A custom-built single-channel in-ear electroencephalography sensor for sleep phase detection: an interdependent solution for at-home sleep studies.

Sleep is vital for health. It has regenerative and protective functions. Its disruption reduces the quality of life and increases susceptibility to disease. During sleep, there is a cyclicity of distinct phases that are studied for clinical purposes using polysomnography (PSG), a costly and technically demanding method that compromises the quality of natural sleep. The search for simpler devices for recording biological signals at home addresses some of these issues. We have reworked a single-channel in-ear electroencephalography (EEG) sensor grounded to a commercially available memory foam earplug with conductive tape. A total of 14 healthy volunteers underwent a full night of simultaneous PSG, in-ear EEG and actigraphy recordings. We analysed the performance of the methods in terms of sleep metrics and staging. In another group of 14 patients evaluated for sleep-related pathologies, PSG and in-ear EEG were recorded simultaneously, the latter in two different configurations (with and without a contralateral reference on the scalp). In both groups, the in-ear EEG sensor showed a strong correlation, agreement and reliability with the 'gold standard' of PSG and thus supported accurate sleep classification, which is not feasible with actigraphy. Single-channel in-ear EEG offers compelling prospects for simplifying sleep parameterisation in both healthy individuals and clinical patients and paves the way for reliable assessments in a broader range of clinical situations, namely by integrating Level 3 polysomnography devices. In addition, addressing the recognised overestimation of the apnea-hypopnea index, due to the lack of an EEG signal, and the sparse information on sleep metrics could prove fundamental for optimised clinical decision making.

Arousal burden is highest in supine sleeping position and during light sleep.

STUDY OBJECTIVES: Arousal burden (AB) is defined as the cumulative duration of arousals during sleep divided by the total sleep time. However, in-depth analysis of AB related to sleep characteristics is lacking. Based on previous studies addressing the arousal index (ArI), we hypothesized that the AB would peak in the supine sleeping position and during non-rapid eye movement stage 1 (N1) and show high variability between scorers. METHODS: Nine expert scorers analyzed polysomnography recordings of 50 participants, the majority with an increased risk for obstructive sleep apnea. AB was calculated in different sleeping positions and sleep stages. A generalized estimating equation was utilized to test the association between AB and sleeping positions, sleep stages, and scorers. The correlation between AB and ArI was tested with Spearman's rank-order correlation. RESULTS: AB significantly differed between sleeping positions (p<0.001). The median AB in the supine sleeping position was 47-62% higher than in the left and right position. The AB significantly differed between the sleep stages (p<0.001); the median AB was more than 200% higher during N1 than during other sleep stages. In addition, the AB differed significantly between scorers (p<0.001) and correlated strongly with ArI (r=0.935, p<0.001). CONCLUSIONS: AB depends on the sleeping position, sleep stage, and scorer as hypothesized. AB behaved similarly as the ArI, but the high variability in the ABs between scorers indicates a potential limitation caused by subjective manual scoring. Thus, the development of more accurate techniques for scoring arousals is required before AB can be reliably utilized.

Assessment of sleep characteristics using Fitbit Charge 4 in head and neck cancer patients undergoing palliative chemotherapy and radiotherapy: a prospective observational study.

Background: Sleep disturbance is prevalent among cancer patients. The quantification of this sleep disturbance is missing, especially in palliative care settings. Aim: The aim of this study was to study the sleep patterns of the patients undergoing palliative chemotherapy and radiotherapy for head and neck cancer (HNC) using a Fitbit Charge 4 sleep-tracking device. Design: Prospective observational study. Setting: A total of 110 HNC patients undergoing palliative chemotherapy and radiotherapy at a tertiary care teaching hospital in Central India. Results: Forty-four percent of patients had a poor sleep score (less than 60). Average sleep duration was 218.66 ± 139.05 min; non-rapid eye movement (NREM) sleep duration 197.7 ± 115.91 (light NREM 171.36 ± 104 and deep NREM 23.36 ± 16.73); REM sleep duration was 30.44 ± 34.14 min. The Pittsburgh Sleep Quality Index was 10.23 ± 3.45, which indicated sleep deprivation over the past 1 month. Moderate levels of anxiety, depression, confusion, and distress existed in the cohort. Statistically significant but weak correlation existed between sleep score, anxiety, and depression. Strong correlation existed between distress score and sleep score. Confusion score did not have a significant correlation with sleep score. Conclusion: HNC patients in palliative care settings were chronically sleep deprived. Sleep architecture was also disturbed. Moderate levels of anxiety, depression, confusion, and distress existed in the studied cohort; these psychosocial disturbances had a weak correlation with the sleep score and are likely to be multifactorial. Trial registration: Institutional Ethics Committee number: IHEC-LOP/2020/IM0349. The study has been registered with clinical trial registry of India with registration number CTRI/2021/03/032400 (http://www.ctri.in).

A Novel Screening Tool for Severe Obstructive Sleep Apnea.

Purpose: Obstructive sleep apnea (OSA) is a prevalent condition with long waiting lists for the gold standard polysomnography (PSG) test. Screening tests are essential to identify and prioritize patients with severe OSA. Current questionnaires do not accurately detect severe cases. This study aims to develop an alternative screening tool based on anthropometric and morphological characteristics to determine the severity of OSA. Methods: The study included 149 patients with sleep apnea symptoms who did not have additional diseases. The obstructive sleep apnea morphologic scale (OSAMS) was created using 5 parameters: 3 internal parameters related to the upper respiratory tract (tonsil size, oropharyngeal passage, and hypopharyngeal-laryngeal examination) and 2 external parameters (neck circumference and body mass index). Each parameter was scored, and the total scores were correlated with the apnea-hypopnea index (AHI) of PSG to determine the severity of OSA. Results: A statistically significant moderate positive correlation was found between AHI and OSAMS scores (rho = .491; P < .001). A grand total score >4 provided 80.3% sensitivity and 53.9% specificity to identify patients with severe OSA. OSAMS demonstrated superior results compared to existing questionnaires for OSA screening in our study group. Conclusions: OSAMS is a potential alternative to existing questionnaires to screen patients with severe OSA, offering a practical approach based on morphology during physical examinations.

Are scoring respiratory effort-related arousals worth the effort? --A study comparing outcomes between 4 % vs 3 % hypopnea scoring rules.

STUDY OBJECTIVES: The respiratory effort-related arousal (RERA) has been combined with apneas and hypopneas into the respiratory disturbance index (RDI). RERAs are characterized by ≥ 10 s of increasing upper airway effort terminating in arousal without meeting hypopnea criteria. The recent change to hypopnea definitions now includes a ≥30 % reduction in airflow for 10 s with EITHER a 3 % oxygen desaturation OR an arousal. Consequently, many events previously categorized as RERAs will now be included in the 3 % hypopneas, likely reducing the number of events scored as RERAs. We hypothesized that the 3 % apnea-hypopnea index (3%AHI) would approximate the 4%RDI, with the number of 3 % RERAs being negligible. RESEARCH QUESTION: How does the transition from the 4 % to the 3 % hypopnea rules impact the significance of RERAs in clinical practice, and how we should relate the AHI and RDI using the different hypopnea rules? METHODS: We prospectively collected 76 consecutive polysomnography results in 4 adult age groups. We re-scored the respiratory events utilizing both the 3 % and the 4 % hypopnea rules and compared the outcomes. RESULTS: Among 76 diagnostic studies (mean age 47.5 years, males 47.4 %), the 3 % RERA index [0.8 (0.0, 3.1)] [median (Q1, Q3)] was significantly lower than the 4 % RERA index [3.5 (1.0, 7.3)]. The 3%AHI was 3.07 ± 9.23 (mean ± SD) higher than the 4%RDI (p = 0.005). The 3%AHI was 8.63 ± 8.86 higher than the 4%AHI in all age groups (p < 0.001). This was mainly due to an increased hypopnea index (+8.51 ± 9.03, p < 0.001). In patients with obstructive sleep apnea (OSA), the 3%RERA contributes 4.3 % to the 3%RDI, while the 4%RERA contributes 27.7 % to the 4%RDI. INTERPRETATIONS: Both 3%RDI and 3%AHI are higher than the 4%RDI, primarily due to identification of more hypopnea events, resulting in more patients being classified as having OSA. This change in criteria complicates the comparison of hypopnea and RERA contributions between sleep studies scored using the different hypopnea rules.

Impact of sleep disturbances on outcomes in intensive care units.

BACKGROUND: Sleep deprivation is common in intensive care units (ICUs) and may alter respiratory performance. Few studies have assessed the role of sleep disturbances on outcomes in critically ill patients. OBJECTIVES: We hypothesized that sleep disturbances may be associated with poor outcomes in ICUs. METHODS: Post-hoc analysis pooling three observational studies assessing sleep by complete polysomnography in 131 conscious and non-sedated patients included at different times of their ICU stay. Sleep was assessed early in a group of patients admitted for acute respiratory failure while breathing spontaneously (n = 34), or under mechanical ventilation in patients with weaning difficulties (n = 45), or immediately after extubation (n = 52). Patients admitted for acute respiratory failure who required intubation, those under mechanical ventilation who had prolonged weaning, and those who required reintubation after extubation were considered as having poor clinical outcomes. Durations of deep sleep, rapid eye movement (REM) sleep, and atypical sleep were compared according to the timing of polysomnography and the clinical outcomes. RESULTS: Whereas deep sleep remained preserved in patients admitted for acute respiratory failure, it was markedly reduced under mechanical ventilation and after extubation (p < 0.01). Atypical sleep was significantly more frequent in patients under mechanical ventilation than in those breathing spontaneously (p < 0.01). REM sleep was uncommon at any time of their ICU stay. Patients with complete disappearance of REM sleep (50% of patients) were more likely to have poor clinical outcomes than those with persistent REM sleep (24% vs. 9%, p = 0.03). CONCLUSION: Complete disappearance of REM sleep was significantly associated with poor clinical outcomes in critically ill patients.

Lack variation of low slow-wave activity over time in the frontal region in NREM sleep may be associated with dyskinesia in Parkinson's disease.

OBJECTIVE: Levodopa-induced dyskinesia (DYS) adversely affects the quality of life of Parkinson's disease (PD) patients. However, few studies have focused on the relationship between DYS and sleep and electroencephalography (EEG). Our study aimed to establish the objective physiological indicators assessed by polysomnography (PSG) that are associated with DYS in PD patients. METHODS: We enrolled 122 patients with PD, divided into two groups: PD with DYS (n = 27) and PD without DYS group (non-DYS, n = 95). The demographics and clinical characteristics and sleep assessment in the two groups were collected. More importantly, overnight six-channel PSG parameters were compared in the two groups. We also compared different bands and brain regions of average power spectral density within each group. RESULTS: Compared with the non-DYS group, the DYS group tended to have a significantly higher percentage of nonrapid eye movement sleep (NREM). Gender, levodopa equivalent daily dose (LEDD), rapid eye movement (REM) sleep (min), and the NREM percentage were positively correlated with the occurrence of DYS. After adjusting for gender, disease duration, LEDD, taking amantadine or not, and Montreal Cognitive Assessment (MoCA), NREM%, N3%, and REM (min), the percentage of NREM sleep (p = 0.035), female (p = 0.002), and LEDD (p = 0.005), and REM sleep time (min) (p = 0.012) were still associated with DYS. There was no significant difference in whole-night different bands of average power spectral density between two groups. There was no significant difference in normalized average power spectral density of slow wave activity (SWA) (0.5-2 Hz, 0.5-4 Hz, and 2-4 Hz) of early and late NREM sleep in the DYS group. Dynamic normalized average power spectral density of SWA of low-frequency (0.5-2 Hz) reduction in the frontal region (p = 0.013) was associated with DYS in logistic regression after adjusting for confounding factors. CONCLUSION: PD patients with DYS have substantial sleep structure variations. Higher NREM percentage and less REM percentage were observed in PD patients with DYS. Dynamic normalized average power spectral density of low-frequency (0.5-2 Hz) SWA reduction in the frontal area could be a new electrophysiological marker of DYS in PD.

Prevalence of Obstructive Sleep Apnoea in patients with primary nasal and nasopharyngeal pathologies.

The aim of this study was to study the prevalence of obstructive sleep apnea syndrome in patients with nasal and nasopharyngeal pathologies. A total of 60 consenting patients between the age of 14 to 60 years with primary nasal and nasopharyngeal pathologies were taken up for the study. These patients underwent history taking, detailed clinical examination including BMI, diagnostic nasal endoscopy and overnight polysomnography. The polysomnography results of people with different pathologies were compared and analysed. Based on the analysis it was arrived that isolated pathologies like septal deviation, nasal polypi and adenoid hypertrophy provided a statistically significant association with occurrence and severity of OSA. Also, that patients with combined pathologies were more proportionately affected by OSA than those with isolated pathologies. Nasal and nasopharyngeal pathologies have significant association with obstructive sleep apnea syndrome and all patients with these pathologies need to undergo polysomnography along with other routine investigations.

Evaluating Positional Obstructive Sleep Apnea in Children: Prevalence, Characteristics, and Risk Factors.

Purpose: This study investigates the prevalence, risk factors, and clinical characteristics of positional obstructive sleep apnea (POSA) among pediatric patients diagnosed with obstructive sleep apnea (OSA). Patients and Methods: A total of 1,236 children aged 0 to 17 years who underwent nocturnal polysomnography (PSG) and completed the Sleep Questionnaire were included. After excluding those with an AHI <1, neurological or muscular disorders, or insufficient sleep time in specific positions, 908 patients remained: 158 with POSA and 750 with non-positional OSA (NPOSA). Propensity score matching (PSM) was applied at a 1:2 ratio, resulting in a final sample of 153 POSA and 306 NPOSA patients. Data analyses were performed using R software (version 4.2.3). Results: The prevalence of POSA was 12.8%. After PSM, patients with POSA had a lower overall AHI (8.66 vs 10.30), REM-AHI (14.30 vs 17.40), and NREM-AHI (7.43 vs 8.77) compared to those with NPOSA. POSA patients also had a shorter total sleep time (411 vs 427 minutes), spent less time in the supine position (168 vs 225 minutes), and more time in non-supine positions (241 vs 202 minutes) than NPOSA patients. Additionally, while the supine AHI was higher in POSA patients (15.60 vs 10.30), the non-supine AHI was lower (5.00 vs 11.00) compared to NPOSA patients. The minimum oxygen saturation was slightly higher in POSA patients (0.88 vs 0.87). All differences were statistically significant (P < 0.05). Risk factors for POSA included mild OSA, allergic rhinitis, non-allergic rhinitis, and obesity. Conclusion: The prevalence of POSA in children is lower than in adults, and its severity is less than that of NPOSA. Compared to NPOSA patients, POSA patients had significantly higher AHI during supine sleep and lower AHI during non-supine sleep. POSA patients also spent more time in non-supine positions, suggesting that avoiding supine sleep may help reduce apnea events. These findings highlight the importance of monitoring and managing sleep posture in POSA patients.

Another look at the necessity of polysomnography for infants with Prader-Willi syndrome prior to initiation of growth hormone therapy.

The average age of diagnosis of Prader-Willi syndrome (PWS) in most countries is less than 6 months of age. With the current medical knowledge of the benefits of growth hormone for infants with PWS, including improved cognitive function and improved psychomotor development, parents of infants with PWS want growth hormone therapy initiated as soon as possible. But the current recommendations to perform overnight polysomnography prior to initiation of growth hormone treatment often delays the initiation of therapy. We submit that overnight polysomnography for young infants (<6 months of age) is not necessary prior to growth hormone treatment, as there are no findings on polysomnography in this age group that should delay or prevent the initiation of growth hormone therapy.

Validation of a Textile-Based Wearable Measuring Electrocardiogram and Breathing Frequency for Sleep Apnea Monitoring.

Sleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea. Polysomnography (PSG) represents the gold standard for SA diagnosis. This laboratory-based procedure is complex and costly, and less cumbersome wearable devices have been proposed for SA detection and monitoring. A novel textile multi-sensor monitoring belt recording electrocardiogram (ECG) and breathing frequency (BF) measured by thorax excursion was developed and tested in a sleep laboratory for validation purposes. The aim of the current study was to evaluate the diagnostic performance of ECG-derived heart rate variability and BF-derived breathing rate variability and their combination for the detection of sleep apnea in a population of patients with a suspicion of SA. Fifty-one patients with a suspicion of SA were recruited in the sleep laboratory of the Cantonal Hospital St. Gallen. Patients were equipped with the monitoring belt and underwent a single overnight laboratory-based PSG. In addition, some patients further tested the monitoring belt at home. The ECG and BF signals from the belt were compared to PSG signals using the Bland-Altman methodology. Heart rate and breathing rate variability analyses were performed. Features derived from these analyses were used to build a support vector machine (SVM) classifier for the prediction of SA severity. Model performance was assessed using receiver operating characteristics (ROC) curves. Patients included 35 males and 16 females with a median age of 49 years (range: 21 to 65) and a median apnea-hypopnea index (AHI) of 33 (IQR: 16 to 58). Belt-derived data provided ECG and BF signals with a low bias and in good agreement with PSG-derived signals. The combined ECG and BF signals improved the classification accuracy for SA (area under the ROC curve: 0.98; sensitivity and specificity greater than 90%) compared to single parameter classification based on either ECG or BF alone. This novel wearable device combining ECG and BF provided accurate signals in good agreement with the gold standard PSG. Due to its unobtrusive nature, it is potentially interesting for multi-night assessments and home-based patient follow-up.

The Association between Suicidal Ideation and Subtypes of Comorbid Insomnia Disorder in Apneic Individuals.

Background/Objectives: Given the existence of higher suicidality in apneic individuals, this study aimed to determine the potential role played by subtypes of the comorbid insomnia disorder (CID) in the occurrence of suicidal ideation for this specific subpopulation. Methods: To perform our analyses, 1488 apneic individuals were retrospectively extracted from the Sleep Laboratory hospitalization register. Only apneic individuals with suicidal ideation highlighted during the psychiatric interview and/or with a score ≥1 on item G of the Beck Depression Inventory confirmed during the clinical interview were included in the group with suicidal ideation. The likelihood of suicidal ideation associated with CID subtypes was investigated using logistic regression analyses. Results: The prevalence of suicidal ideation was 9.3% in our sample of apneic individuals. After hierarchically introducing the significant confounders for adjustment, multivariate logistic regression analyses demonstrated that unlike short sleep duration alone and CID without short sleep duration, the likelihood of suicidal ideation was only higher for CID with short sleep duration in apneic individuals. Conclusions: Thus, we highlighted in this study that CID with short sleep duration could play a major role in higher suicidality for apneic individuals, which seems to require systematic screening and appropriate treatment of this comorbid sleep disorder to enable better management of suicidal risk in this specific subpopulation.

Assessing Cognitive Impairments in Obstructive Sleep Apnea Patients Using Montreal Cognitive Assessment (MoCA) Scores.

Obstructive Sleep Apnea (OSA) is a chronic condition associated with cognitive impairment and various comorbidities. This prospective study evaluated cognitive deficits in OSA patients and identified clinical factors affecting cognitive function. Seventy-two participants were assessed using polysomnography (PSG) and the Montreal Cognitive Assessment (MoCA). Findings revealed significantly lower MoCA scores in severe OSA patients compared to those with mild or moderate OSA. Severe OSA patients had a median MoCA score of 23.5 (20.0-25.0), indicating more significant cognitive impairment, while those with normal OSA severity had the highest median score of 28.5 (27.8-29.2). Mild and moderate OSA patients had median scores of 26.5 (21.0-28.0) and 25.0 (23.80-26.0), respectively (p < 0.008). Logistic regression showed that ex-smoking status negatively impacted MoCA scores more in the unadjusted model (p = 0.003) than in the adjusted one (p = 0.018). Forced Vital Capacity (FVC) positively correlated with MoCA scores, stronger in the unadjusted model (p < 0.001 vs. p < 0.03). Higher Oxygen Desaturation Index (ODI) correlated with higher MoCA scores while increasing Apnea-Hypopnea Index (AHI) severity correlated with lower MoCA scores in both models. A significant negative correlation was found between age and MoCA score (r = -0.473, p < 0.001), and between MoCA score and AHI (r = -0.350, p < 0.003). This study highlights the need for sensitive cognitive screening tools like MoCA in evaluating OSA patients, linking cognitive impairment closely with OSA severity and other clinical factors.

Impact of mini-dose dexmedetomidine supplemented analgesia on sleep structure in patients at high risk of obstructive sleep apnea: a pilot trial.

Background: Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes. Objectives: To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA. Design: A pilot randomized, double-blind, placebo-controlled trial. Setting: A tertiary university hospital in Beijing, China. Patients: One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28 mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022. Intervention: After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02 µg/kg/h) or placebo. We monitored polysomnogram from 9:00 pm to 6:00 am during the first night. Main outcome measures: Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0-100 score range, higher score better). Results: All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p = 0.029); it also decreased the percentage of stage N1 sleep (median difference, -10%; 95% CI, -20% to -1%; p = 0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p = 0.060). Adverse events were similar between groups. Conclusion: Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events. Clinical trial registration: Clinicaltrials.gov, identifier NCT04608331.

Sex differences in the risk of excessive daytime sleepiness in mild and moderate ischaemic stroke patients: a retrospective database study.

BACKGROUND: Excessive daytime sleepiness (EDS) is a common complication of stroke that has a detrimental effect on patients' daily life and functional recovery. The clinical characteristics and risk factors for poststroke EDS may differ between males and females. METHODS: A retrospective study based on hospital medical records was conducted on patients with a diagnosis of stroke who participated in polysomnographic monitoring at the Affiliated Hospital of Yangzhou University from February 2022 to May 2024. Baseline data, laboratory test data, polysomnographic data, and related scale scores were retrospectively collected. The Epworth Sleepiness Scale (ESS) score was used to assess EDS after stroke. Binary logistic regression was used to determine the risk factors for daytime sleepiness. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed via IBM SPSS 26.0. RESULTS: ESS scores were higher in males than in females, whereas females had higher Pittsburgh Sleep Quality Index (PSQI) scores and Hospital Anxiety and Depression Scale (HADS) scores. Male sex and higher depression scores were risk factors for EDS; among male patients, higher anxiety scores were a risk factor for EDS, whereas smoking was a protective factor. Depression, a higher arousal index and a reduced proportion of N3 sleep periods were risk factors for EDS in females. CONCLUSIONS: The characteristics and influencing factors of EDS differ between the sexes in patients with mild and moderate ischaemic stroke. Our study may provide evidence and guidance for clinical diagnosis and treatment. Interventional studies are needed to assess the impact of treating these risk factors in the future.

Conscious experiences during Non-Rapid Eye Movement sleep parasomnias.

Disorders of Arousal (DOA) are non-rapid eye movement (NREM) parasomnias traditionally regarded as unconscious states. However, recent research challenges this assumption. This narrative review aims to explore the presence and qualitative features of conscious experiences in patients with DOA during their episodes. The literature indicates a higher recall of mental activity during DOA episodes than previously believed, estimated at about 50-60% in adults (immediately post-episode). Data on children are limited but suggest a lower recall rate (<30% when interviewed retrospectively). Patient reports range from brief scenic fragments to elaborate scenarios with plot development, often fraught with negative emotions and misfortunes and with considerable correspondence between subjective experiences and observed behaviors. In many of the described cases, patients appear to enact their dreams, entering a hallucinatory state where internally generated images overlay external percepts. The potential implications for clinical management, research endeavors, and legal considerations regarding nocturnal violence, along with existing limitations and controversial points, are discussed.

Effects of transcranial magnetic stimulation on sleep quality in fibromyalgia: A double-blind randomized clinical trial.

OBJECTIVES: The aim of the current study was to assess the therapeutic impact of repeated low frequency repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (rDLPFC) on sleep problems in patients with fibromyalgia. METHODS: Forty two patients with fibromyalgia who had sleep difficulties were randomly assigned to receive either real or sham rTMS treatment. Patients received 20 treatment sessions (5 sessions per week) in which 1200 rTMS pulses were applied over the rDLPFC using a frequency of 1 Hz and an intensity of 120 % of the resting motor threshold. All participants were evaluated at baseline, and then 1 month and 3 months after treatment using the Fibromyalgia Impact Questionnaire (FIQ), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Sleep Scale (MOS-SS) and polysomnography (PSG). RESULTS: There were significant time (pre, 1month, and 3 months)X group (real versus sham group) interactions in all 3 clinical rating scales; FIQ (Df = 1.425, F = 237.645, P = 0.001), PSQI (Df = 2, F = 64.005, P = 0.001), MOS-SS (Df = 2, F = 28.938, P = 0.001) due to the fact that the real group improved significantly more over time than the sham group. Similarly, the real group improved more on the PSG parameters than the sham group. The effect sizes were large both in the rating scales and PSG, indicating a substantial clinical improvement. Correlation as an exploratory analysis between the changes (pre - post 3 months) in MOS-SS and PLMs index (/h) showed significant negative correlation (r = -0.643, P = 0.002). CONCLUSIONS: 20 sessions of LF-rTMS over rDLPFC can improve sleep quality in both subjective (PSQI and MOSS) as well as objective (PSG) rating scales.

Trastornos del sueño en pacientes con fibrosis quística / Sleep disorders in patients with cystic fibrosis

Los trastornos del sueño son comunes en pacientes con fibrosis quística y afectan significativamente su calidad de vida. Estos pacientes experimentan una reducción en la calidad del sueño, hipoxemia nocturna, alteraciones en la polisomnografía y una alta prevalencia de síndrome de apneahipopnea obstructiva del sueño. Los factores que contribuyen a estas alteraciones incluyen la tos crónica, los síntomas digestivos, las rutinas de tratamiento y, posiblemente, la disfunción del canal CFTR. Sin embargo, el impacto de los moduladores de CFTR en la mejora de los trastornos del sueño aún no está claramente establecido, lo que resalta la necesidad de más estudios para comprender mejor su papel en el manejo del sueño en pacientes con fibrosis quística.

Sleep disorders are common in patients with cystic fibrosis and significantly affect their quality of life. These patients experience reduced sleep quality, nocturnal hypoxemia, polysomnography alterations, and a high prevalence of obstructive sleep apnea-hypopnea syndrome. Contributing factors include chronic cough, digestive symptoms, treatment routines, and potentially CFTR channel dysfunction. However, the impact of CFTR modulators on improving sleep disorders is not yet clearly established, highlighting the need for further studies to better understand their role in sleep management in cystic fibrosis patients.

Early detection and treatment of obstructive sleep apnoea in infants with Down syndrome: a prospective, non-randomised, controlled, interventional study.

Background: Infants with Down syndrome (DS) are at high risk of obstructive sleep apnoea (OSA) which is associated with neurocognitive dysfunction and behaviour problems. The aim of our study was to evaluate the effect of early OSA treatment in infants with DS on neurocognitive development and behaviour. Methods: In this prospective, interventional, non-randomised study, 40 infants with DS underwent polysomnography (PSG) every 6 months in room air between 6 and 36 months of age (Screened Group) and were compared to a control group of 40 infants with DS receiving standard of care and a single, systematic PSG in room air at 36 months of age (Standard Care Group). When present, OSA was treated. The primary endpoint was the total score of the Griffiths Scales of Child Development, Third Edition (Griffiths III) and its subscores at 36 months. Secondary endpoints included a battery of neurocognitive and behaviour questionnaires, and PSG outcomes. Findings: On the Griffiths III, the total score was significantly higher in the Screened Group compared to the Standard Care Group (difference: 4.1; 95%CI: 1.3; 7.6; p = 0.009). Results in Griffiths III subscores and secondary endpoints were in support of better neurocognitive outcomes in the Screened Group compared with the Standard Care Group. At 36 months, median (Q1; Q3) apnoea-hypopnea index was higher in the Standard Care Group (4.0 [1.5; 9.0] events/hour) compared to the Screened Group (1.0 [1.0; 3.0] events/hour, p = 0.006). Moderate and severe OSA were more frequent in the Standard Care Group as compared to the Screened Group (18.9% versus 3.7% for moderate OSA and 27.0% versus 7.4% for severe OSA). Interpretation: Early diagnosis and treatment of OSA in infants with DS may contribute to a significantly better neurocognitive outcome and behaviour at the age of 36 months. Funding: The study was funded by the Jérôme Lejeune Foundation.

Sleep, Sleepiness, and Memory.

Objective To evaluate the relationship between sleep and sleepiness with memory complaints. Materials and Methods Patients who were submitted to polysomnography between May and September of 2022 and answered the prospective and retrospective memory questionnaire and the Epworth sleepiness scale were included, respectively. Data were entered into an Excel spreadsheet and converted to a file compatible with the SPSS software. Results The sample consisted of 98 subjects, 62.2% male, mean age of 45.9 years, 73.4% overweight, 54.1% with comorbidities, and 51% with excessive sleepiness. There was a significant difference in sleep efficiency, respiratory disturbance index (RDI), slow wave sleep (SWS), and rapid eye movement (REM) sleep for the group with comorbidities; in latency to sleep and SWS between genders; and in RDI for the body mass index group. No correlation between RDI and memory could be identified, but there were statistically significant correlations between REM and sleep efficiency; RDI and REM sleep; RDI and SWS; SWS and sleep efficiency; and sleep efficiency and latency to sleep onset. Older adults performed better on memory tests when total sleep time (TST) is longer than 5 hours and excessive daytime sleepiness is related to complaints of prospective, retrospective, and total memory. Conclusion Elderly people with TST longer than 5 hours have a better memory. Although a correlation between RDI and memory was not observed, a correlation between excessive daytime sleepiness-one of the main symptoms of patients with sleep disorders-and memory was.