STUDY OBJECTIVES: To assess the impact of the non-respiratory arousal burden at baseline polysomnography (PSG) on residual daytime sleepiness in positive airway pressure (PAP)-treated obstructive sleep apnea (OSA). METHODS: We included OSA patients from the European Sleep Apnea Database registry with available arousal data who had at least 2 treatment follow-up visits. The primary outcome was the Epworth Sleepiness Scale (ESS) score under PAP. The non-respiratory arousal ratio (NRAR) was defined as the ratio of non-respiratory to total arousals at baseline PSG. A linear mixed model tested the effect of NRAR tertiles on residual sleepiness. Baseline variables that differed significantly between groups were included as covariates. RESULTS: 800 patients with OSA (69.6 % male, mean age 57.1 ± 12.0 years, mean NRAR 0.22 ± 0.20) were evaluated during three follow up visits at a mean of 197.4, 499.3, and 731.6 days after PAP initiation. The interaction between time and NRAR tertile was statistically significant (F = 4.55, p = 0.001). The lowest NRAR tertile was associated with lower residual sleepiness over time compared to the highest NRAR tertile. The associations were independent of sex, comorbidities, body mass index, blood pressure, baseline apnea-hypopnea index, and baseline ESS score. CONCLUSIONS: NRAR at baseline PSG predicts residual sleepiness in PAP-treated OSA patients. The findings offer new insights into OSA phenotyping and have important implications for patient care.
- MeSH
- arousal * fyziologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukční spánková apnoe * terapie patofyziologie komplikace MeSH
- polysomnografie * MeSH
- poruchy nadměrné spavosti patofyziologie MeSH
- registrace * MeSH
- senioři MeSH
- somnolence MeSH
- trvalý přetlak v dýchacích cestách * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
STUDY OBJECTIVES: Sleep-disordered breathing and diabetes mellitus (DM) are often concomitant; however, data on the impact of sleep-disordered breathing on mortality in the population with diabetes remain scarce. METHODS: The population from the Sleep Heart Health Study, a multicenter prospective observational study representing 5,780 patients with polysomnography and mortality data, including 453 patients with DM, was analyzed to assess the impact of sleep-disordered breathing variables and the presence of DM on all-cause, cardiovascular disease, and noncardiovascular disease associated mortality. Survival analysis and proportional hazard regression models were used to calculate the adjusted hazard ratios (aHRs) for mortality. RESULTS: Patients with DM and the average oxygen saturation > 91.4% had significantly lower all-cause (aHR 0.52, confidence interval [CI] 0.34-0.80) and cardiovascular disease mortality risk (aHR 0.44, CI 0.22-0.87) as compared with patients with oxygen saturation below this value. Apnea-hypopnea index > 31 (aHR 1.58, CI 1.10-2.28) and oxygen desaturation index > 13.3 (aHR 1.58, CI 1.10-2.25) were associated with increased all-cause mortality in participants with DM on treatment. Sleep efficiency and proportion of rapid eye movement sleep did not have any impact on mortality in patients with DM and thus differed significantly from individuals without DM, where increased all-cause mortality was observed in those with sleep efficiency < 81.4% (aHR 0.77, CI 0.68-0.87) or rapid eye movement sleep < 14.9% (aHR 0.78, CI 0.68-0.89). CONCLUSIONS: Patients with diabetes on treatment and moderate to severe sleep-disordered breathing experience increased all-cause mortality. Reduced average oxygen saturation predicted both all-cause and cardiovascular death in the population with diabetes. CITATION: Vichova T, Petras M, Waldauf P, Westlake K, Vimmerova-Lattova Z, Polak J. Sleep-disordered breathing increases mortality in patients with diabetes. J Clin Sleep Med. 2025;21(1):89-99.
- MeSH
- diabetes mellitus * mortalita epidemiologie MeSH
- kardiovaskulární nemoci mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- polysomnografie * statistika a číselné údaje MeSH
- prospektivní studie MeSH
- senioři MeSH
- syndromy spánkové apnoe * mortalita komplikace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Poruchy spánku predstavujú častú komorbiditu u pacientov s cievnou mozgovou príhodou (CMP). Vzájomné vzťahy medzi poruchami spánku a CMP sú komplexné a obojsmerné. Poruchy spánku môžu jednak predstavovať rizikový faktor vzniku CMP, na druhej strane môže lézia centrálneho nervového systému navodiť narušenie spánku. Spánkové poruchy a ich liečba môžu vo výraznej miere modifikovať proces rekonvalescencie pacienta a ovplyvňovať aj riziko recidívy CMP. V nasledujúcom texte približujeme uvedenú problematiku. Pozornosť venujeme nielen detailne preskúmanému spánkovému apnoe, ale objasňujeme aj úlohu porúch hybnosti viazaných na spánok a insomnie. Interakcie CMP s hypersomniami, poruchami cirkadiánnej rytmicity a parasomniami budú musieť detailnejšie odhaliť až budúce prospektívne štúdie.
Sleep disorders represent a common comorbidity in patients with stroke. Their relationships are complex and bidirectional. Sleep disorders can act as a risk factor for the development of stroke. On the other hand, lesions in the central nervous system can lead to sleep disturbances. Sleep disorders and their treatment can significantly modify the recovery process of the patient and also affect the risk of stroke recurrence. In the following text, we present the mentioned topic. We focus not only on the well-studied sleep apnea but also explain the role of sleep-related movement disorders and insomnia. The interactions of stroke with hypersomnias, circadian rhythm disorders, and parasomnias will need to be more thoroughly investigated by future prospective studies.
- MeSH
- cévní mozková příhoda * diagnóza etiologie klasifikace prevence a kontrola MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- poruchy cirkadiánního rytmu (spánek) diagnóza klasifikace komplikace MeSH
- poruchy iniciace a udržování spánku diagnóza klasifikace komplikace MeSH
- poruchy spánku a bdění * diagnóza etiologie klasifikace komplikace MeSH
- poruchy spánku z vnitřních příčin diagnóza klasifikace komplikace MeSH
- syndromy spánkové apnoe diagnóza klasifikace komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.
- MeSH
- dospělí MeSH
- interpersonální vztahy MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukční spánková apnoe * terapie psychologie MeSH
- osobní uspokojení * MeSH
- percepce MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- sexuální partneři psychologie MeSH
- trvalý přetlak v dýchacích cestách * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Ictal central apnoea is a feature of focal temporal seizures. It is implicated as a risk factor for sudden unexpected death in epilepsy (SUDEP). Here we study seizure-related apnoeas in two different models of experimental seizures, one chronic and one acute, in adult genetically-unmodified rats, to determine mechanisms of seizure-related apnoeas. Under general anaesthesia rats receive sensors for nasal temperature, hippocampal and/or neocortical potentials, and ECG or EMG for subsequent tethered video-telemetry. Tetanus neurotoxin (TeNT), injected into hippocampus during surgery, induces a chronic epileptic focus. Other implanted rats receive intraperitoneal pentylenetetrazol (PTZ) to evoke acute seizures. In chronically epileptic rats, convulsive seizures cause apnoeas (9.9 ± 5.3 s; 331 of 730 convulsive seizures in 15 rats), associated with bradyarrhythmias. Absence of EEG and ECG biomarkers exclude obstructive apnoeas. All eight TeNT-rats with diaphragm EMG have apnoeas with no evidence of obstruction, and have apnoea EMGs significantly closer to expiratory relaxation than inspiratory contraction during pre-apnoeic respiration, which we term "atonic diaphragm". Consistent with atonic diaphragm is that the pre-apnoeic nasal airflow is expiration, as it is in human ictal central apnoea. Two cases of rat sudden death occur. One, with telemetry to the end, reveals a lethal apnoea, the other only has video during the final days, which reveals cessation of breathing shortly after the last clonic epileptic movement. Telemetry following acute systemic PTZ reveals repeated seizures and seizure-related apnoeas, culminating in lethal apnoeas; ictal apnoeas are central - in 8 of 35 cases diaphragms initially contract tonically for 8.5 ± 15.0 s before relaxing, in the 27 remaining cases diaphragms are atonic throughout apnoeas. All terminal apnoeas are atonic. Differences in types of apnoea due to systemic PTZ in rats (mainly atonic) and mice (tonic) are likely species-specific. Certain genetic mouse models have apnoeas caused by tonic contraction, potentially due to expression of epileptogenic mutations throughout the brain, including in respiratory centres, in contrast with acquired focal epilepsies. We conclude that ictal apnoeas in the rat TeNT model result from atonic diaphragms. Relaxed diaphragms could be particularly helpful for therapeutic stimulation of the diaphragm to help restore respiration.
- MeSH
- apnoe patofyziologie MeSH
- bránice * patofyziologie MeSH
- chronická nemoc MeSH
- elektroencefalografie MeSH
- krysa rodu rattus MeSH
- modely nemocí na zvířatech * MeSH
- pentylentetrazol toxicita MeSH
- potkani Sprague-Dawley MeSH
- relaxace svalu fyziologie MeSH
- tetanový toxin toxicita MeSH
- záchvaty * patofyziologie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: and Objectives: The clinical presentation of Obstructive Sleep Apnoea (OSA) differs between genders. This study aimed to identify the specific OSA phenotypes of women in the European Sleep Apnoea Database (ESADA) cohort. MATERIALS AND METHODS: Latent class cluster analysis was applied to data from 9710 female OSA patients. Variables used included age, Body Mass Index (BMI), Epworth Sleepiness Scale (ESS), comorbidities (cardiovascular, pulmonary, psychiatric, metabolic, other) and the Apnoea Hypopnea Index (AHI). RESULTS: Four different clusters were found: Cluster 1"Women with ischemic heart disease" (38.3 %):middle aged (59 years [53-65]),overweight to obese (BMI 30.1 kg/m2 [26.9-33.5]), AHI 22.9 events/h[17.4-30], ESS 9 [5,12] with the highest prevalence of ischemic heart disease (56 %). Cluster 2"Elderly women with comorbidities" (23 %): oldest (66 years[60-71]), obese (BMI 36 kg/m2 [31.6-40.4]),AHI 46 events/h [30-60.1]),ESS 9 [6-13] with the highest prevalence of comorbidities. Cluster 3"Sleepy obese women" (16.2 %): the youngest (49 years [42-55]), sleepiest (ESS 12 [8-16]), most obese(BMI 43 kg/m2[37.6-48.9]) females with severe OSA (AHI 53.3 events/h [32-80.5]). Cluster 4 "Women with mild OSA and low comorbidities" (22.5 %): middle aged (53.5 years [46-60]) with BMI 29 kg/m2[25-34.1],ESS9 [5,13]),AHI 8.6events/h[6.9-10.4])and low prevalence of comorbidities. The distribution of the clusters differed across Europe. PAP administration was higher in Clusters 2 and 3 but low in Cluster 4. CONCLUSION: Four distinct female phenotypes were identified with different clinical presentation and comorbidities. Sex-based phenotyping may provide improved risk stratification and personalized treatment.
- MeSH
- fenotyp * MeSH
- index tělesné hmotnosti * MeSH
- kohortové studie MeSH
- komorbidita * MeSH
- lidé středního věku MeSH
- lidé MeSH
- obezita epidemiologie MeSH
- obstrukční spánková apnoe * epidemiologie MeSH
- prevalence MeSH
- senioři MeSH
- shluková analýza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- lidé MeSH
- obstrukční spánková apnoe * diagnóza terapie MeSH
- umělá inteligence MeSH
- výzkum MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
Předoperační úzkost se vyskytuje až u 70 % dětí, které podstupují operační výkon. Tento nepříjemný prožitek u řady dětí trvá i po skončení operace, a dokonce i po propuštění z nemocnice. Silná předoperační úzkost má řadu negativních klinických a behaviorálních následků. Cílem managementu předoperační úzkosti je identifikace rizikových pacientů a zahájení preventivních opatření, která zahrnují nefarmakologické intervence doplněné v indikovaných případech podáním sedativní premedikace.
Up to 70 % of children undergoing surgery experience pre-operative anxiety. This unpleasant experience continues for many children after the operation and even after discharge from hospital. Severe preoperative anxiety has a number of negative clinical and behavioural consequences. The aim of preoperative anxiety management is to identify patients at risk and to initiate preventive measures that include non-pharmacological interventions, supplemented by the administration of sedative premedication, when indicated
- MeSH
- behaviorální terapie metody MeSH
- dexmedetomidin farmakologie terapeutické užití MeSH
- dítě MeSH
- lidé MeSH
- management nemoci MeSH
- midazolam farmakologie terapeutické užití MeSH
- obstrukční spánková apnoe diagnóza farmakoterapie MeSH
- perioperační péče metody psychologie MeSH
- předoperační období * MeSH
- úzkost z výkonu * diagnóza prevence a kontrola psychologie MeSH
- úzkost klasifikace prevence a kontrola psychologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
