Automated sleep scoring system using multi-channel data and machine learning.

Sleep staging is one of the most important parts of sleep assessment and it has an important role in early diagnosis and intervention of sleep disorders. Manual sleep staging requires a specialist and time which can be affected by subjective factors. So that, automatic sleep-scoring method with high accuracy is beneficial. In this work 50 patients sleep data taken from 19 sensors of Philips Alice clinic polysomnography (PSG) device. There is an average of 4772801 data for each individual in a single channel, and approximately 87 million data is processed in 19 channels. Due to the large amount of data, after under sampling technique, dataset is created and Random Forest, Extra Trees and Decision Tree classifiers are applied on it. Although accuracy values vary from one person to another, average of 95.258% for Extra Trees, 95.17% for Random Forest and 91.318% for Decision Tree obtained. Furthermore, precision, recall and F1-score values were also 0.95362, 0.95258 and 0.94568 on average. Beyond the previous works in the area of sleep stage scoring, proposed work differentiated from them by having own database, providing higher accuracy and employing 19 channels. The results showed that the proposed work may alleviate the burden of sleep doctors and speed up sleep scoring.

The alterations of retinal vasculature detected on optical coherence tomography angiography associated with chronic obstructive pulmonary disease.

OBJECTIVES: This study aimed to evaluate the retinal vasculature of the macula and optic disc in patients with chronic obstructive pulmonary disease (COPD) by optical coherence tomography angiography (OCTA). METHODS: The right eyes of 70 COPD patients and 71 healthy individuals were evaluated. These patients had moderate airflow limitation and mean PO2 of 60 mmHg, and their average age was less than 60 years. Superficial and deep capillary plexus vascular densities, foveal avascular zone (FAZ) width, and optic disc parameters were measured with OCTA. In addition, the correlation between the PO2 level in COPD patients and superficial, deep, and peripapillary vascular densities and FAZ was examined in the study. RESULTS: The COPD group had a significant decrease in the vascular density in the superficial (fovea [p = 0.019]; parafovea [p = 0.013]; and perifovea [p = 0.001]) and deep capillary plexus (fovea [p = 0.028]; parafovea [p = 0.005]; and perifovea [p = 0.002]). Also, the enlargement of the FAZ (p = 0.002) and a decrease in the peripapillary vascular density (p = 0.006) were observed in the COPD group. There was a positive correlation between PO2 level and superficial, deep, and peripapillary vascular densities in COPD patients and a negative correlation with FAZ (r = 0.559-0.900). CONCLUSION: Hypercapnia, respiratory acidosis, and chronic hypoxia associated with COPD may affect the macula and optic nerve, resulting in a serious decrease in vascular density, and OCTA can be a very important tool in the follow-up and treatment of these patients.

Evaluation of corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome.

PURPOSE: In the present study we evaluate the corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome (OSAS). METHODS: The study included a total of 100 patients including 35 patients with mild OSAS, 34 patients with moderate OSAS and 31 patients with severe OSAS, and the right eyes of 30 patients as a control group. Patients were examined to exclude the possibility of ocular diseases. Cellular density in the cornea epithelium (cell/mm2), corneal thickness (µ), percentage of hexagonal cells (%) and the coefficient of variation were evaluated using a specular microscope. RESULTS: Corneal thickness was significantly decreased in all OSAS groups when compared to the control group (p = 0.002), while no significant difference was identified among the OSAS groups. The corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation were significantly different between the OSAS groups and the control group (p < 0.001). CONCLUSION: More significant impairments were noted in the corneal endothelium of the patients in the OSAS group than in the control group, and specular microscopy is in valuable in the follow-up and treatment of such patients.

Evaluation of Acromegaly patients with sleep disturbance related symptoms.

BACKGROUND AND OBJECTIVES: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. METHODS: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. RESULTS: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). CONCLUSION: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity.

Evaluation of the corneal endothelium by specular microscopy in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The objective of this study is to evaluate the corneal endothelium in patients with chronic obstructive pulmonary disease (COPD) using a specular microscope. METHODS: The right eyes of 64 patients with a COPD diagnosis and 65 healthy individuals were evaluated. Cell density (CD) (cell/mm2 ), corneal thickness (CT) (µ), hexagonal cell ratio (%), and coefficient of variation (cell area standard deviation/mean cell area, µm2 ) were analyzed by specular microscopy (SM). RESULTS: The CT was significantly reduced in the COPD group compared with the control group (P = 0.021). Moreover, a significant difference was found between the COPD group and the control group in terms of corneal endothelial CD (P = 0.011), hexagonal cell ratio (P = 0.008), and coefficient of variation (P = 0.012). CONCLUSION: The corneal endothelial structure was significantly deteriorated in patients with COPD compared with the control group. SM is a valuable method that could be used in treatment and follow-up of corneal endothelium in patients with COPD.

Evaluation of sleep-related respiratory disorders in patients with multiple sclerosis.

Patients with multiple sclerosis (MS) often report fatigue, poor sleep and complaint of sleep disorders. Neurofilament light chain (NF-L) has been identified as a potential biomarker for disease progression in MS patients. In this study, we aimed to evaluate sleep characteristics in MS patients and its relationship with the level of serum NF-L. In the present study carried out as a prospective and cross-sectional study, 32 relapsing-remitting MS (RRMS) patients and 32 control subjects were included. Epworth Sleepiness Scale and Fatigue Severity Scale tests were applied to the groups and the full night polysomnography was performed. Serum samples were obtained for NF-L analysis. Apnea-hypopnea index (AHI), AHI in rapid eye movement sleep (AHI REM), percentage of NonREM stage 1 (N1) and NonREM stage 3 (N3) values were significantly different in RRMS patients (p < 0.05). There was correlation between AHI and Expanded Disability Status Scale indicating a negative directed moderate relationship (r = - 0.343 p = 0.055). Serum NF-L correlations with sleep efficiency and percentage of NonREM stage 2 (N2) were showed mild significant correlation (r = - 0.342 as - 0.535, p < 0.05). We found that sleep disorders are prevalent in RRMS patients and it has a negative effect on the clinical outcome of disease. In clinical practice, the association of these two diseases should be taken into consideration because sleep disturbances increase the disability of MS disease especially presenting with fatigue.

Insufficiency of positive airway pressure treatment on increased mean platelet volume: a prospective controlled study in patients with obstructive sleep apnea syndrome.

BACKGROUND: To analyze the association between obstructive sleep apnea syndrome (OSAS) and some hematological variables such as mean platelet volume (MPV), platelet distribution width (PDW), and the impact of positive airway pressure (PAP) treatment on these parameters. METHODS: The participants of the present prospective study consist of 36 OSAS patients diagnosed with polysomnography and recommended PAP treatment and 30 healthy members as the control group. Complete blood analyses were conducted to the patient group twice; before the initiation of the PAP treatment and 1 month after regular PAP use. The control group was administered a complete blood analyses only once. Patient and control group were compared in terms of various parameters such as MPV, PDW, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC) values, and platelet counts. RESULTS: MPV value of the patient group was before and after PAP treatment significantly higher than the control group (respectively; Z = 2.246; p = 0.025, and Z = 2.033; p = 0.042). However, there were no statistically significant differences in the values before and after PAP treatment in the patient group (Z = 0.727; p = 0.467). In terms of platelet numbers and PDW values, no significant differences were determined (p > 0.05). CONCLUSION: MPV value was significantly elevated in OSAS patients. However, the 1 month of PAP treatment was insufficient in decreasing elevated MPV values.

Extensive Exposure to Tear Gases in Ankara.

OBJECTIVES: The most common chemical substances used as mass control agents are chloroacetophenone, chlorobenzylidene malononitrile, and oleoresin capsicum. These agents not only have local and rapid effects but also have systemic and long-term effects. The aim of the present study was to discuss the patterns of tear gas exposure and to investigate its effects on respiratory functions. MATERIALS AND METHODS: A face-to-face survey was conducted in 86 individuals who had been exposed to tear gas indoor and outdoor during the public protests in June 2013. RESULTS: The most frequently reported respiratory complaints included cough, dyspnea, phlegm, and chest pain. Spirometry measurements including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also performed. Indoor exposers have lower mean % predicted FVC and FEV1 values than outdoor exposers. All complaints and signs were more common in indoor exposure to tear gas than in outdoor exposure. CONCLUSION: Safety of the chemicals used as mass control agents during protests is doubtful as these agents are associated with several health risks.

Alternative technique to transfer jaw relations for custom mandibular advancement devices: A case report.

Background: Oral appliance therapy for obstructive sleep apnea can be helpful in mild and moderate cases. This clinical report evaluates the efficacy of a protocol that predicts an optimal jaw position and describes the response of a young OSA patient to treatment. Clinical Presentation: A 27-year-old woman was diagnosed with moderate OSA and had an apnea-hypopnea index (AHI) of 25.8/hr. In order to fabricate a custom device, an alternative procedure to determine the optimal protrusion and vertical positioning of the jaw was applied. After a follow-up period of 14 months, her apnea-hypopnea index (AHI) significantly decreased from 25.8 to 1.0 per hr with the appliance. The total number of respiratory events decreased from 211 to 8. Conclusion: Improved polysomnographic parameters showed that the oral device was efficient in treatment. The advantages of the device in this study are that it is comfortable, economical, and simple to fabricate.

Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience.

Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38-65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms. What is known? • Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential. • Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough. What is new? • We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores. • We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.

Comparison of full-night and ambulatory polysomnography with ApneaGraph in the subjects with obstructive sleep apnea syndrome.

The localization of the obstruction is crucial in determining the appropriate surgical treatment for obstructive sleep apnea syndrome (OSAS); ApneaGraph has been introduced for diagnosis of OSAS and localization of airway obstruction level. This study aims to evaluate the diagnostic value of ApneaGraph for both clinical staging and site of obstruction. Thirty male OSAS patients were prospectively enrolled in this clinical trial. The following parameter were included to the study: Body mass indexes and neck circumferences of the subjects, Epworth sleepiness scale, site of obstruction detected by flexible endoscopy and ApneaGraph, apnea hypopnea index (AHI), apnea index, hypopnea index, maximal oxygen desaturation and average oxygen saturation which were detected by both polysomnography (PSG) and ApneaGraph devices. Our data presented that, although AHI measured by ApneaGraph and PSG were significantly correlated; severity stages of the subjects were different in 44 % of the subjects when based on AHI of ApneaGraph, compared to PSG. Majority of the changes were from severe OSAS to mild or moderate levels. Similar dominant collapse levels were detected in 64 % of the subjects by both devices. It was seen that transpalatal obstruction was better correlated between ApneaGraph and flexible endoscopy. As a conclusion, we might assume that ApneaGraph can be used as a screener for OSAS and it appears to be a more reliable device to confirm dominancy of palatal level obstruction.

The efficacy of Watch PAT in obstructive sleep apnea syndrome diagnosis.

Polysomnography is currently considered as the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS). But high expense and the backlog of the sleep centers have resulted in a search for an alternative method of diagnosis. The aim of this study is to assess the efficacy and reliability of Watch PAT as an alternate option in OSAS diagnosis. The patients have worn a Watch PAT(®) 200 device in the sleep laboratory during a standard polysomnography. The correlation in REM and Non-REM AHI scores, sleep periods and the mean O2 saturation percentage between Watch PAT and PSG sleep studies were assessed. There was a statistically significant very strong correlation between PSG and Watch PAT AHI scores (Spearman's rho = 0.802 p < 0.001). The mean recording time with PSG and Watch PAT was 463.06 ± 37.08 and 469.33 ± 72.81 min, respectively, and there was no statistically significant difference (p = 0.068). However, there was a statistically significant difference between two methods regarding the average sleep time and REM sleep period. No statistically significant difference was revealed in the mean O2 saturation percentage (p < 0.001). Watch PAT is an efficient device and is considered to be an adjunctive diagnostic method for PSG in diagnosis of OSAS.

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma.

OBJECTIVES: Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS: Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS: We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION: The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

Management of obstructive sleep apnea in an edentulous lower jaw patient with a mandibular advancement device.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed.

Relationship between obstructive sleep apnea syndrome and thyroid diseases.

Obstructive sleep apnea syndrome (OSAS) is a widespread disorder characterized by recurrent, partial, or complete episodes of apnea due to upper airway tract obstruction during sleep. OSAS frequency is likely to increase in hypothyroidism because of obesity, macroglossia, dysfunctional upper respiratory tractus (URT) musculature, deposition of mucopolysaccharides in URT tissues, and decreased ventilatory control. This study examines the relationship between OSAS and thyroid disease in OSAS subjects. This study includes 150 polysomnographically diagnosed OSAS patients (50 mild, 50 moderate, 50 severe OSAS cases) treated at Endocrinology and Metabolism Department of Ankara Numune Training and Research Hospital between January 2010 and May 2011 and 32 non-OSAS control subjects. All patients were given serum TSH, free T3 (fT3), free T4 (fT4), anti thyroid peroxidase (Anti-TPO), and anti-thyroglobulin (anti-TG) tests, as well as thyroid ultrasounds. We did not find any difference in prevalence of hypothyroidism, numbers of nodules and parenchyma heterogenicity determined by ultrasound, between OSAS subgroups and controls (p > 0,05). In this study, functional and ultrasonographic examination of the thyroid gland did not reveal any relationship between OSAS and thyroid disease. We believe hence that long-term follow-up studies can establish the possible significance of routine evaluation of OSAS patients for thyroid disease.

The high dependency of supine position in obstructive sleep apnea.

OBJECTIVE: To define the frequency of supine positional obstructive sleep apnea (OSA) in patients diagnosed with OSA and to describe the demographic associations with positional OSA (PO). METHODS: A retrospective study was performed in a total of 3813 patients who underwent full-night polysomnography at the Sleep Disorders Center of the Ataturk Chest Diseases, Thoracic Surgery Education and Research Hospital, Ankara, Turkey between June 2007 and June 2010. A total of 3214 patients diagnosed with OSA were included in the study. Positional OSA was defined as a total AHI more than or equal to 5, and supine AHI/non-supine AHI more than or equal to 2. Characteristics of positional OSA and non-positional OSA groups were compared statistically. RESULTS: Patients classified as positional OSA composed 39.9% of all OSA patients. Positional OSA patients were younger with lower body mass index and their OSA was less severe. CONCLUSION: Positional OSA, which may require different treatment approaches, is not uncommon among OSA patients and should be understood as a different clinical entity.

[Rapid eye movement related obstructive sleep apnea syndrome: antropometric and polysomnographic findings]. / Hizli göz hareketleri ile iliskili obstrüktif uyku apne sendromu: Antropometrik ve polisomnografik bulgular.

INTRODUCTION: Obstructive sleep apnea syndrome is characterized by episodic narrowing of the upper respiratory ways accompanied by an oxygen desaturation during sleep. REM-related obstructive sleep apnea syndrome, comprises a subgroup of sleep disordered breathing with a 10-36% frequency. The aim of the present study is to analyze the frequency, the antropometric and polygraphic features of REM-related obstructive sleep apnea syndrome. MATERIALS AND METHODS: A total of 427 cases [332 males (77.4%) and 95 females (22.6%)] with definitive obstructive sleep apnea syndrome diagnosis with polysomnography records were included into the study. RESULTS: Of all the cases, 108 (25.3%) were REM-related sleep respiratory disorder. There was no difference between the two groups with regard to age and sex. However, the obstructive sleep apnea syndrome group non-related to REM demonstrated a more severe obstructive sleep apnea syndrome and a longer neck circumference. Superficial sleep was longer in the REM non-related group, while deep refreshing sleep (Non-REM 3) was longer in the REM-related group. The subgroup analysis of the REM-related group with regard to sex revealed a higher body mass index in the female subgroup. CONCLUSION: REM-related sleep respiratory disorder is more often in mild-to-moderate obstructive sleep apnea syndrome cases, the male/female ratio of REM-related sleep respiratory disorder is not different from the obstructive sleep apnea syndrome prevalence in the community.

The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea.

BACKGROUND AND OBJECTIVE: There is an increased risk of cardiovascular and cerebrovascular events in patients with obstructive sleep apnea (OSA). High-sensitivity C-reactive protein (hs-CRP) is a marker that predicts atherosclerotic complications. However, there are contradictory results about the correlation between serum hs-CRP levels and OSA severity. The purpose of this work was to evaluate the relationship between hs-CRP levels and the severity of OSA in newly diagnosed OSA patients. METHODS: The study group was composed of 76 patients with clinical suspicion of OSA. Subjects with body mass indexes (BMI) ≥30 kg/m(2) were classified as obese. Full-night polysomnography (PSG) was performed on all patients. Patients with an apnea-hypopnea index (AHI) ≥5 were considered to have OSA, and patients with an AHI <5 were accepted as the control group. Blood samples were taken from all patients to analyze serum hs-CRP levels the morning after PSG. RESULTS: The serum hs-CRP levels were significantly higher in the OSA group (4.03 ± 3.58 mg/L) than in the control group (2.41 ± 1.95 mg/L) (p = 0.013). This high level was positively correlated with BMI (r = 0.376, p = 0.001) and with AHI (r = 0.280, p = 0.014). In multiple regression analysis, elevated hs-CRP levels were associated with AHI (F = 3.293, p = 0.033), which was independent of obesity. CONCLUSIONS: Patients with OSA have elevated serum levels of hs-CRP, a marker for inflammation and an independent risk predictor for cardiovascular morbidity. The severity of OSA is responsible for the elevation of hs-CRP.

Obstructive sleep apnea syndrome (OSAS) and social support in elder patients.

Social support is a very important aspect in debilitating diseases. OSAS is a disabling disease that impairs social functioning and accounts for a large socio-economic burden for the community. In this study our aim is to investigate social support levels among OSAS patients: 85 of them with the diagnosis of OSAS were enrolled in the study. Multidimensional scale of perceived social support (MSPSS) is used to measure the perception of individuals' social support sufficiency. In contrast to many studies, we found that social support levels of elder patients were higher than the young ones and family subscale was significantly higher. It might be both due to Turkish family structure that the grands are in close relationship with the other family members and the adverse effects of the disease which have more negative impact on young patients' life. In conclusion, social support is an important aspect in OSAS patients. The interventions for the enhancement of social support could lead to substantial cost-savings, reduce morbidity, and increase well-being.