep parameters, we recommend insomnia patients engage in moderate-intensity AE, such as jogging or brisk walking, three times a week for approximately 30 minutes. Additionally, options include moderate-intensity RT or AE+RT four to five times a week. When engaging in the above exercises, attention should be paid to the choice of time period, and exercise within 3 hours before bedtime should be avoided as much as possible.
Comorbid insomnia and sleep apnea is a highly prevalent disorder characterized by both insomnia and sleep apnea, leading to more severe impairment of daytime function and quality of life than in patients with either insomnia or obstructive sleep apnea (OSA) alone. Non-benzodiazepine drugs (NBZDs) are frontline medications for insomnia treatment, as they can improve insomnia symptoms and enhance sleep quality. However, they are not recommended for OSA treatment due to their potential to increase the apnea-hypopnea index (AHI) and worsen the severity of sleep-disordered breathing. Currently, the therapeutic effects of NBZDs on COMISA are not well-established and require further investigation. Therefore, this article adopts a systematic review approach to compile relevant literature on the use of NBZDs in patients with OSA and COMISA, analyzing the impact of NBZDs on various indicators such as AHI, oxygen desaturation index, and sleep quality. It evaluates the clinical efficacy and safety of medications including zopiclone, eszopiclone, zolpidem, and zaleplon in the treatment of COMISA, aiming to provide guidance on the rational use of NBZDs for these patients.
Obstructive sleep apnea (OSA) is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases, and affects cognitive function and multi-system organ function in the elderly. Therefore, it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society, as the initiator, organized domestic experts in related fields to repeatedly discuss the operation process, requirements, specific ways and methods of noninvasive positive pressure ventilation (NPPV) treatment for elderly OSA patients with reference to domestic and international clinical studies, and finally made this expert consensus, which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.
With the aging and life expectancy increasing in China, sleep disorders in the elderly (≥80 years old) have received widespread attention. As one of the common problems, sleep disorders seriously affect the quality of life and physical and mental health among the elderly, and can also aggravate or induce multiple diseases.
To conduct a scoping review of studies on sleep disorders in community dwelling older adults over 80 years and provide guidance for the early diagnosis and treatment of sleep disorders in community dwelling older adults in China.
PubMed, Embase, CINAHL, Web of Science, Cochrane Library, OpenGrey, SinoMed, CNKI, Wanfang Data, and VIP databases were searched for literature on sleep disorders in community dwelling older adults from inception to March 15, 2023. Literature was independently screened by 2 investigators and basic characteristics of the literature were extracted (authors, time of publication, country, type of study, sample size, assessment tool or modality, prevalence, findings) .
A total of 10 486 papers were searched, and 21 papers were finally included, of which 14 were in English and 7 were in Chinese, 16 were cross-sectional studies, 2 were quasi-experiment studies and 3 were longitudinal studies. The results of the analysis indicated that sleep disorders were more prevalent with serious adverse effects in the community dwelling older adults aged over 80 years (the prevalence rate ranged from 10.0% to 60.3%), which were assessed by nine tools or modalities, including three structured scales with the more commonly used scale being Pittsburgh Sleep Quality Index (PSQI). The influencing factors of sleep disorders were divided into three categories of social demographic factors, physical health and disease-related factors, psychological and behavioral characteristic factors. Interventions such as music therapy, therapy combined with interaction mode groups were found to be effective in improving sleep disorders. However, few prevention and intervention studies were conducted.
The high prevalence of sleep disorders among older people in the community is high with serious effects, there is insufficient knowledge about sleep disorders among community dwelling older adults and fewer types of assessment tools lacking specificity in China. The influencing factors of sleep disorders among older people are complex and diverse, with a lack of research on prevention and intervention.
Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) and asthma are two prevalent chronic respiratory diseases. Recent research has revealed that OSAHS not only shares several common risk factors with asthma but also exhibits a high comorbidity rate with it. This mutual interaction complicates the course of both diseases and increases complexity to clinical diagnosis and treatment. This review aims to provide a comprehensive summary and analysis, from an epidemiological and pathophysiological perspective, of the research progress and challenges concerning the OSAHS comorbided with asthma, particularly in severe asthma.
Hypertension and obstructive sleep apnea (OSA) often coexist, posing challenges in the management of blood pressure in these patients. A reliable and objective predictor is needed to anticipate the occurrence of hypertension and assess the status of blood pressure control in OSA patients, which would facilitate their blood pressure management.
To explore the correlation between red blood cell distribution width (RDW) and hypertension in patients with OSA.
A retrospective study was conducted at the Sleep Center of Peking University International Hospital, involving 510 patients who were diagnosed with OSA using polysomnography between January 2019 and September 2022. The derivation cohort comprised of 370 enrolled patients between January 2019 and December 2021, while the validation cohort included the remaining 140 patients enrolled between January and September 2022. Within the derivation cohort, patients were categorized into two groups based on their adherence to the definition of hypertension: hypertension group (n=211) and non-hypertension group (n=159). Subsequently, the hypertension group was further divided into two subgroups: blood pressure control subgroup (n=107) and blood pressure uncontrolled subgroup (n=104). The clinical characteristics and laboratory examination results of patients in the hypertension group and non-hypertension group, as well as those in the blood pressure control subgroup and blood pressure uncontrolled subgroup, were analyzed. Univariate and multivariate Logistic regression analyses were employed to investigate the predictors of hypertension in OSA patients and the status of blood pressure control in OSA patients with combined hypertension. The receiver operating characteristic (ROC) curve was plotted to evaluate the sensitivity and specificity of RDW in predicting the occurrence of hypertension among OSA patients, with its validity confirmed in the validation cohort.
The multivariate Logistic regression analysis revealed that an increased BMI (OR=1.087, 95%CI=1.007-1.174, P=0.032), diabetes (OR=3.310, 95%CI=1.484-7.380, P=0.003), and a decreased RDW (OR=0.598, 95%CI=0.507-0.704, P<0.001) were independent predictors of hypertension in OSA patients. Furthermore, an increased hemoglobin level (OR=1.027, 95%CI=1.005-1.050, P=0.016) and a decreased RDW (OR=0.804, 95%CI=0.669-0.965, P=0.019) were identified as independent predictors of poor blood pressure control status in OSA patients with combined hypertension. The results of ROC curve analysis for RDW in predicting hypertension in OSA patients showed that the area under the ROC curve was 0.779 (95%CI=0.732-0.826, P<0.001), with an optimal cut-off value identified at 39.9 fL. Considering the clinical usability, when using an RDW≤40 fL as the threshold value, the sensitivity and specificity for predicting hypertension in OSA patients were 70.14% and 81.76%, respectively. The validation cohort, utilizing an RDW cutoff value of ≤40 fL, demonstrated that RDW predicted the hypertension in OSA patients with a sensitivity of 63.64% and a specificity of 80.95%. The area under the ROC curve was 0.757 (95%CI=0.678-0.835, P<0.001) .
The reduction of RDW is associated with the occurrence of hypertension and poor blood pressure control status in patients with OSA. OSA patients exhibiting decreased RDW level are at an elevated risk for hypertension.
Sleep disturbances are the most common health issues in high-altitude environments. Current research on the sleep architecture of healthy populations is limited to the same altitude and involves a small number of subjects, lacking sufficient reliability.
This study aims to analyze the differences in sleep monitoring indicators among healthy adults of different ages and genders across various altitudes, exploring the impact of altitude, age, and gender interactions on these indicators.
Healthy volunteers recruited from the plains of Chengdu, Sichuan Province, and the plateau area of Kunming, Yunnan Province, from January 2020 to September 2022 were selected as study subjects. Volunteers' gender, height, body mass, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were collected. Total sleep time (TST), sleep efficiency, and sleep parameters [percentage of stage N1 (N1%), stage N2 (N2%), stage N3 (N3%) of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep in total sleep time] were recorded. Age was categorized into two groups (20-39 and 40-60 years) for a two-way ANOVA to explore the effects of age, gender, and altitude on sleep parameters.
A total of 91 people were recruited in low-altitude areas, including 48 men and 43 women. A total of 90 people were recruited for the high-altitude area, including 46 men and 44 women. In females, TST was higher in high-altitude areas compared to low-altitude areas (P<0.05). In both males and females, N1% was higher and N2% was lower in high-altitude areas (P<0.05). N3% was higher in females than in males in high-altitude areas (P<0.05). In males, REM% was higher in high-altitude areas (P<0.05). TST was higher in the 20-39 age group than in the 40-60 age group in high-altitude areas (P<0.05). Sleep efficiency was higher in the 40-60 age group in low-altitude areas compared to high-altitude areas, with the 20-39 age group showing higher sleep efficiency in high-altitude areas (P<0.05). In both age groups, N1% was higher in high-altitude areas (P<0.05). In low-altitude areas, N1% was higher in the 20-39 age group than in the 40-60 age group, whereas in high-altitude areas, it was lower in the 20-39 age group (P<0.05). N2% was higher in low-altitude areas in both age groups (P<0.05), with the 40-60 age group having a higher N2% in high-altitude areas (P<0.05). N3% was higher in the 20-39 age group in high-altitude areas (P<0.05). In low-altitude areas, N3% was lower in the 20-39 age group compared to the 40-60 age group, while in high-altitude areas, it was higher in the 20-39 age group (P<0.05). REM% was higher in high-altitude areas in both age groups (P<0.05) .
The factors of age and altitude have varying degrees of influence on total sleep time, sleep efficiency, N1%, N2%, and REM%. Age factors have a greater impact on sleep structure, the older the age, the shorter TST, the lower the sleep efficiency, the higher the proportion of N1. The higher the altitude, the greater the influence of age on sleep structure. In the high altitude area, the TST, sleep efficiency and N3% of the elderly population are lower, and the proportion of N1% is higher.
Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies.
To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors.
Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression.
A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P<0.05). Acute exacerbations ≥2 times (OR=2.220, 95%CI=1.093-4.510) and malnutrition risk (OR=1.961, 95%CI=1.044-3.683) were risk factors for anxiety and depression symptoms in COPD patients (P<0.04). In COPD patients, PSQI score was positively correlated with HADS-A (rs=0.413) and HADS-D score (rs=0.430), and there was a positive correlation between HADS-A score and HADS-D score (rs=0.719, P<0.05) .
The incidence of poor sleep quality, anxiety and depression symptoms was high in COPD patients, and age, malnutrition risk, regular physical activity and number of acute exacerbations in the past year are important influencing factors. Medical staff, family members and patients themselves should improve the awareness of sleep quality, anxiety and depression, and actively carry out screening and intervention work for key patients to improve the sleep quality and mental health of patients.
The prevalence of obstructive sleep apnea (OSA) has been increasing year by year, but the current diagnostic criteria of apnea-hypopnea index (AHI) >5 times/h commonly used for OSA has gradually revealed drawbacks in the diagnosis, severity evaluation, treatment effect and long-term complications prediction of the disease. This study proposed that there is a need for more information about the duration of apnea-hypopnea for assessing OSA in addition to AHI.
To investigate the significance of duration of respiratory events in nocturnal hypoxemia in adults with OSA.
A total of 296 patients with suspected OSA who were admitted to the sleep monitoring room of the First Hospital of Shanxi Medical University from October 2021 to March 2022 were selected as the study subjects. Before PSG, the subjects underwent a physical examination in terms of height, body mass, neck circumference, and were asked about their sleep history, as well as history of hypertension and diabetes. The subjects were divided into three groups according to AHI of 5 times/h≤AHI<15 times/h as the mild OSA group (n=56), 15 times/h≤AHI<30 times/h as the moderate OSA group (n=62), AHI≥30 times/h as the severe OSA group (n=178). The three groups were compared for blood oxygen indexes[lowest oxygen saturation (LSpO2), mean oxygen saturation (MSpO2), baseline oxygen saturation (BSpO2), oxygen desaturation index (ODI), oxygen saturation (SpO2) below 90% in total sleep time (T90) ]and duration parameters of respiratory events [mean total apnea duration (MTAD), mean hypopnea duration (MHD), mean apnea-hypopnea duration (MAD), the longest apnea duration (LTAD), the longest hypopnea duration (LHD), the longest apnea-hypopnea duration (LAD), total apnea-hypopnea duration (TAD), AHI, percentage of apnea/hypopnea time from total sleep time (AHT%) ]. Spearman rank correlation analysis was used to investigate the correlation between respiratory event duration parameters and blood oxygen indexes. The OSA patients were divided into the short event group (short TAD subgroup, short AHT% subgroup, n=74) and long event group (long TAD subgroup, long AHT% subgroup, n=222) according to the median of TAD and AHT% (69.78 min and 14.33%, respectively), and the correlation of TAD, AHT% and AHI with blood oxygen indexes in each group was further analyzed.
There were significant differences in gender, age, BMI, neck circumference, daytime sleepiness, history of hypertension and diabetes among the mild, moderate and severe OSA groups (P<0.05). ODI and T90 in the severe OSA group were higher than those in the mild and moderate OSA groups, and LSpO2 and MSpO2 were lower than those in the mild and moderate OSA groups (P<0.05) ; LSpO2 in the moderate OSA group was lower than that in the mild OSA group, ODI and T90 were higher than that in the mild OSA group (P<0.05). MTAD, LTAD, TAD, AHT% in the severe OSA group were higher than those in the mild and moderate OSA groups, and MHD was lower than that in the mild and moderate OSA groups (P<0.05) ; LHD in the severe OSA group was lower than that in the moderate OSA group, LAD was higher than that in the mild OSA group. MTAD, LTAD, TAD and AHT% in the moderate OSA group were higher than those in the low OSA group (P<0.05). The scatter plot and loess fitting curve showed that the values of MTAD, MHD, MAD, LTAD, LHD and LAD all increased first and then decreased with AHI. TAD and AHT% were prolonged with increasing AHI. Spearman rank correlation analysis showed that AHI, MTAD, LTAD, TAD, AHT% were negatively correlated with LSpO2 and MSpO2, but positively correlated with ODI and T90 in OSA patients (P<0.05) ; MHD and LHD were positively correlated with LSpO2 and MSpO2, and negatively correlated with ODI and T90 (P<0.05) ; MAD was negatively correlated with ODI (P<0.05) ; LAD was negatively correlated with LSpO2 (P<0.05). Further subgroup Spearman rank correlation analysis showed that TAD, AHT% and AHI were negatively correlated with LSpO2 and positively correlated with ODI in short TAD subgroup, short AHT% subgroup, long TAD subgroup and long AHT% subgroup (P<0.05), and had no correlation with BSpO2 (P>0.05) ; TAD, AHT%, and AHI were all negatively correlated with MSpO2 and positively correlated with T90 in the long event group (P<0.05) .
Duration of respiratory events plays an important role in the evaluation of nocturnal hypoxemia in OSA patients, and can be used as a supplement to the existing diagnostic and evaluation index AHI, and indexes such as TAD and AHT% are even more representative than AHI in some cases. The combination of AHI and LSpO2 with the duration of respiratory events can more objectively assess the severity of OSA patients.
There is a close association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and stroke. The coexistence of the two diseases not only affects the rehabilitation process of patients, prolongs their hospitalization time, but also may increase the risk of death. At present, there is still a lack of clinical research on continuous positive airway pressure (CPAP) combined with respiratory training for stroke patients with OSAHS.
To examine the impact of threshold inspiratory muscle training (TIMT) in conjunction with CPAP on sleep status, pulmonary function, and respiratory muscle strength in stroke patients with OSAHS.
Sixty-nine patients with stroke and OSAHS who met the enrollment criteria were selected from the Second Affiliated Hospital of Zhengzhou University from April 2022 to August 2023. The patients were divided into experimental group (n=35) and control group (n=34) by random number table method. The control group received CPAP and conventional treatment, and the experimental group received TIMT on this basis for 6 weeks. The sleep status, lung function and respiratory muscle function of the two groups were compared before and after intervention.
Six weeks after the intervention, the mean blood oxygen saturation (SpO2), proportion of deep sleep (proportion of N3 sleep in total sleep time), minimum arterial oxygen saturation (LSaO2), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), one-second rate (FEV1/FVC), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were all higher than those before intervention in the 2 groups (P<0.05) ; After 6 weeks of intervention, SpO2, proportion of deep sleep (proportion of N3 sleep in total sleep time), LSaO2, FEV1, FVC, FEV1/FVC, MEP and MIP in experimental group were higher than those in control group (P<0.05). Sleep apnea hypopnea index (AHI), oxygen loss index (ODI), arousal index and Epworth lethargy scale (ESS) scores in the 2 groups were lower than those before intervention (P<0.05). After 6 weeks of intervention, the ODI, arousal index and ESS scores of experimental group were lower than those of the control group (P<0.05) .
TIMT combined with CPAP can significantly improve the sleep disorder of stroke patients with OSAHS, and improve arterial oxygen partial pressure, respiratory muscle strength and pulmonary function.
In recent years, in the context of global aging, the number of patients with chronic diseases in China has increased significantly, and the the coexistence of multiple diseases has become more and more common, which seriously threatens the life safety and quality of life of the older adults in China.
To investigate the status of multimorbidity of older adults, and explore the relationship and pathways of action between sleep, physical activity, social network and multimorbidity of older adults, providing ideas for the effective prevention of multimorbidity and health improvement of older adults.
Elderly people aged≥60 years in the Community Health and Behavior of the Elderly Panel Study (CHBEPS) established by our team in 2021 were selected as the subjects of the survey, a questionnaire was used to investigate the study population, the research objects were investigated by questionnaire, and the general situation was collected by self-designed basic information collection form, IPAQ-S-C, LSNS-6 and PSQI were used to assess the physical activity, social network and sleep of the subjects. AMOS 28.0 statistical software was used to set up the structural equation model.
A total of 3 392 valid questionnaires were collected from 3 531 people over 60 years old, with an effective recovery rate of 96.06%. The average score of physical activity was 2 426.42 (495.00, 3 060.00) MET-min/w, the average score of social network was (15.91±6.43), and the average score of sleep was (5.49±3.53). There were 788 (23.23%) older adults with insufficient social network and 353 (10.41%) older adults with fair or very poor sleep quality. The prevalence of multimorbidity among the survey respondents was 41.13% (1 395/3 392). The results of correlation analysis showed that social network was negatively correlated with sleep level (rs=-0.113, P<0.01) and multimorbidity (rs=-0.049, P<0.01), and was positively correlated with physical activity (rs=0.073, P<0.01). Multivariate Logistic regression analysis showed that physical activity of 0-600 MET-min/w (OR=0.576, 95%CI=0.342-0.970) and good sleep quality (OR=0.409, 95%CI=0.209-0.803) were protective factors for multimorbidity (P<0.05). The results of structural equation modeling showed that social networks could affect physical activity and sleep quality (standardized path coefficient=0.096, t=4.982, P<0.001; standardized path coefficient=-0.043, t=-5.981, P<0.001), physical activity and sleep quality could affect multimorbidity (standardized path coefficient=0.023, t=5.280, P<0.001; standardized path coefficient=0.111, t=9.409, P<0.001). Social network had no direct effect on multimorbidity, but an indirect effect on it through two mediators of physical activity and sleep. The indirect effect of social network on multimorbidity through physical activity accounted for 10% of the total effect, and the indirect effect of social network on multimorbidity through sleep accounted for 36.5% of the total effect.
The prevalence of multimorbidity is high in the older adults (41.13%). The social network of the elderly group should be appropriately expanded to encourage them to maintain a moderate amount of physical activity and a good quality of sleep, alleviate and prevent the occurrence of multimorbidity.
Obstructive sleep apnea hypopnea syndrome (OSAHS) in adults is a common sleep-breathing disorder closely associated with hypertension, diabetes, cardiovascular diseases, and other health concerns. Despite its widespread impact on global health, the screening and diagnosis of OSAHS is still not widely available in clinical practice. In this context, the U.S. Preventive Services Task Force (USPSTF) has recently released updated recommendations for adult OSAHS screening to help more people identify and treat potential sleep-breathing disorders. This article interprets the latest recommendations and consider the practical situation in China, providing reference for OSAHS screening of adults in China.
With the accelerated aging of the national population, the rapid increase of the elderly with dementia has become an increasingly prominent problem. Sleep is the basic need of the human body, and sleep problems have become an independent risk factor for the cognitive function of the elderly. Moderate sleep duration is essential for the removal of brain wastes, synaptic plasticity, and the maintenance of normal function of the nervous system. However, the current sleep problems of the elderly have not attracted widespread attention, and the sleep time of the elderly needs to be further studied.
To explore the dose-response relationship between sleep duration and risk of senile dementia.
CNKI, Wanfang Data, VIP, CBM, PubMed, Cochrane Library, Embase and Web of Science databases were searched for prospective cohort studies on the relationship between sleep duration and risk of senile dementia from inception to June 2023. Literature data were independently extracted by two researchers, and literature quality evaluation was performed. Dose-response Meta-analysis was performed by applying restricted cubic spline regression model in Stata 16.0 software.
A total of 9 papers with 58 342 study subjects and 9 887 exposures were included. Meta-analysis showed that sleep duration was associated with the risk of senile dementia (RR=1.32, 95%CI=1.17-1.48, P<0.05). The results of the subgroup analysis showed that the risk of senile dementia was increased by 19.2% in those with ≤6 h/d of sleep (RR=1.19, 95%CI=1.07-1.33, P<0.05) ; sleeping duration≥8 h/d increased the risk of senile dementia by 55.02% (RR=1.55, 95%CI=1.32-1.82, P<0.05). Dose-response meta-analysis results showed a U-shaped nonlinear relationship between sleep duration and risk of senile dementia (P<0.001). Compared with the reference sleep duration of 7 h/d, the risk of morbidity at each time point was as follows 5 h/d: RR=1.024, 95%CI=0.928-1.130; 5.5 h/d: RR=1.036, 95%CI=0.938-1.143; 6 h/d: RR=1.034, 95%CI=0.952-1.124; 6.5 h/d: RR=1.015, 95%CI=0.973-1.059; 7.5 h/d: RR=1.014, 95%CI=0.993-1.035; 8 h/d: RR=1.056, 95%CI=1.023-1.091; 8.5 h/d: RR=1.124, 95%CI=1.062-1.190; 9 h/d: RR=1.212, 95%CI=1.098-1.338; 9.5 h/d: RR=1.316, 95%CI=1.133-1.528; 10 h/d: RR=1.431, 95%CI=1.169-1.752.
There is a U-shaped nonlinear dose-response relationship between sleep duration and the risk of senile dementia, and the daily sleep duration ≥8 h will increase the risk of senile dementia.
Special Issue:Sleep
