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Sleep Disorders: Latest Advances and Prospects

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 19723

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Special Issue Editor

Prof. Dr. Piotr Bialasiewicz

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Guest Editor

Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland
Interests: sleep medicine; respioratory diseases; metabolic disorders; sleep apnea
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Special Issue Information

Dear Colleagues,

The field of sleep medicine has been constantly expanding. It encompasses numerous intertwined disorders and syndromes related to psychiatry, neurology and internal medicine. Sleep disorders, as different and divergent as they seem, do have, however, some common ground. One of these is a relatively prevalent symptom of daily sleepiness which bears serious consequences, from road accidents to impaired workplace performance and daily functioning. Another is the disruption of clock gene regulation or nocturnal hypoxemia, acting through a potent transciption factor—HIF-1alpha—affecting various metabolic pathways and implicated in serious complications of metabolic syndrome. Moreover, disrupted sleep, independently of the underlying disorder and metabolic derangements, has been posited as a risk factor for cardiovascular diseases. The treatment of sleep disorders also illustrates the diversified nature thereof, from behavioral interventions and medications to CPAP devices; from causal to merely symptomatic ones; from succes to frustrating failure. Furthermore, disrupted sleep is recognized in many chronic afflictions (e.g., inflammatory bowel disease, rheumatoid arthritis), aggravating morbidity but also being a risk factor for exacerbations, creating a vicious loop. Therefore, I strongly encourage and invite all the researchers ingaged in this interdisciplinary area to contribute to this Special Issue of JCM devoted to sleep disorders.

Prof. Dr. Piotr Bialasiewicz
Guest Editor

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Keywords

Insomnia
Central hypersomnias
Circadian rhytm disorders
PLM disease
Sleep apnea syndrome
Nocturnal hypoventilation syndromes
Treatment of sleep disorders
Secondary sleep disorders

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Published Papers (7 papers)

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Research

14 pages, 3129 KiB

Open AccessArticle

Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings

by Gloria Tejero-Garcés, Francisco J. Ascaso, Paula Casas, Maria I. Adiego, Peter Baptista, Carlos O’Connor-Reina, Eugenio Vicente and Guillermo Plaza

J. Clin. Med. 2022, 11(3), 815; https://doi.org/10.3390/jcm11030815 - 3 Feb 2022

Cited by 2 | Viewed by 1721

Abstract

Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild–moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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14 pages, 21496 KiB

Open AccessArticle

Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol

by Patricia Fernández-Sanjuán, Juan José Arrieta, Jaime Sanabria, Marta Alcaraz, Gabriela Bosco, Nuria Pérez-Martín, Adriana Pérez, Marina Carrasco-Llatas, Isabel Moreno-Hay, Marcos Ríos-Lago, Rodolfo Lugo, Carlos O’Connor-Reina, Peter Baptista and Guillermo Plaza

J. Clin. Med. 2022, 11(3), 658; https://doi.org/10.3390/jcm11030658 - 27 Jan 2022

Cited by 8 | Viewed by 3135

Abstract

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m², and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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11 pages, 730 KiB

Open AccessArticle

Factors Affecting Long-Term Compliance of CPAP Treatment—A Single Centre Experience

by Agata Gabryelska, Marcin Sochal, Bartosz Wasik, Przemysław Szczepanowski and Piotr Białasiewicz

J. Clin. Med. 2022, 11(1), 139; https://doi.org/10.3390/jcm11010139 - 27 Dec 2021

Cited by 16 | Viewed by 3180

Abstract

Continuous positive airway pressure (CPAP) has been the standard treatment of obstructive sleep apnoea/hypopnoea syndrome (OSA) for almost four decades. Though usually effective, this treatment suffers from poor long-term compliance. Therefore, the aim of our one centre retrospective study was to assess factors responsible for treatment failure and long-term compliance. Four hundred subsequent patients diagnosed with OSA and qualified for CPAP treatment were chosen from our database and compliance data were obtained from medical charts. Many differing factors kept patients from starting CPAP or led to termination of treatment. Overall, almost half of patients ended treatment during the mean time of observation of 3.5 years. Survival analysis revealed that 25% of patients failed at a median time of 38.2 months. From several demographic and clinical covariates in Cox’s hazard model, only the presence of a mild OSA, i.e., AHI (apnoea/hypopnoea index) below 15/h was a factor strongly associated with long term CPAP failure. The compliance results of our study are in line with numerous studies addressing this issue. Contrary to them, some demographic or clinical variables that we used in our survival model were not related to CPAP adherence. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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13 pages, 1363 KiB

Open AccessArticle

Cardiac Autonomic Dysfunction Is Associated with Severity of REM Sleep without Atonia in Isolated REM Sleep Behavior Disorder

by Sooyeoun You, Kyoung Sook Won, Keun Tae Kim, Hyang Woon Lee and Yong Won Cho

J. Clin. Med. 2021, 10(22), 5414; https://doi.org/10.3390/jcm10225414 - 19 Nov 2021

Cited by 3 | Viewed by 1985

Abstract

¹²³I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was performed to assess cardiac autonomic dysfunction and demonstrate its correlation with clinical and polysomnographic characteristics in patients with isolated rapid eye movement (REM) sleep behavior disorder. All subjects including 39 patients with isolated REM sleep behavior disorder and 17 healthy controls underwent MIBG cardiac scintigraphy for cardiac autonomic dysfunction assessment. The isolated REM sleep behavior disorder was confirmed by in-lab overnight polysomnography. A receiver operating curve was constructed to determine the cut-off value of the early and delayed heart-to-mediastinum ratio in patients with isolated REM sleep behavior disorder. Based on each cut-off value, a comparison analysis of REM sleep without atonia was performed by dividing isolated REM sleep behavior disorder patients into two groups. MIBG uptake below the cut-off value was associated with higher REM sleep without atonia. The lower heart-to-mediastinum ratio had significantly higher REM sleep without atonia (%), both with cut-off values of early (11.0 ± 5.6 vs. 29.3 ± 23.2%, p = 0.018) and delayed heart-to-mediastinum ratio (9.1 ± 4.3 vs. 30.0 ± 22.9%, p = 0.011). These findings indicate that reduced MIBG uptake is associated with higher REM sleep without atonia in isolated REM sleep behavior disorder. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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9 pages, 532 KiB

Open AccessArticle

Nocturnal Blood Pressure Fluctuations in Patients with Rapid Eye Movement-Related Obstructive Sleep Apnea

by Hajime Kumagai, Hiroyuki Sawatari, Tetsuro Hoshino, Noriyuki Konishi, Yuka Kiyohara, Kengo Kawaguchi, Hiroko Tsuda, Yoko Haseda, Ryujiro Sasanabe and Toshiaki Shiomi

J. Clin. Med. 2021, 10(21), 5023; https://doi.org/10.3390/jcm10215023 - 28 Oct 2021

Cited by 3 | Viewed by 2454

Abstract

Rapid eye movement-related obstructive sleep apnea (REM-related OSA) is a polysomnographic phenotype. Nocturnal blood pressure (BP) fluctuations remain unclear in patients with REM-related OSA. We studied 27 patients with REM-related OSA, categorized as having REM-apnea-hypopnea index (REM-AHI) ≥ 5/h, REM-AHI/non-REM-AHI ≥ 2, and non-REM-AHI < 15/h. Beat-to-beat systolic BP (SBP) variability and nocturnal SBP fluctuation patterns using pulse transit time (PTT) were investigated. The maximum increase and average nocturnal SBP were significantly higher in males than in females (p = 0.003 and p = 0.008, respectively). The rate of non-dipping patterns in nocturnal SBP fluctuations was 63% in all patients (males, 70%; females, 50%). Epworth Sleepiness Scale (ESS) and Self-rating Depression Scale (SDS) scores in females were higher than those in males (8.4 ± 6.1 vs. 13.4 ± 5.4 points, p = 0.04; 43.8 ± 7.9 vs. 52 ± 11.6 points, p = 0.04, respectively). A high proportion of patients with REM-related OSA had a non-dipping pattern. Using PPT, we observed that in patients with REM-related OSA, SBP variability was greater in males. Despite clinical symptoms being slightly more severe in females, nocturnal SBP fluctuations should be considered in male patients with REM-related OSA. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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9 pages, 1192 KiB

Open AccessArticle

One-Stage Multilevel Surgery for Treatment of Obstructive Sleep Apnea Syndrome

by Gabriela Bosco, Marta Morato, Nuria Pérez-Martín, Andrés Navarro, Miguel A. Racionero, Carlos O’Connor-Reina, Peter Baptista and Guillermo Plaza

J. Clin. Med. 2021, 10(21), 4822; https://doi.org/10.3390/jcm10214822 - 20 Oct 2021

Cited by 7 | Viewed by 2037

Abstract

We report the results of one-stage multilevel upper airway surgery for patients who could not tolerate continuous positive airway pressure (CPAP). Patients treated with multilevel surgery at a University Hospital in 2015–2019 were identified from a prospectively maintained database. The inclusion criteria were aged 18–70 years, body mass index (BMI) < 35 kg/m², apnea–hypopnea index (AHI) > 20, and lingual tonsil hypertrophy grade 3 or 4. Drug-induced sleep endoscopy was performed before surgery in all patients. Multilevel surgery was performed in one stage and included expansion sphincter pharyngoplasty (ESP), coblation tongue base reduction (CTBR), and partial epiglottectomy (PE) as required. The outcome measures were postoperative AHI, time percentage oxygen saturation < 90%, and Epworth Sleepiness Scale (ESS) score. A total of 24 patients were included: median age 49.1 years, average BMI 27.26 kg/m², and 90% men. Ten patients received ESP plus CTBR plus PE, eight received ESP plus CTBR, and six received ESP plus PE. The mean preoperative AHI was 33.01 at baseline and improved to 17.7 ± 13 after surgery (p < 0.05). The ESS score decreased from 11 ± 5.11 to 7.9 ± 4.94 (p < 0.05). The surgical success rate according to Sher’s criteria was 82.3%. The median follow-up was 23.3 months (range 12–36). These findings suggest that multilevel surgery is a safe and successful treatment of OSAHS. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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14 pages, 2444 KiB

Open AccessArticle

Pressure Algometry Evaluation of Two Occlusal Splint Designs in Bruxism Management-Randomized, Controlled Clinical Trial

by Bartosz Dalewski, Agata Kamińska, Paweł Kiczmer, Krzysztof Węgrzyn, Łukasz Pałka, Katarzyna Janda and Ewa Sobolewska

J. Clin. Med. 2021, 10(11), 2342; https://doi.org/10.3390/jcm10112342 - 27 May 2021

Cited by 21 | Viewed by 3827

Abstract

The aim of this pilot study was to evaluate the short-term effectiveness of two different occlusal devices and their impact on the pressure pain threshold (PPT) values among patients who reported to the Dental Prosthetics Outpatient Clinic of Pomeranian Medical University (Szczecin, Poland) and who were diagnosed with probable bruxism. Two groups were formed (A and B) to which patients were assigned randomly. Each group used a different occlusal splint for bruxism management. The occlusal appliance by Okeson, or the bimaxillary splint, was used overnight by each patient for 30 days of the study. The PPT was measured twice, at the first visit and after 30 days of using each occlusal device, with Wagner Paintest FPX 25 algometer. Bruxism was diagnosed based on data from the patient’s medical history and from the physical examination. Nocturnal Bruxism Criteria according to the International Classification of Sleep Disorders (Third Edition) was used for the patient’s evaluation. Results: similar pain factor (PF) reduction was observed in both the examined groups, regardless of the device used; canine guidance and no guidance were similarly effective in terms of increasing pain resilience. Full article

(This article belongs to the Special Issue Sleep Disorders: Latest Advances and Prospects)

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