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1.
J Stroke Cerebrovasc Dis ; 29(2): 104510, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31767524

RESUMO

BACKGROUND AND PURPOSE: Evidence of an association between sleep apnea (SA) and early neurological deterioration (END) in acute phase ischemic stroke is scant. We investigated the prevalence of SA and the impact of SA severity on END in acute ischemic stroke (AIS) patients. METHODS: We prospectively enrolled consecutive AIS patients admitted to our stroke unit within 72 hours of symptom onset. SA severity was assessed with ApneaLink-a validated portable respiratory monitor. SA was defined as an apnea-hypopnea index (AHI) of greater than or equal to 5 per hour. END was defined as an incremental increase in the National Institutes of Health Stroke Scale (NIHSS) score by greater than or equal to 1 point in motor power, or greater than or equal to 2 points in the total score within the first week after admission. RESULTS: Of the 305 patients studied, 254 (83.3%) patients had SA (AHI ≥ 5 per hour), and of these, 114 (37.4%) had mild SA (AHI 5-14 per hour), 59 (19.3%) had moderate SA (AHI 15-29 per hour), and 81 (26.6%) had severe SA (AHI ≥ 30 per hour). Thirty-six (11.8%) patients experienced END: 2 of the 51 (3.9%) patients without SA and 34 of the 254 (14.4%) patients with SA. Multivariable regression analysis showed AHI independently predicted END (odds ratio 1.024; 95% confidence interval 1.006 to 1.042; P = .008). CONCLUSIONS: SA is common in the acute phase of ischemic stroke, and SA severity is associated with the risk of END.


Assuntos
Isquemia Encefálica/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Avaliação da Deficiência , Progressão da Doença , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
2.
Heart Fail Clin ; 16(1): 45-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735314

RESUMO

Sleep-disordered breathing (SDB), including obstructive sleep apnea, central sleep apnea (CSA), and Cheyne-Stokes respiration, is common in patients with heart failure (HF) and associated with lower left ventricular ejection fraction (EF), increased arrhythmia burden, and increased mortality. Continuous positive airway pressure therapy improves short-term and long-term outcomes in HF patients. Adaptive servoventilation (ASV) therapy in patients with low-EF HF with predominant CSA is not recommended. Ongoing trials are evaluating whether ASV will have a role in SDB treatment. Phrenic nerve stimulation is an emerging treatment option that has shown promising outcomes. All HF patients should be screened for SDB.


Assuntos
Insuficiência Cardíaca/complicações , Síndromes da Apneia do Sono/etiologia , Sono/fisiologia , Função Ventricular Esquerda/fisiologia , Saúde Global , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/fisiopatologia , Taxa de Sobrevida/tendências
3.
Sleep Med Clin ; 14(4): 431-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640871

RESUMO

Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scale.


Assuntos
Condução de Veículo , Síndromes da Apneia do Sono/fisiopatologia , Sonolência , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Cooperação do Paciente , Fatores de Risco , Síndromes da Apneia do Sono/terapia , Vigília
4.
Artigo em Inglês | MEDLINE | ID: mdl-31540542

RESUMO

Abstract: Recent evidences suggest that non-arousal mechanisms can restore and stabilize breathing in sleeping patients with obstructive sleep apnea. This possibility can be examined under deep sedation which increases the cortical arousal threshold. We examined incidences of cortical arousal at termination of apneas and hypopneas in elderly patients receiving propofol sedation which increases the cortical arousal threshold. Ten elderly patients undergoing advanced endoscopic procedures under propofol-sedation were recruited. Standard polysomnographic measurements were performed to assess nature of breathing, consciousness, and occurrence of arousal at recovery from apneas and hypopneas. A total of 245 periodic apneas and hypopneas were identified during propofol-induced sleep state. Cortical arousal only occurred in 55 apneas and hypopneas (22.5%), and apneas and hypopneas without arousal and desaturation were most commonly observed (65.7%) regardless of the types of disordered breathing. Chi-square test indicated that incidence of no cortical arousal was significantly associated with occurrence of no desaturation. Higher dose of propofol was associated with a higher apnea hypopnea index (r = 0.673, p = 0.033). In conclusion, even under deep propofol sedation, apneas and hypopneas can be terminated without cortical arousal. However, extensive suppression of the arousal threshold can lead to critical hypoxemia suggesting careful respiratory monitoring.


Assuntos
Nível de Alerta/fisiologia , Hidrocortisona/biossíntese , Propofol/farmacologia , Síndromes da Apneia do Sono/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Propofol/administração & dosagem , Estudos Prospectivos , Respiração
5.
Int J Pediatr Otorhinolaryngol ; 127: 109667, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31499263

RESUMO

OBJECTIVE: To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing (SDB). METHODS: This was a retrospective, cross-sectional study. A consecutive series of children ≤3 years old who underwent management for SDB were retrospectively identified from a prospectively kept surgical database. The early onset group was compared with two separate late onset (≥4years old) groups. Diagnoses associated with PD included gastroesophageal reflux disease (GERD), swallowing dysfunction, prematurity, asthma, and obesity. Distribution of PD diagnoses, airway lesions, syndromic conditions, pulse oximetry scores, and endoscopic pattern of airway obstruction were compared. RESULTS: 73 patients with early onset SDB were identified (51 boys, mean age 2.25 ±â€¯0.64 years, range 1.75-3 years) and compared with two groups of later onset SDB consisting of 75 and 72 patients with mean ages of 7.58 ±â€¯2.40 years and 8.04 ±â€¯3.34 years respectively (range 4-16 years). The early onset SDB group had a higher prevalence of PD diagnoses compared to the later onset group with 35 of 73 patients being diagnosed compared to 41 of 147 children (p = 0.01). Early onset SDB patients were more likely to have GERD or swallowing dysfunction (p < 0.01) while later onset patients more commonly presented with associated asthma or obesity (p < 0.01). There was no statistically significant difference in airway lesions between groups. CONCLUSION: Early-onset SDB is associated with conditions causing PD more often than later-onset SDB. Identifying these conditions and optimizing their management may impact outcomes in treating pediatric SDB.


Assuntos
Doenças Faríngeas/complicações , Faringe/fisiopatologia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/fisiopatologia , Adolescente , Idade de Início , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Asma/complicações , Criança , Pré-Escolar , Estudos Transversais , Transtornos de Deglutição/complicações , Endoscopia , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Lactente , Masculino , Obesidade/complicações , Oximetria , Doenças Faríngeas/fisiopatologia , Nascimento Prematuro/fisiopatologia , Estudos Retrospectivos , Síndromes da Apneia do Sono/diagnóstico
6.
Sensors (Basel) ; 19(15)2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31370241

RESUMO

Sleep monitoring in an unattended home setting provides important information complementing and extending the clinical polysomnography findings. The validity of a wearable textile electrocardiography (ECG)-belt has been proven in a clinical setting. For evaluation in a home setting, ECG signals and features were acquired from 12 patients (10 males and 2 females, showing an interquartile range for age of 48-59 years and for body mass indexes (BMIs) of 28.0-35.5) over 28 nights. The signal quality was assessed by artefacts detection, signal-to-noise ratio, and Poincaré plots. To assess the validity, the data were compared to previously reported data from the clinical setting. It was found that the artefact percentage was slightly reduced for the ECG-belt from 9.7% ± 14.7% in the clinical setting, to 7.5% ± 10.8% in the home setting. The signal-to-noise ratio was improved in the home setting and reached similar values to the gel electrodes in the clinical setting. Finally, it was found that for artefact percentages above 3%, Poincaré plots are instrumental to evaluate the origin of artefacts. In conclusion, the application of the ECG-belt in a home setting did not result in a reduction in signal quality compared to the ECG-belt used in the clinical setting, and thus provides new opportunities for patient pre-screening or follow-up.


Assuntos
Eletrocardiografia/métodos , Monitorização Fisiológica , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador , Razão Sinal-Ruído , Sono/fisiologia , Síndromes da Apneia do Sono/fisiopatologia , Têxteis , Dispositivos Eletrônicos Vestíveis
9.
Brain Dev ; 41(8): 662-670, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337524

RESUMO

OBJECTIVE: To explore impaired cognition characteristics and abnormal behavior in children with Sleep-Disordered Breathing (SDB) via Event-Related Potentials (ERPs), continuous performance testing (CPT), and the Child Behavior Checklist (CBCL). METHODS: A total of 108 children aged 6-8 years old were recruited, including fifty-four children (28 boys) with SDB and fifty-four normal children (28 boys). CBCL and Chinese version of the OSA-18 questionnaire were administered. Nineteen children with SDB (OSA-18 questionnaire value >60) and Nineteen normal children completed a CPT task. ERP was extracted using the BESA software. RESULTS: No significant differences in the correct number, reaction time, or the number of commission error were noted between the CPT of the two groups (P > 0.05). The ERP Go-P3 amplitudes at F3, Fz and F4 of the SDB group were significantly higher than those of the control group (P < 0.05). The NoGo-N2 amplitudes at F3 and Fz of the SDB group were significantly lower than those of the control group (P < 0.05). The Fz and F4 Go-P3 and FZ NoGo-P3 latency of the SDB group were significantly longer than those of the control group (P < 0.05). However, among boys, the CBCL scores of the SDB group including the subscores, schizo, somatic complaints, compulsion, aggression, and hyperactivity, as well as the total score, were significantly higher than the control group (all P < 0.05). CONCLUSION: Children with SDB demonstrate significant functional deficits in regard to conflict monitoring, attention, and inhibition. The frontal region is the primary area of dysfunction, especially in the left brain region, and inhibition function dysfunction may be a common pathogenesis of SDB and ADHD. Moreover, boys with SDB may exhibit more behavior problems when compared to girls.


Assuntos
Transtornos do Comportamento Infantil/etiologia , Potenciais Evocados/fisiologia , Síndromes da Apneia do Sono/fisiopatologia , Atenção/fisiologia , Criança , Transtornos do Comportamento Infantil/metabolismo , China , Cognição/fisiologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Tempo de Reação/fisiologia , Síndromes da Apneia do Sono/metabolismo , Inquéritos e Questionários
10.
PLoS One ; 14(7): e0218920, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31269081

RESUMO

INTRODUCTION: The neuroendocrine background of acute sleep fragmentation in obstructive sleep apnea and sleep fragmentation involvement in psychiatric comorbidities, common in these patients, are still largely unknown. The aim of this study was to determine the effects of short-term experimental sleep fragmentation on anxiety -like behavior and hormonal status in rats. METHODS: Male rats were adapted to treadmill (ON and OFF mode with belt speed set on 0.02m/s and 0.00m/s) and randomized to: 1) treadmill control (TC, only OFF mode); 2) motion, activity control (AC, 10min ON and 30min OFF mode) and 3) sleep fragmentation (SF, 30s ON and 90s OFF mode) group. Six hours later, the animals were tested in the open field, elevated plus maze and light/dark test (n = 8/group). Testosterone, estradiol, progesterone and corticosterone were determined in separate animal cohort immediately upon sleep fragmentation (n = 6/group). RESULTS: SF rats showed decreased rearings number, decreased time spent in the central area and increased thigmotaxic index compared to TC and AC rats in the open field test. Similarly, increased anxiety upon sleep fragmentation was observed in the elevated plus maze and the light/dark test. Significantly lower testosterone, estradiol and progesterone levels were determined in SF in comparison to AC and TC groups, while there was no significant difference in the levels of corticosterone. CONCLUSION: Short term sleep fragmentation enhances anxiety-related behavior in rats, which could be partly mediated by the observed hormonal changes presented in the current study in form of testosterone, estradiol and progesterone depletion.


Assuntos
Síndromes da Apneia do Sono/fisiopatologia , Privação do Sono/fisiopatologia , Sono/fisiologia , Transtornos de Estresse Traumático Agudo/fisiopatologia , Animais , Ansiedade/complicações , Ansiedade/fisiopatologia , Comportamento Animal/fisiologia , Corticosterona/líquido cefalorraquidiano , Modelos Animais de Doenças , Estradiol/metabolismo , Teste de Esforço , Humanos , Aprendizagem em Labirinto , Progesterona/líquido cefalorraquidiano , Ratos , Síndromes da Apneia do Sono/líquido cefalorraquidiano , Privação do Sono/líquido cefalorraquidiano , Privação do Sono/complicações , Transtornos de Estresse Traumático Agudo/líquido cefalorraquidiano , Testosterona/líquido cefalorraquidiano
11.
J Stroke Cerebrovasc Dis ; 28(9): 2481-2487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277996

RESUMO

The Goal: The aim of the study was to investigate whether stroke volume or the presence of ischemic stroke lesion on follow-up computed tomography 1 day after admission had association with sleep apnea among ischemic stroke patients undergoing thrombolysis. MATERIALS AND METHODS: We prospectively recruited 110 consecutive ischemic stroke patients and performed computed tomography on admission and after 24 hours after intravenous thrombolysis. Stroke volume was measured from post-thrombolysis computed tomography scans. Unattended cardiorespiratory polygraphy with a 3-channel device was performed during 48 hours after admission. FINDINGS: Of 110 ischemic stroke patients treated with thrombolysis 65.5% were men. Mean age was 65.8 years and body mass index 27.5 kg/m2. The mean Epworth sleepiness scale score was 4.7. Eight patients (12.7%) with visible acute stroke after thrombolysis and none in the other group had hemorrhage as complication (P ˂ .001). Sleep apnea, determined as a respiratory event index greater than or equal to 5/hour, was diagnosed in 96.4% patients. Respiratory event index greater than 15/h was found in 72.8% of patients. Both mean baseline oxygen desaturation index (23.9 versus 16.5, P = .028) and obstructive apneas/hour (6.2 versus 2.7, P = .007) were higher in visible stroke group. Stroke volume (mean 15.9 mL) correlated with proportion of time spent below saturation less than 90%, P = .025. CONCLUSIONS: Acute ischemic stroke patients treated with thrombolysis with visible stroke were more likely to have nocturnal hypoxemia than patients with not visible strokes. Stroke volume correlated with time spent below saturation of 90%.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Hipóxia/etiologia , Síndromes da Apneia do Sono/etiologia , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Hipóxia/diagnóstico , Hipóxia/fisiopatologia , Infusões Intravenosas , Pulmão/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração , Fatores de Risco , Sono , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Diabetes Res ; 2019: 8417575, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31179343

RESUMO

Background: Metabolic syndrome (MS) and sleep-disordered breathing (SDB) are highly prevalent in patients with diabetes mellitus type 2 (DM2). The present study examined whether there is an independent association between SDB and MS in a sample of outpatients with DM2. Methods: MS was determined in 679 patients of the DIACORE-SDB substudy, a study of outpatients with DM2. According to the National Cholesterol Education Program (NCEP) criteria, MS is defined by at least three of the following five criteria: waist circumference of >102 cm (men)/>88 cm (women), blood pressure of ≥130/85 mmHg, a fasting triglyceride level of >150 mg/dl, high-density lipoprotein (HDL) of <40 mg/dl (men)/<50 mg/dl (women), and a fasting glucose level of ≥110 mg/dl. The apnea-hypopnea index (AHI) was assessed with a 2-channel ambulatory monitoring device and used to define the severity of SDB (AHI < 15.0: no/mild SDB; AHI 15.0-29.9: moderate SDB; AHI ≥ 30.0: severe SDB). Results: 228 (34%) of the 679 participants (mean age 66 years, mean body mass index (BMI) 31.2 kg/m2, and mean AHI 14/hour) had SDB. MS was significantly more frequent in patients with more severe SDB (no/mild SDB vs. moderate SDB vs. severe SDB: 72% vs. 79% vs. 85%, respectively, p = 0.038). Logistic regression analysis adjusted for sex, age, obesity (BMI ≥ 30 kg/m2), and the HOMA index showed a significant association between the AHI and the presence of MS (OR (95%CI) = 1.039 (1.011; 1.068); p = 0.007). Further, male sex, obesity, and the HOMA index were significantly associated with MS. Conclusion: SDB is significantly and independently associated with MS in outpatients with DM2.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Síndrome Metabólica/fisiopatologia , Síndromes da Apneia do Sono/fisiopatologia , Idoso , Apneia , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Colesterol/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipóxia , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Pacientes Ambulatoriais , Prevalência , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Triglicerídeos/sangue
13.
PLoS One ; 14(6): e0217217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206522

RESUMO

BACKGROUND: Sleep disordered breathing manifested as sleep apnea (SA) is prevalent in the general population, and while it is associated with increased morbidity and mortality risk in some patient populations, it remains under-diagnosed. The objective of this study was to assess the accuracy of respiration-rate (RR) and tidal-volume (TV) estimation algorithms, from body-surface ECG signals, using a smartphone based ambulatory respiration monitoring system (cvrPhone). METHODS: Twelve lead ECG signals were collected using the cvrPhone from anesthetized and mechanically ventilated swine (n = 9). During ECG data acquisition, the mechanical ventilator tidal-volume (TV) was varied from 250 to 0 to 750 to 0 to 500 to 0 to 750 ml at respiratory rates (RR) of 6 and 14 breaths/min, respectively, and the RR and TV values were estimated from the ECG signals using custom algorithms. RESULTS: TV estimations from any two different TV settings showed statistically significant difference (p < 0.01) regardless of the RR. RRs were estimated to be 6.1±1.1 and 14.0±0.2 breaths/min at 6 and 14 breaths/min, respectively (when 250, 500 and 750 ml TV settings were combined). During apnea, the estimated TV and RR values were 11.7±54.9 ml and 0.0±3.5 breaths/min, which were significantly different (p<0.05) than TV and RR values during non-apnea breathing. In addition, the time delay from the apnea onset to the first apnea detection was 8.6±6.7 and 7.0±3.2 seconds for TV and RR respectively. CONCLUSIONS: We have demonstrated that apnea can reliably be detected using ECG-derived RR and TV algorithms. These results support the concept that our algorithms can be utilized to detect SA in conjunction with ECG monitoring.


Assuntos
Eletrocardiografia , Monitorização Fisiológica/instrumentação , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Smartphone , Animais , Masculino , Taxa Respiratória , Processamento de Sinais Assistido por Computador , Suínos , Volume de Ventilação Pulmonar
14.
Heart Vessels ; 34(11): 1801-1810, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31111194

RESUMO

Heart rate turbulence (HRT) is regarded as a parameter of cardiac autonomic dysfunction. Several studies have suggested that patients with sleep disordered breathing (SDB) have an impaired HRT, which play a role in the relationship between SDB and risk of cardiovascular morbidity and mortality. However, the impact of SDB on HRT independent from obesity is still debatable. Data of eligible subjects who underwent sleep test and 24 h Holter electrocardiogram (ECG) recording from 2009-2012 were analyzed. HRT parameters, turbulence onset (TO), and turbulence slope (TS) in the 24 h recording, while awakening, and sleeping (TO-24 h, TO-awake, TO-sleep, TS-24 h, TS-awake, and TS-sleep, respectively) were compared across subjects with no-to-mild, moderate, and severe SDB. Univariable and multivariable regression analyses including TO or TS as a dependent variable were performed. Data from 41 subjects were evaluated. Compared with the no-to-mild and moderate SDB groups, in the severe SDB group, the TO-24 h and TO-awake were significantly greater, and the TS-24 h, TS-awake, and TS-sleep were significantly lower. In multivariable analyses, the apnea-hypopnea index (AHI) was correlated directly with TO-24 h (coefficient, 0.36; P = 0.03) and TO-awake (coefficient, 0.40; P = 0.01). SDB severity, as represented by AHI, is related to HRT impairments in non-obese subjects. SDB, independent from obesity, may affect cardiac autonomic dysfunction.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Eletrocardiografia Ambulatorial/métodos , Cardiopatias/fisiopatologia , Frequência Cardíaca/fisiologia , Síndromes da Apneia do Sono/fisiopatologia , Sono/fisiologia , Idoso , Feminino , Seguimentos , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade , Polissonografia , Prognóstico , Estudos Retrospectivos , Síndromes da Apneia do Sono/complicações
15.
Clin Chest Med ; 40(2): 269-283, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31078209

RESUMO

We examine recent findings that have revealed interdependence of function within the chemoreceptor pathway regulating breathing and sympathetic vasomotor activity and the hypersensitization of these reflexes in chronic disease states. Recommendations are made as to how these states of hyperreflexia in chemoreceptors and muscle afferents might be modified in treating sleep apnea, drug-resistant hypertension, chronic heart failure-induced sympathoexcitation, and the exertional dyspnea of chronic obstructive pulmonary disease.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Células Quimiorreceptoras/fisiologia , Humanos , Síndromes da Apneia do Sono/fisiopatologia
16.
Sensors (Basel) ; 19(9)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31072036

RESUMO

There exists a technological momentum towards the development of unobtrusive, simple, and reliable systems for long-term sleep monitoring. An off-the-shelf commercial pressure sensor meeting these requirements is the Emfit QS. First, the potential for sleep apnea screening was investigated by revealing clusters of contaminated and clean segments. A relationship between the irregularity of the data and the sleep apnea severity class was observed, which was valuable for screening (sensitivity 0.72, specificity 0.70), although the linear relation was limited ( R 2 of 0.16). Secondly, the study explored the suitability of this commercial sensor to be merged with gold standard polysomnography data for future sleep monitoring. As polysomnography (PSG) and Emfit signals originate from different types of sensor modalities, they cannot be regarded as strictly coupled. Therefore, an automated synchronization procedure based on artefact patterns was developed. Additionally, the optimal position of the Emfit for capturing respiratory and cardiac information similar to the PSG was identified, resulting in a position as close as possible to the thorax. The proposed approach demonstrated the potential for unobtrusive screening of sleep apnea patients at home. Furthermore, the synchronization framework enabled supervised analysis of the commercial Emfit sensor for future sleep monitoring, which can be extended to other multi-modal systems that record movements during sleep.


Assuntos
Balistocardiografia/instrumentação , Programas de Rastreamento , Monitorização Fisiológica/instrumentação , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Sono/fisiologia , Algoritmos , Artefatos , Eletrocardiografia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Polissonografia , Respiração , Processamento de Sinais Assistido por Computador
18.
Technol Health Care ; 27(3): 243-256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932906

RESUMO

BACKGROUND: Although actigraphy is widely used to measure sleep quality, few studies directly compared actigraphy data with polysomnography data, especially electromyography data. OBJECTIVE: We developed an algorithm which transforms actigraphy and electromyography signals to verify the interchangeability between them and tested the utility of this algorithm in sleep healthcare. METHODS: Thirty-eight subjects underwent polysomnography and actigraphy. We transformed electromyography signals extracted from polysomnography as integrated electromyography (IEMG) and actigraphy signals as integrated acceleration (IACC) using their physical properties. We compared receiver operating characteristic (ROC) curves obtained from transformed datasets with those of raw datasets in distinguishing REM and non-REM sleep. RESULTS: There was no significant correlation between raw electromyography and raw actigraphy data (r= 0.001, p= 0.124). After applying our transformation algorithm, significant correlation between IEMG and IACC was shown (r= 0.392, p< 0.001). In order to overcome small adjusted R2 from simple regression model (adjusted R=2 0.153, p< 0.001), we used panel data regression model to correct individual variances (adjusted R=2 0.542, p< 0.001). In ROC curve for distinguishing REM and non-REM sleep, AUCs were 0.536, 0.735 and 0.729 in raw data, IEMG and IACC respectively. CONCLUSIONS: The transformation algorithm revealed the relationship between electromyography and actigraphy data, and also yielded improved sleep staging ability.


Assuntos
Actigrafia/métodos , Algoritmos , Eletromiografia/métodos , Polissonografia/métodos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Adolescente , Adulto , Eletricidade , Feminino , Humanos , Cinética , Masculino , Fases do Sono , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-30857293

RESUMO

Sleep-disordered breathing (SDB) is an emerging dementia risk factor. Data on the prevalence of SDB in dementia patients and its association with cognitive impairment is so far only based on patients with severe dementia. In 101 geriatric patients mostly with mild dementia recruited on German geriatric wards, SDB was assessed during overnight polygraphy in the patient room with a portable sleep apnea examination device and associations of SDB severity with severity of impairment in cognitive and emotional function as well as mobility were investigated. We also elucidated which factors influence compliance of SDB diagnostics. In 82 of the 101 dementia patients (81.2%), SDB could be assessed. Of those, only 12.2% had an apnea-hypopnea index (AHI) < 5/h demonstrating the absence of SDB. 40.2% exhibited 5/h ≤ AHI < 15/h representing mild SDB, and 47.6% revealed an AHI ≥ 15/h representing moderate/severe SDB. Patients in these three AHI categories did not significant differ from each other in demographical and clinical characteristics. Patients with an AHI ≥ 15/h particularly often presented with heart failure and vitamin D deficiency. We observed a low to moderate association between severity of SDB and severity of dementia. Tolerance of the nasal airflow sensor of at least 6 h was present in less than one third of all patients. The tolerant group exhibited more symptoms of depression and higher physical fitness compared to the non-tolerant group. We observed a high prevalence of SDB also in geriatric patients with mild dementia underlining the importance of SDB screening in the elderly.


Assuntos
Cognição , Emoções , Hospitalização , Movimento , Síndromes da Apneia do Sono/complicações , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Feminino , Insuficiência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/psicologia
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