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.
Sleep disorders, especially insomnia and sleep behavior disorders, are highly prevalent in children with autism spectrum disorder (ASD) , which cause a wide range of detrimental effects on the children and their families. Several international professional organizations have highlighted integrating sleep disorders into the comprehensive evaluation and treatment in children with ASD, and developed relevant clinical guidelines or expert consensuses, such as the A Practice Pathway for the Identification, Evaluation, and Management of Insomnia in Children and Adolescents with Autism Spectrum Disorders by the Autism Treatment Network (ATN) , Autism: the Management and Support of Children and Young People on the Autism Spectrum by the National Institute for Health and care Excellence (NICE) , and Practice Guideline: Treatment for Insomnia and Disrupted Sleep Behavior in Children and Adolescents with Autism Spectrum Disorder by the American Academy of Neurology (AAN) . However, there is no applicable clinical guideline or expert consensus for sleep disorders among Chinese children with ASD, which greatly restricts the development of relevant clinical practice. We interpreted the above-mentioned two guidelines and one consensus, focusing mainly on several aspects, such as the levels of evidence and strength of recommendations, the definition of sleep disorders and associated factors, and behavioral treatments and melatonin-based therapies. It is hoped that our endeavors will contribute to the diagnosis and management of sleep disorders in Chinese children with ASD and the development of relevant clinical guidelines or expert consensuses.
Along with the development of aging, much attention has been paid to geriatric health issues in China. Sleep disturbance is a common sleep problem endangering older people's health.
To systematically assess the prevalence of sleep disturbances in Chinese older people.
Studies about sleep disturbance in Chinese elderly were searched in database of CNKI, CQVIP, SinoMed, WanFang Data, PubMed, EmBase, The Cochrane Library, Web of Knowledge and PsycINFO from inception to 31st May, 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies using the 11 criteria recommended by the Agency for Healthcare Research and Quality. Stata 16.0 was used for meta-analysis.
A total of 91 studies, with a sample of 81 354 cases were included. Meta-analysis showed that the overall prevalence rate of sleep disturbances among Chinese older people was 46.0%〔95%CI (41.7%, 50.4%) 〕. Further analysis indicated that the prevalence of sleep disturbances among men and women was 40.0%〔95%CI (30.9%, 49.2%) 〕and 49.4%〔95%CI (42.8%, 55.9%) 〕, respectively. And it was 35.1%〔95%CI (28.8%, 41.4%) 〕 for the 60-70-year-olds, 46.1%〔95%CI (33.8%, 58.4%) 〕 for the 70-80-year-olds, and 44.4%〔95%CI (32.7%, 56.2%) 〕 for the 80-and-over-year-olds. The sleep disturbance prevalence rate among those living in urban and rural areas was 41.5%〔95%CI (32.8%, 50.2%) 〕and 44.0%〔95%CI (36.4%, 51.7%) 〕, respectively. And it was 46.3%〔95%CI (37.6%, 55.1%) 〕for those with junior high school or lower education level, and 37.9%〔95%CI (26.7%, 49.1%) 〕for those with senior high school or higher education level. Meta-regression analysis showed that marital status and chronic disease prevalence were associated with sleep disturbances (P<0.05) .
The prevalence of sleep disturbances in Chinese older people is high. To reduce the risk of sleep disturbances and improve the sleep quality in this group, the prevention and intervention of sleep disturbances should be valued and targeted interventions should be delivered.
The prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) is high. The development of telemedicine and mobile applications play an important role in the diagnosis and screening of OSAHS patients.
To evaluate the value of smartphone snoring analysis software Mianyun Sara in screening of Chinese adults with OSAHS.
One hundred and thirty patients〔mean age (49.7±17.4) years old, 70% male and 30% female, mean body mass index (28.2±5.0) kg/m2〕who were admitted to the Sleep Center of Peking University People's Hospital from April to December 2020 were selected and underwent overnight monitoring with Mianyun Sara and polysomnography (PSG) simultaneously. The relevant indicators generated by Mianyun Sara's automatic analysis and the relevant indicators interpreted by sleep professional technicians according to the recommended guidelines, the agreement between the apnea hypopnea index (AHI) derived from this method and PSG were evaluated, as well as the sensitivity and specificity of the diagnosis of OSAHS.
(1) The total sleep time (TST) monitored by Mianyun Sara was 523.67 (497.50, 542.64) min, and the TST monitored by PSG was 408.25 (364.25, 462.50) min, the difference was statistically significant (Z=-9.540, P<0.001) . The AHI monitored by Mianyun Sara was 15.83 (6.18, 27.49) times/h, and the AHI monitored by PSG was 18.25 (6.15, 35.68) times/h, the difference was statistically significant (Z=-2.601, P=0.009) . (2) There was a positive correlation between the AHI obtained by the two monitoring methods (r=0.645, P<0.001) . Bland-Altman analysis showed that the AHIs measured by Mianyun Sara and PSG were statistically consistent, with an average difference of -5.7 times/h, and the 95% consistency limit of (-40.5, 29.2) times/h. (3) Taking AHI≥5 times/h as the gold standard for the diagnosis of OSAHS, Mianyun Sara's optimal diagnostic value for OSAHS was AHI>8.34 times/h, with a corresponding sensitivity of 83.81% and a specificity of 92.00%. The area under the curve (AUC) was 0.91 (0.84, 0.95) , the positive predictive value (PPV) was 97.8%, and the negative predictive value (NPV) was 57.5%, at different AHI thresholds (5, 15, 30 times/h) , the sensitivity/specificity corresponding to the best diagnostic value were 83.8%/92.0%, 88.2%/74.1% and 64.9%/91.4%, respectively.
Mianyun Sara has a good screening value for adult OSAHS patients and there is close agreement between Mianyun Sara and PSG.
The pathogenesis of obstructive sleep apnea (OSA) has been explained from both anatomic and non-anatomic perspectives. Previous studies have indicated that OSA is most closely associated with anatomic factors related to upper airway obstruction, but its association with non-anatomic factors for upper airway obstruction has been increasingly understood and valued. The non-anatomic parameters for evaluating therapeutic effect include pharyngeal critical closing pressure, arousal threshold, loop gain and dilator muscle dysfunction, namely PALM. Monitoring and analyzing the weight of these four factors in the pathogenesis of OSA may contribute to the guidance of individualized treatment. Loop gain is a method for measuring the gain or sensitivity of negative feedback loop of respiratory control system to estimate the ventilation volume obtained by increasing the driving force of respiration to some extent. Higher loop gain may lead to hypocapnia and inhibition of upper airway respiratory drive, thereby aggravating the severity of OSA. We detailed a method for measuring loop gain and its clinical significance in patients with OSA.
Cardiopulmonary problems will increase the risk of health harms yet they are often neglected in clinical rehabilitation treatment for stroke patients. In addition, sleep problems also often affect the rehabilitation effect in these patients, while routine drug treatment could not achieve satisfactory effect.
To assess the effect of precisely prescribed exercise on cardiopulmonary fitness and sleep quality in stroke patients.
Sixty-four stroke inpatients were recruited from Rehabilitation Department, Changzhou Dean Hospital from April 2020 to August 2021, and equally randomized into a control group and an experimental group. At baseline, cardiopulmonary fitness was assessed using cardiopulmonary exercise testing (CPET) , and sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) for both groups. Then control group received 12-week routine rehabilitation training, while experimental group received 12-week routine rehabilitation training plus aerobic exercise precisely prescribed based on baseline CPET parameters. Intra- and inter-group comparisons were made between pre- and post-training major CPET parameters, dyspnea and leg fatigue measured by the Borg Scale and sleep quality.
At the end of training, the experimental group demonstrated higher peak oxygen uptake (VO2peak) , percentage of predicted peak oxygen uptake (VO2peak%pred) , peak metabolic equivalent (METpeak) , peak heart rate (HRpeak) , peak load, and anaerobic threshold (AT) , and lower intensity of perceived dyspnea and leg fatigue than the control group (P<0.05) . The above-mentioned eight parameters improved significantly after training in the experimental group (P<0.05) . The experimental group had lower post-training scores of six domains (subjective sleep quality, sleep latency, sleep duration, sleep disturbances, use of sleep medication, daytime dysfunction) and lower post-training total score of PSQI than the control group (P<0.05) . The total score of PSQI and the scores of its seven domains were all lowered significantly when the training was finished (P<0.05) .
The precisely prescribed aerobic exercise by the results of CPET could effectively improve the cardiopulmonary fitness, exercise intensity, exercise endurance, and sleep quality as well as the sense of exercise fatigue in stroke patients.
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disorder. At present, there are great differences in evaluation indicators of clinical randomized controlled trials (RCTs) on OSAHS treated by traditional Chinese medicine (TCM ) . Therefore, it is of great significance to further explore the evaluation indicators of clinical RCTs of OSAHS.
To analyze the evaluation indicators of clinical RCTs on OSAHS treated by TCM, in order to provide reference for the selection of appropriate Chinese medicine for the treatment of OSAHS in RCTs outcome indicators.
The RCTs in the TCM treatment of OSAHS were retrieved from CNKI, WanFang Data, VIP, CBM, PubMed and other data bases from 2015-01-01 to 2021-10-20. The basic characteristics of the collected literature included the first author, sample size, gender, age, course of disease, intervention measures, TCM syndrome type, course of treatment, and outcome indicators. According to the functional attributes, the evaluation indicators were divided into TCM syndrome, physical and chemical indicators, life quality indicators, long-term prognosis indicators, safety events indicators, and Western medicine signs indicators. The quality of the included literature was evaluated using a systematic bias risk assessment tool recommended by the Cochrane Collaboration, and the literature quality was evaluated using RevMan 5.4 software.
A total of 41 RCTs were included, including 2 971 patients, involving 270 outcomes of 70 indicators, which were classified as TCM syndrome, physical and chemical indicators, safety events indicators, Western medicine signs indicators, and quality of life indicators. Among them, physical and chemical indicators, symptoms and signs indicators are the most, quality of life indicators are less. There are 14 items of 2 kinds of combination indicators, 16 items of 3 kinds of combination indicators and 7 items of 4 kinds of combination indicators. The measurement time ranged from 7 days to 6 months, and the most was 1 month (15 RCTs, 36.59%) , followed by 3 months (11 RCTs, 31.70%) .
At present, there are large differences in evaluation indicators of TCM treatment of OSAHS, relatively insufficient attention on TCM syndrome score, poor attention on quality of life indicators, no unified standard for evaluation indicators, large span of measurement time points, and no long-term prognostic indexes.
Sleep problems are increasingly common in residents with the acceleration of pace of life. Studies have shown that sleep duration is associated with chronic diseases such as hypertension and diabetes, but there is a lack of research on its association with hyperuricemia.
To assess the association and its dose-response level between sleep duration and hyperuricemia.
Data stemmed from the 2019 surveillance of epidemiology and risk factors of chronic diseases in adult residents in Haidian District, Beijing, involving individuals aged 18-79 years old, with an experience of living in Haidian District at least six months. The information was obtained via a face-to-face questionnaire survey, including the following aspects: demographics (sex, age, education level, marital status, occupation) , lifestyle factors (smoking and drinking, physical activity level, sleep duration) , history of chronic diseases (hypertension and diabetes) , height, weight, blood pressure, laboratory indices (fasting blood glucose, serum uric acid, and serum creatinine) . A multivariable Logistic regression model was used to assess the association between sleep duration and the risk of hyperuricemia, whose dose-response relationship was analysed using restricted cubic spline regression.
A total of 5 380 people were enrolled, with an average age of (46.9±16.0) years and an average sleep duration of (7.24±1.16) hours. Univariate Logistic regression analysis showed that, compared with those with 7-9 hours of sleep duration, the risk of hyperuricemia increased in those with less than 7 hours of sleep duration and in those with greater than 9 hours of sleep duration 〔OR (95%CI) =1.30 (1.12, 1.51) ; OR (95%CI) =1.48 (1.15, 1.89) 〕. After adjusting for age, gender, education level, marital status, occupation, smoking, drinking, physical activity level, BMI, hypertension, diabetes, and serum creatinine, the risk of hyperuricemia still increased in those with less than 7 hours of sleep duration and in those with greater than 9 hours of sleep duration 〔OR (95%CI) =1.37 (1.17, 1.62) ; OR (95%CI) =1.39 (1.07, 1.81) 〕. Restricted cubic spline regression analysis showed that sleep duration had a U-shaped association with hyperuricemia (non-linear test, χ2=27.530, P<0.001) .
Too longer or shorter sleep duration was a factor responsible for increased risk of hyperuricemia among adults in Haidian District of Beijing.
Sleep research has a major part to play in facilitating the development of sleep medicine. In China, the development of sleep medicine started later compared with other medical disciplines, and related advances have been seldom reported.
To review the development of sleep research in China by analyzing sleep research projects supported by the National Natural Science Foundation of China (NSFC) , providing data for future development of sleep research.
Data were collected from the NSFC, including the supported projects regarding sleep-disordered breathing (code H0113) and sleep and sleep disorders (code H0916) as well as those with corresponding codes involving sleep or sleep disorder of Department of Health Sciences, and supported projects involving sleep or sleep disorder in Departments of Life Sciences. The number and composition of supported projects and funding amount, geographical, regional and institutional distribution of supported projects in terms of number and funding amount were statistically analyzed.
From 1988 to 2019, the sleep research projects supported by the NSFC numbered 399 in total. The number of these projects and the founding amount for them showed an increasing trend, particularly after 2010. The types of projects were gradually enriched, among which four were key projects, while no key talent projects had been supported. The geographical and institutional distribution of supported projects was uneven, presenting a tendency of aggregation in some specific regions and institutions, and a pattern of Matthew effect. Colleges and universities were the main body of sleep research. At present, sleep research is mainly based on basic experiments and clinical applications.
In general, the level and composition distribution of sleep research projects supported by the NSFC during the period demonstrated a trend of gradual enhancement, but still need improvements. To promote the development of sleep medicine, it is recommended to strengthen the reserve force via improving the top-level design and macro layout concerning NSFC supported projects, and to achieve early prevention, appropriate diagnosis and treatment of sleep disorders via taking advantage of interdisciplinary cooperation and integration.
Many factors are associated with hypertension, the most prevalent chronic disease, among which, the association of sleep disturbance and hypertension has received wide attention as sleep medicine advances rapidly in recent years. However, relevant studies on sleep disturbance and hypertension have some limitations, and there is no bibliometric analysis of hotspots about sleep disturbance and hypertension.
To review and summarize the research hotspots and trends of literature related to sleep disturbances and hypertension.
Studies about sleep disturbance and hypertension were searched in Web of Science Core Collection from inception to June 30, 2021 using "hypertension" and "sleep disturbance" "insomnia" "sleep deprivation" "sleep fragmentation" and "short-term sleep" as subject headings. CiteSpace 5.7.R5W was used for visual analysis.
In total, 4 589 studies were included for analysis. The number of studies generally showed an increasing trend, with a peak in 2018, and a rapider growth rate between 2011 and 2021. The top 10 most frequently used keywords in the studies published between 2011 and 2021 were hypertension, blood pressure, prevalence, obstructive sleep apnea, risk factor, sleep, cardiovascular disease, positive airway pressure, obesity and insomnia. The tag clusters were sleep time, sleep quality, sleep-disordered breathing, obstructive sleep apnea, sleep apnea, insomnia, stress, sleep, epidemiology, heart failure and symptoms. Keyword clustering analysis revealed that major directions in the studies published between 2011 and 2021 were: (1) the association of sleep-disordered breathing, especially obstructive sleep apnea, and hypertension; (2) the association of sleep time and blood pressure; (3) the association of sleep quality and blood pressure. The most frequently cited studies were mainly about sleep apnea, obstructive sleep apnea and short-term sleep. REDLINE was the most prolific author, and the largest group of authors was formed with her as the core. The US was the most prolific country, and the most prolific institution was the University of Pittsburgh.
The research on sleep disturbance and hypertension had become increasingly popular. The research hotspots of this field had changed greatly in 2011 and 2018. The effects of obstructive sleep apnea and sleep duration on hypertension were the mostly focused hotspots.
Effects of Non-invasive Positive Pressure Ventilation on Sleep of Patients in Respiratory Intensive Care Unit Assessed by Overnight Polysomnography
Sleep disorders are commonin RICU patients, with mechanical ventilation as one of the important factors leading to sleep disorders in RICU patients. Previous studies have mainly focused on the effect of invasive positive pressure ventilation (IPPV) on sleep in RICU patients, but there is no study on the effect of polysomnography on sleep in RICU patients with non-invasive positive pressure ventilation (NIPPV) .
To evaluate patients' sleep disorders and the effect of NIPPV on sleep in patients in respiratory intensive care unitsby overnight polysomnography.
The clinical data of 31 patients who underwent overnight polysomnography in the Department of Respiratory and Critical Care Medicine of Peking University First Hospital from May 2012 to August 2021 were retrospectively analyzed. The clinical data〔sex, age, height, body mass index, APACHEⅡscore, underlying diseases, main diagnosis, white blood cell count, hemoglobin, serum albumin, high-sensitivity C-reactive protein (hs-CRP) , arterial blood gas analysis, respiratory failure classification, total length of hospital stay, length of stay in RICU, RICU stay in the past 6 months, death during hospitalization〕, sleep characteristics 〔respiratory events: apnea-hypopnea index (AHI) , respiratory disturbance index (RDI) , total detection time, total sleep time, sleep latency, sleep efficiency, sleep stage: time, latency and proportion of REM and NREM, pulse oxygen: minimum pulse oxygen, average pulse oxygen during sleep, heart rate: minimum heart rate, maximum heart rate〕 of patients were collected. The patients were divided into NIPPV group and control group (non-NIPPV group) according to whether NIPPV treatment was performed during overnight polysomnography, and the clinical data and sleep characteristics of the two groups were compared.
There were 15 cases in the NIPPV group and 16 cases in the control group. Compared with the control group, the total sleep time (P=0.028) , REM sleep time (P=0.034) , NREM time (P=0.003) and N2 sleep time (P=0.003) were shortened in the NIPPV group, while the sleep efficiency (P=0.038) decreased, and the average heart rate increased (P=0.028) .
Sleep disturbance is a common problem in RICU patients, and NIPPV patients are more likely to lead to decreased total sleep time, decreased REM sleep, and decreased sleep efficiency. It is recommended that RICU patients be routinely assessed with overnight polysomnography and given appropriate intervention to conduct appropriate interventions.
Chinese Consensus on Diagnosis and Assessment of Sleep Apnea Syndrome in Older Adults
It is a necessary trend to improve the quality of life of rapidly increasing number of older adults. Sleep disorders are significantly associated with the quality of life in older adults, among which sleep apnea syndrome (SAS) is second only to insomnia, which is an inducer of multiple diseases, and directly associated with many chronic diseases, such as cardiovascular and cerebrovascular diseases, Alzheimer's disease, metabolic abnormalities, respiratory diseases, even leads to sudden death. So SAS in older adults should be given great attention by the whole society. With this in mind, the Chinese Association of Geriatric Sleep Medicine, Chinese Geriatrics Society invited Chinese sleep medicine experts to develop a consensus on the classification, risk factors, clinical symptoms, diagnosis and assessment methods, diagnostic procedures as well as complications of SAS in older adults based on a review of relevant clinical studies, aiming to provide a reference for the standardization of SAS diagnosis and assessment in China.
Effect of Sleep Time and Sleep Quality on the Risk of Low Back Pain among the Middle-aged and Elderly People in China
As one of the disabling pains, low back pain seriously affects the quality of life of patients and causes a huge economic burden to them. Studies have shown that poor sleep quality has a certain effect on the occurrence of low back pain, but the dose-response relationship between sleep time and the risk of low back pain has been currently unclear, and there is a lack of relevant research in this area in China.
To explore the effect of sleep time and sleep quality on the risk of low back pain among the middle-aged and elderly people in China.
Using the longitudinal data of China Health and Retirement Longitudinal Study (CHARLS) between 2011 to 2015, all middle-aged and elderly people with a baseline age >45 year sat baseline from the three surveys in 2011, 2013, and 2015 were selected as the research subjects. The cut-off time of follow-up was 2015-12-31, and the self-reported low back and back pain was used as the outcome event, and follow-up was terminated upon the occurrence of the outcome event. Multivariate Cox proportional hazards regression analysis was used to assess the effect of sleep time and sleep quality on the risk of low back pain and the combined effect of them. Restricted cubic spline model was used to analyze the dose-response relationship between sleep time and the risk of low back pain.
A total of 4 459 subjects were included, with an average follow-up of (3.6±0.8) years; sleep duration: <7 h/d in 1 549 subjects (34.74%) , 7-8 h/d in 1 843 subjects (41.33%) , ≥9 h/d in 1 067 subjects (23.93%) ; 2 700 people (60.55%) with good sleep quality and 1 759 people (39.45%) with impaired sleep quality. A total of 643 people developed low back pain, the incidence rate was 14.42% (643/4 459) . The prevalence of low back pain in middle-aged and elderly people with sleep time <7 h/d was higher than that in middle-aged and elderly people with sleep time of 7-8 h/d and ≥9 h/d 〔the prevalence rates were 20.92% (324/1 549 ) , 10.91% (201/1 843) and 11.06% (118/1 067) 〕 (P<0.05) . The prevalence of low back pain among middle-aged and elderly people with impaired sleep quality was higher than that of middle-aged and elderly people with good sleep quality 〔21.38% (376/1 759) and 9.89% (267/2 700) 〕 (P<0.05) . The multivariate Cox proportional hazards regression analysis showed that, compared with sleep time of 7-8 h/d, sleep time <7 h/d was the influential factor of low back pain 〔HR=1.63, 95%CI (1.37, 1.95) , P<0.05〕; compared with better sleep quality, impaired sleep quality was an influential factor of low back pain 〔HR=1.85, 95%CI (1.58, 2.17) , P<0.05〕; compared with male and female sleeping for 7-8 h/d, the risk of low back pain in male and female sleeping <7 h/d was 1.47 times 〔95%CI (1.09, 1.98) , P<0.05〕 and 1.76 times 〔95%CI (1.41, 2.20) , P<0.05〕.The data changed to 2.09 times 〔95%CI (1.60, 2.74) , P<0.05〕 and 1.73 times 〔95%CI (1.41, 2.11) , P<0.05〕 when comparing happened between impaired and good sleep quality (P<0.05) . Restricted cubic spline model analysis showed a linear dose-response relationship between sleep time and the risk of low back pain (Ptrend<0.05, Pnon-linear=0.33) , and the risk of low back pain increased with the decrease of sleep time. There was a linear dose-response relationship between sleep time and the risk of low back pain in male and female (male: Ptrend<0.05, Pnon-linear=0.66; female: Ptrend<0.05, Pnon-linear=0.23) , and the risk of low back pain in male and female increased with the decrease of sleep time (<7 h/d) .The multivariate Cox proportional hazards regression analysis showed that, only sleep time ≥9 h/d with good sleep quality was not associated with the risk of low back pain compared to sleep time 7-8 h/d with good sleep quality (P>0.05) , sleep time<7 h/d with good sleep quality, sleep time<7 h/d with impaired sleep quality, sleep time 7-8 h/d with impaired sleep quality, sleep time≥ 9 h/d with impaired sleep quality all increased the risk of low back pain (P<0.05) .
Insufficient sleep time and impaired sleep quality are closely related to the occurrence of low back pain, and the risk of low back pain is significantly increased when insufficient sleep time and impaired sleep quality coexist.
Depression is a common mood disorder that seriously affects the recovery of various functions in patients after stroke. Antidepressant drug therapy alone could not achieve satisfactory treatment responses.
To investigate the effects of rational emotive behavior therapy (REBT) on sleep and mood in patients with post-stroke depression.
Seventy-one patients with post-stroke depression were selected from Department of Neurological Rehabilitation, the Second Affiliated Hospital of Zhengzhou University from June 2019 to June 2020, and according to random number table, they were divided into the control group (n=35) or combined treatment group (n=36) . The control group received four consecutive weeks of treatment with oral sertraline hydrochloride tablets (25 mg per day within the first week, and 50 mg per day within other three weeks) . The combined treatment group received four consecutive weeks of treatment with REBT (three times per week, the treatment duration for each time lasting for 30 minutes) plus the same treatment for the control group. Pittsburgh Sleep Quality Index (PSQI) , Insomnia Severity Index (ISI) , 17-item Hamilton Depression Rating Scale (HAMD-17) , Hamilton Anxiety Rating Scale (HAMA) , and Modified Barthel Index (MBI) were used to assess pre- and post-treatment sleep quality, insomnia severity, depression prevalence, anxiety prevalence and ability to engage in basic activities of daily living, respectively.
The mean scores of PSQI, ISI, HAMD-17, and HAMA showed a significant decrease and the mean score of MBI demonstrated a significant increase in both groups after treatment (P<0.05) . The mean post-treatment scores for PSQI and HAMA demonstrated no significant differences between two groups (P>0.05) . The combined treatment group had lower mean post-treatment scores of ISI and HAMD-17 and higher mean post-treatment score of MBI than the control group (P<0.05) . The improvement in depression was much better in the combined treatment group (P<0.05) . The improvement in anxiety was more obviously in the combined treatment group (P<0.05) .
REBT plus oral sertraline hydrochloride tablets could produce better effects on improving insomnia, mood, and ability to engage in basic activities of daily living in patients with post-stroke depression.
Special Issue:Sleep
