RESUMEN
BACKGROUND: Parkinson's Disease (PD) is frequently associated with a spectrum of sleep-related disorders, including insomnia, Excessive Daytime Sleepiness (EDS), REM sleep Behaviour Disorder (RBD), Restless Legs Syndrome (RLS), and Sleep-related Breathing Disorders (SBDs). These disorders significantly impact PD patients' Quality of Life (QoL) and present unique diagnostic and therapeutic challenges. METHODS: This review has explored the intricate relationship between PD and sleep-related disorders, emphasizing their distinctive features and underlying neurobiological mechanisms. It aimed to consolidate current knowledge to optimize clinical management and improve patient care. The profound impact of these disorders on QoL has been evaluated, along with precise diagnostic methodologies. Additionally, various therapeutic strategies, including pharmacological treatments, nonpharmacological interventions, and device-aided therapies, have been examined. RESULTS: Sleep-related disorders are prevalent among PD patients. Specifically, RBD exhibits a prevalence of 40-50%, often preceding the onset of motor symptoms, indicating its potential as an early marker of PD. Despite their significant impact on QoL, these non-motor symptoms are frequently under-recognized and inadequately managed in clinical practice. Pharmacological treatments, along with nonpharmacological interventions, like cognitive-behavioral therapy for insomnia and lifestyle modifications, have shown varied efficacy. Device-aided therapies have also demonstrated the potential to improve sleep-related disorders and overall non-motor symptom burden. CONCLUSION: Effective management of sleep-related disorders in PD calls for personalized, comprehensive, and multimodal therapeutic approaches. This requires the collaborative efforts of neurologists, sleep specialists, psychiatrists, and other healthcare professionals. Future research should focus on the intricate relationship between PD and sleep disorders, aiming to develop innovative treatments and significantly improve patient outcomes.
RESUMEN
Undiagnosed chronic hypercapnic respiratory failure may be encountered during the evaluation of sleep-related breathing disorders at the sleep clinic. This article reviews the mechanism of chronic hypercapnic respiratory failure and the systematic approach to the assessment of specific sleep disorders associated with nocturnal hypoventilation encountered in clinical practice.
Asunto(s)
Hipercapnia , Insuficiencia Respiratoria , Humanos , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/diagnóstico , Hipercapnia/fisiopatología , Enfermedad CrónicaRESUMEN
To examine sleep latency and sleep disturbance as mediators between nighttime cell phone use variables (cell phone use for unstructured leisure activities and for accessing emotionally charged media content before sleep: CPU_BeforeBed and CPU_Arousal) and psychological well-being (PWB) of college students. 521 (74% female) undergraduate students from a large public university were surveyed using a validated self-report quantitative questionnaire assessing CPU variables, sleep quality, and PWB. Pearson correlation analyses were used to compute the correlation between CPU_BeforeBed, CPU_Arousal, sleep latency, and sleep disturbance. Ordinary least-squares regressions were conducted to assess the estimates of the relationships within the models. One-way ANOVA was used to see the difference between the groups. The partial eta squared was used to determine the effect size between the groups. The PROCESS method was used to perform mediation analyses. The sample consisted of undergraduate students between 18 and 29 years old, with an average age of 20 years (SD = 3.18). The sample was diverse in terms of ethnicity (49% Caucasian, 24% Latinx, 19% Asian, 3% African American, 1% Native American, 3% identified as "other") and the number of years the participants had been attending a 2 year or 4 year higher institution (38% incoming freshman, 19% sophomore, 17% junior, 14% senior, and 13% returning senior). The correlation between CPU_BeforeBed and PWB (α = - 0.044, p = 0.615), and the correlation between CPU_Arousal and PWB (α = - 0.061, p = 0.228) were not statistically significant. However, the correlation between sleep latency and PWB (α = - 0.140, p = 0.001), and the correlation between sleep disturbance and PWB (α = - 0.121, p = 0.005) were statistically significant. The mediation effect of sleep latency on the association between CPU_BeforeBed and PWB (Effect = - 0.0325, SE = 0.0145, p < 0.05), and the mediation effect of sleep disturbance on the association between CPU_Arousal and PWB (Effect = - 0.0214, SE = 0.0086, p < 0.05) were statistically significant. Sleep latency and sleep disturbance act as a mediator on the association between CPU_BeforeBed and PWB, and the association between CPU_Arousal and PWB. However, CPU_BeforeBed and CPU_Arousal did not have a direct impact on their PWB. These findings may help college students in regulating CPU habits before going to bed. These findings may also help medical practitioners make informed decisions about the use of cell phones for patients with sleep-related disorders. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-022-00388-3.
RESUMEN
PURPOSE: To determine the prevalence of sleep-related disorders, poor sleeping, and factors associated with poor sleep quality among inhabitants of Parakou, Benin. METHODS: This was a cross-sectional study conducted from April-August 2018 on 930 randomly selected adults (age ≥ 18 years). Using the Pittsburg Sleep Quality Index, the Insomnia Severity Index, and the Epworth Sleepiness Scale, subjects were questioned on their sleep, on parasomnias, and on movement-related sleep disorders. RESULTS: Overall, the prevalence of insomnia was 22% (95% CI, 19.1-24.4) and severe insomnia was 0.8%. The prevalence of excessive daytime sleepiness was 15% (95% CI, 12.5-17.0). Daily nightmares (2%) and rhythmic movements (6%) were those most commonly reported among parasomnias and movement-related sleep disorders. No major differences were found between men and women. The prevalence of poor sleeping (PSQI > 5) was 39% (95%CI, 36.3-42.5). Adjusted analyses showed a higher risk of poor sleeping in those aged 45-54 years (aOR = 1.78, p = 0.032) or ≥ 55 years (aOR = 3.61, p < 0.001), those overweight or obese (aOR = 1.53, p = 0.007), those underweight (aOR = 2.90, p = 0.030), and among females (aOR = 1.84, p < 0.001). Being divorced was associated with a lower risk of poor sleeping (aOR = 0.18, p = 0.036). Poor sleepers were more commonly found among those who had excessive daytime sleepiness (65% versus 36%, p < 0.001) and insomnia (86% versus 27%, p < 0.001). CONCLUSION: Sleep-related disorders were common in Parakou city, Benin, with four out of ten persons having poor sleep quality. There is a need to improve the management of sleep-related disorders and promote better sleep practices for the community.
Asunto(s)
Trastornos de Somnolencia Excesiva/epidemiología , Parasomnias/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Calidad del Sueño , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Benin/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: The purpose of the present study was to determine the airway changes in skeletal class II division 1 malocclusion patients with mandibular retrognathism, treated with Twin-Block (TB) appliance. METHODS: Airway assessment was carried for twelve patients (mean age 11.7 ± 1.1 years) who underwent myofunctional therapy using TB appliance for correction of skeletal class II division 1 malocclusion with mandibular retrognathism. Acoustic pharyngometry (AP) was used to assess and quantify the comparative changes in the upper airway, pretreatment and posttreatment. RESULTS: Data acquired was subjected to appropriate statistical analysis. The paired 't' test was used to compare pre-treatment (T0) and after the positive pterygoid response (T1). TB appliance increased mean minimum airway area by 0.28 ± 0.25 cm2 and mean airway by 0.47 ± 0.44 cm2 with 95% CI. Posttreatment minimum airway and mean area changes were found to be statistically significant (P-value<0.01). CONCLUSION: TB appliance therapy has a positive effect on upper airway and is beneficial for the treatment of sleep-related disorders associated with Class II division 1 malocclusion for achieving positive functional changes, esthetics, and healthier quality of life.
RESUMEN
Sleep duration in the USA has declined continually during the second half of the twentieth century, before reaching a plateau in the early twenty-first century. However, not everyone has been equally affected by this continuous decline. Epidemiological studies indicate that ethnic minorities are sleeping even less than those in the general population. Today, Americans are sleeping, on average, for 6 h. This is significantly below the minimum recommended sleep duration of at least 7 h a day. This insufficiency of sleep duration, however, is not evenly distributed in the population, and different racial and ethnic minority groups are known to have an increased risk of experiencing shorter sleep duration and poorer sleep quality than their White peers. In tandem with this disproportionate decline in sleep duration are similar racial and ethnic disparities in overall health. This paper explores the differences in sleep duration and quality which exist for different ethnic groups, the probable causes behind such inequities, and their relationship to the growth of specific disease conditions. This review also considers sleep disorders in various racial and ethnic groups, and how these disorders are related to health outcomes. Finally, we discuss some of the implications of these differences, and particularly their clinical relevance, and recommend ways in which they might be addressed.
Asunto(s)
Enfermedades Cardiovasculares/etnología , Etnicidad , Disparidades en el Estado de Salud , Grupos Minoritarios , Privación de Sueño/etnología , Sueño , Negro o Afroamericano , Diabetes Mellitus Tipo 2/etnología , Hispánicos o Latinos , Humanos , Trastornos Mentales/etnología , Sobrepeso/etnología , Prevalencia , Síndromes de la Apnea del Sueño/etnología , Trastornos del Inicio y del Mantenimiento del Sueño/etnología , Factores Socioeconómicos , Estados Unidos/epidemiología , Población BlancaRESUMEN
Sleep-related disorders have been reported to have a higher prevalence in multiple sclerosis (MS) than in the general population. They are often undervalued for the presence of more severe physical problems and the occurrence at night, without a direct observation in common clinical practice, but if not recognized and treated they can negatively affect the quality of life causing daytime drowsiness and worsening fatigue. Sleep related disorders most commonly reported in MS are as follows: insomnia, sleep-related breathing disorders (SRBD), restless legs syndrome (RLS) and periodic limb movement disorders (PLMD). Secondary narcolepsy, REM sleep behavior disorder (RBD) and propriospinal myoclonus have been also described in some case reports or series. The purpose of this review is to correlate the more common sleep disturbances in MS patients to the involvement of specific brain regions, analyzing their relationship with MRI findings. While insomnia is usually secondary to other disabling symptoms such as nocturia or pain, SRBD, RLS, narcolepsy, RBD and propriospinal myoclonus in MS patients can be the consequence of an injury of specific central nervous system (CNS) areas. Lesions in the pontine tegmentum and the dorsal medulla have been associated with SRBD, spinal cord lesions or atrophy with RLS, bilateral lesions in the lateral hypothalamus with narcolepsy-like symptoms, lesions in the dorsal pontine tegmentum with RBD and intramedullary demyelinating plaques in spinal cord with propriospinal myoclonus. MS specialists and general neurologists should be aware of these comorbidities since neuroimaging, which is routinely performed in MS, could provide helpful clinical indications on patients with secondary sleep-related disorders and to categorize symptomatic patients who need to underdo more in-depth sleep studies.
Asunto(s)
Tronco Encefálico/patología , Comorbilidad , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/patología , Síndromes de la Apnea del Sueño/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Médula Espinal/patología , Tronco Encefálico/diagnóstico por imagen , Humanos , Esclerosis Múltiple/diagnóstico por imagen , Trastornos del Sueño-Vigilia/patología , Médula Espinal/diagnóstico por imagenRESUMEN
BACKGROUND: There are currently no data on the prevalence of sleep-disordered breathing (SDB) in patients with newly-diagnosed lung cancer. This might be of interest given that SDB is associated with increased cancer incidence and mortality. Furthermore, intermittent hypoxia has been linked with tumor growth and progression. The aim of the current study was to investigate the prevalence of SDB in patients with newly-diagnosed lung cancer. METHODS: Patients with newly-diagnosed lung cancer from three centers in Germany were screened for SDB using a two-channel screening system (ApneaLink™). SDB was defined as an apnea-hypopnea index of > 5/h, and was classified as mild if the AHI was 5-15/h whereas an AHI ≥15/h was classified as severe SDB. The presence of SDB-related symptoms was assessed using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: A total of 100 patients were included. The overall prevalence of SDB was 49%; 32 patients (32%) had mild SDB with a median AHI of 7.7/h (quartile [Q1 5.4/h, Q3 10.4/h]) and a median oxygen desaturation index of 8.5 [Q1 4.2/h; Q3 13.4/h] and seventeen patients (17%) had moderate to severe SDB with a median AHI of 25.2 [Q1 18/h, Q3 45.5/h] and a median oxygen desaturation index of 20.6/h [Q1 9.6/h, Q3 36.6/h]. Patients with moderate to severe SDB had mild daytime sleepiness (ESS score 8.24 ± 3.96 vs. 5.74 ± 3.53 in those without SDB vs. 6.22 ± 2.72 in those with mild SDB; p = 0.0343). The PSQI did not differ significantly between the three groups (p = 0.1137). CONCLUSIONS: This study showed a high prevalence of SDB in patients with newly-diagnosed lung cancer. In these patients SDB was associated with intermittent hypoxia and increased daytime sleepiness. Additional research is needed to determine whether SDB influences prognosis and morbidity in patients with lung cancer. TRIAL REGISTRATION: NCT02270853 (ClinicalTrials.gov), date of registration: 14th October 2014.
Asunto(s)
Trastornos de Somnolencia Excesiva , Hipoxia , Neoplasias Pulmonares , Síndromes de la Apnea del Sueño , Anciano , Comorbilidad , Trastornos de Somnolencia Excesiva/diagnóstico , Trastornos de Somnolencia Excesiva/etiología , Femenino , Alemania/epidemiología , Humanos , Hipoxia/diagnóstico , Hipoxia/etiología , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Mortalidad , Oximetría/métodos , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/epidemiología , Síndromes de la Apnea del Sueño/etiología , Síndromes de la Apnea del Sueño/fisiopatología , Higiene del Sueño , Fumar/epidemiologíaRESUMEN
Obstructive sleep apnea (OSA) and periodic limb movements during sleep (PLMs) are sleep-related disorders with a high prevalence in type 2 diabetes. Commonly OSA is considered as a consequence of obesity, but several previous studies have shown the presence of OSA in non-obese diabetic patients. A previous study showed higher PLMs prevalence in patients with type 2 diabetes, compared to age-matched controls. We speculated that both OSA and PLMs may reflect the presence of diabetic autonomic neuropathy. To test this hypothesis, we compared a group of 112 non-obese patients with type 2 diabetes with 66 age-, sex-, and body mass index- matched nondiabetic patients. Both groups have been investigated through a set of tests including the Epworth Sleepiness Scale, polysomnography, and the Orthostatic Grading Scale (OGS), a questionnaire to assess the degree of autonomic dysfunction. Diabetic patients with OSA and PLMs scored higher on the OGS than controls. Our results confirm that both OSA and PLMs are related to dysautonomy and may be unrelated to obesity in type 2 diabetes patients.
RESUMEN
BACKGROUND: For patients with chronic respiratory failure or sleep breathing disorders, adaptation and training are important prerequisites for successful home noninvasive ventilation (NIV) and CPAP. In Europe, management of NIV/CPAP is sometimes performed by physiotherapists (PTs). However, their role within the NIV/CPAP management team is not well defined. OBJECTIVE: To describe the implementation of a standardized protocol to NIV adaptation for patients with chronic respiratory disease. Secondary outcomes were to evaluate the PT's role and time-consumption. METHODS: We enrolled 201 patients with chronic respiratory disease, referred to the cardiopulmonary rehabilitation service (CPRS). Anthropometric and clinical data, adaptation sessions, ventilator typology, side effects, plus activities conducted by the CPRS were recorded. The time spent on a single protocol task plus total time spent on the entire management procedure for NIV/CPAP adaptation was also documented. RESULTS: Adaptation to NIV/CPAP was completed in 8.2 ± 3.2 sessions, lasting 17.2 ± 15.4 min/session. Total CPRS activity included 61% adaptation procedures, 22% educational sessions, 8% evaluation, 7% monitoring and follow-up, and 2% administrative activities. CPRS time-consumption per patient was 149.5 ± 113.7 min. Total CPRS time-consumption was 28,870 min, corresponding to 1.52 hours/working day and 21% of total PT daily activity. After protocol implementation, PTs were able to cover 65% and 35% of the time devoted to ventilation procedures typically carried out by physicians and nurses, respectively. Amyotrophic lateral sclerosis/neuromuscular patients required more time for adaptation and education, compared to patients with obstructive sleep apnea syndrome (P < .001) and pulmonary restrictive disease (P < .001). CONCLUSIONS: Our study has demonstrated that the PTs can play a key role in the respiratory care management of patients with chronic respiratory disease and sleep breathing disorders with neuromuscular diseases requiring higher time consumption, and the inclusion of PTs in the NIV/CPAP management procedure reduces the time spent by other health professionals. The cost effectiveness of this management needs to be verified in larger clinical trial settings.