Estimated respiratory arousal threshold in patients with rapid eye movement obstructive sleep apnea.

PURPOSE: Rapid eye movement (REM) obstructive sleep apnea (OSA) is a prevalent clinical phenotype. However, the literature focusing on the pathophysiology of REM OSA is limited. This study compared the proportion of individuals with a low respiratory arousal threshold between patients with REM and non-REM OSA. METHODS: REM OSA was defined as having an apnea-hypopnea index (AHI) ≥ 5 and AHI during REM (AHI-REM)/AHI during NREM (AHI-NREM) ≥ 2. REM OSA was sub-divided into REM-predominant OSA and REM-isolated OSA. REM-predominant OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM ≥ 5. REM-isolated OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM < 5. Patients with an AHI-REM/AHI-NREM < 2 were defined as having non-REM OSA. A low respiratory arousal threshold was defined as having 2 or more of the following conditions: AHI < 30 events/h, proportion of hypopnea > 58.3%, and nadir SpO2 > 82.5%. RESULTS: The proportions of individuals with low respiratory arousal thresholds among individuals with REM-predominant OSA and REM-isolated OSA were significantly higher (77.2% and 93.7%, respectively) than that of patients with non-REM OSA (48.6%). This was also true when the analysis was performed according to sex. CONCLUSION: These results indicate that a low respiratory arousal threshold might be an important endotype that contributes to the pathogenesis of REM OSA, especially in REM-isolated OSA.

Risk factors for automobile accidents caused by falling asleep while driving in obstructive sleep apnea syndrome.

PURPOSE: We examined the risk factors for automobile accidents caused by falling asleep while driving in subjects with obstructive sleep apnea syndrome (OSAS). METHODS: We asked licensed drivers with history of snoring and excessive daytime sleepiness who had undergone polysomnography (PSG) at the Department of Sleep Medicine/Sleep Disorders Center at Aichi Medical University Hospital to complete the questionnaires on accidents caused by falling asleep while driving. As a subjective measure of sleepiness, we used the Epworth sleepiness scale (ESS). Based on PSG results, 2387 subjects diagnosed with OSAS were divided into three groups according to apnea-hypopnea index (AHI): mild-to-moderate (5 ≤ AHI < 30), severe (30 ≤ AHI < 60), and very severe (AHI ≥ 60). We performed univariate and multivariate logistic regression on variables that might explain falling asleep at the wheel. RESULTS: We compared results between each group and simple snorers (394 subjects with AHI < 5) and found the group with very severe OSAS reported significantly higher rates of driving when drowsy and having accidents in the past 5 years due to falling asleep. CONCLUSIONS: Our multivariate analysis suggests that scores on the ESS and patient-reported frequency of feeling drowsy while regular driving and working are related to automobile accidents caused by falling asleep while driving.

Association between pupillometric sleepiness measures and sleep latency derived by MSLT in clinically sleepy patients.

OBJECTIVES: The multiple sleep latency test (MSLT) has been employed extensively in clinical and research settings as a gold standard for objectively measuring sleepiness. In a general population or in a variety of work settings, however, a more convenient, rapidly administered measuring method is preferable. We examined the potential utility of pupillometry by comparing its objective measures, pupillary unrest index (PUI) and relative pupillary unrest index (RPUI), with MSLT-derived sleep latency (SL). METHODS: The study cohort comprised 45 patients (39 males, 6 females, mean age 38.9 ± 11.3 years) referred to the Sleep Disorders Center for the two-nap SL test. SL was measured twice before noon, and pupillometric measurement was performed immediately before each SL test. Subjective sleepiness was measured by using the Epworth Sleepiness Scale (ESS). RESULTS: The association between PUI and SL was significant and far closer than that between RPUI and SL. A significant difference was observed between the two groups, based on each subject's experience of drowsy driving accidents over the past 3 years in the PUI and RPUI, as well as in SL. The subjective sleepiness measure, ESS, did not relate to any other physiological sleepiness measures. CONCLUSIONS: In our study cohort, the pupillometric sleepiness measure, PUI, was significantly correlated with, and behaved in a manner equivalent to, MSLT-derived SL in clinically sleepy patients. However, several points remain to be carefully examined before applying pupillometry for screening sleepiness in a general population, or in occupational settings.

Association between Rapid Eye Movement Obstructive Sleep Apnea and Metabolic Syndrome in a Japanese Population.

Objective Rapid eye movement (REM) obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. OSA is a potential risk factor for metabolic dysfunction. However, the association between REM OSA and risk of adverse health outcomes remains unclear. The present study investigated the association between REM OSA and metabolic syndrome (MetS), including the MetS components of hypertension, dyslipidemia, and hyperglycemia, in the Japanese population. Methods In total, 836 Japanese patients with mild to moderate OSA were enrolled in this study. We compared the prevalence of MetS, including hypertension, dyslipidemia, and hyperglycemia, between REM OSA and non-REM OSA via univariate analyses of descriptive statistics and logistic regression analyses. Results The prevalence of hypertension was 68.3% in the REM OSA group and 56.6% in the non-REM OSA group (p<0.05). In addition, the prevalence of metabolic syndrome was significantly higher (37.0%) in the REM OSA group than in the non-REM-OSA group (25.2%). Logistic regression analyses showed that the prevalence of hypertension and MetS was significantly greater in the REM OSA group than in the non-REM-OSA group. Conclusion Our findings suggest that patients with REM OSA, regardless of age, sex, and body mass index, are at a higher risk of developing hypertension and MetS than patients with non-REM OSA.

Changes in the sleeping habits of Japanese university students during the COVID-19 pandemic: a 3-year follow-up study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has greatly changed our daily life. Owing to the imposed restrictions, many educational facilities have introduced remote teaching. This study aims to clarify the association between remote teaching and Japanese university students' sleeping habits. METHODS: The participants were medical students at Aichi Medical University. We used data from an ongoing longitudinal sleeping habits survey. For the participants who enrolled in the university during 2018-2020, multilevel analyses of sleep duration during weekdays and weekends across 3 years were conducted, adjusting for sex, grade, place of stay, sleep problems and lifestyle habits. RESULTS: Among the students enrolled in the university, the data of 677 in 2018, 657 in 2019, and 398 in 2020 was available for analysis. The mean sleep duration during weekdays (in minutes) was 407.6 ± 60.3 in 2018, 406.9 ± 63.0 in 2019, and 417.3 ± 80.9 in 2020. The mean sleep duration during weekends (in minutes) was 494.5 ± 82.5 in 2018, 488.3 ± 87.9 in 2019, and 462.3 ± 96.4 in 2020. Multilevel analysis conducted for the 684 participants who enrolled during 2018-2020 showed that sleep duration during weekdays was associated with the place of stay and survey year. Moreover, students reported significantly longer sleep duration during weekdays in 2020 than in 2019, but no significant difference in sleep duration was found between 2018 and 2019. The other multilevel analysis found sleep duration during weekends to be associated with the survey year, sex and always doing something before going to bed. Sleep duration during weekends was shorter in 2020 than in 2019 and longer for male students and students who always do something before going to bed. Ten students were reported to have a delayed sleep phase in 2020. CONCLUSIONS: Students' sleep duration increased during weekdays and decreased during weekends in 2020. This difference could be explained by the COVID-19 pandemic and the introduction of remote teaching.

Costly group apology communicates a group's sincere "intention".

Groups, such as governments and organizations, apologize for their misconduct. In the interpersonal context, the forgiveness-fostering effect of apologies is pronounced when apologizing entails some cost (e.g., compensating damage, canceling a favorite activity to prioritize the apology) because costly apologies tend to be perceived as more sincere than non-costly apologies (e.g., merely saying "sorry"). Since groups lack a mental state (e.g., sincere intention), this could arguably render a group apology ineffective. This research investigated the possibility that people ascribe intention to group agents and that offering a costly group apology is an effective means of fostering perceived sincerity. A vignette study (Pilot Study) showed that costly group apologies tend to be perceived as more sincere than non-costly group apologies. A subsequent functional magnetic resonance imaging study revealed that costly group apologies engaged the bilateral temporoparietal junction and precuneus more so than non-costly group apologies and no apology did. The bilateral temporoparietal junction and precuneus have been implicated in the reasoning of social/communicative intention. Therefore, these results suggest that although a group mind does not exist, people ascribe a mental state (i.e., sincere intention) to a group especially when the group issues a costly apology after committing some transgression.

Role of the Orbitofrontal Cortex in the Computation of Relationship Value.

This research investigated whether the medial orbitofrontal cortex (OFC), which is known to code the value of various rewards, is involved in the relationship value recalibration process. Previous research suggests that people upregulate the relationship value of a specific friend in response to the friend's commitment signals. In a functional magnetic resonance imaging study (Study 1), participants imagined receiving high-cost commitment signals, low-cost commitment signals, or no signals from a particular friend. Participants' subjective rating of the relationship value upregulation was positively correlated with medial OFC activity. Subtraction analyses showed that high-cost commitment signals engaged the medial OFC more than did signal failures. An auxiliary analysis revealed that medial OFC activity in response to low-cost commitment signals was negatively correlated with loneliness. To follow-up these findings, we conducted an online vignette study (Study 2), in which participants rated the relationship value of a real friend before and after imagining receiving a series of low-cost commitment signals from that friend. Corroborating the upregulation hypothesis, perceived relationship value significantly increased after imagining a series of commitment signals. This effect was weaker among individuals high in loneliness.

Insomnia as a Symptom of Rapid Eye Movement-Related Obstructive Sleep Apnea.

Rapid eye movement (REM)-related obstructive sleep apnea (OSA), a polysomnographic phenotype that affects 12-36% of OSA patients, is defined by apnea and hypopnea events that predominantly or exclusively occur during REM sleep. Recent studies indicated that REM-related OSA was associated with the development of nocturnal non-dipping of systolic and diastolic blood pressure, metabolic syndrome, diabetes, and depressive symptoms. However, to date, the association between REM-related OSA and insomnia still remains unclear. We investigated whether there was a difference between REM- and non-REM-related OSA in terms of insomnia-related sleep disturbance as measured by the Pittsburgh Sleep Quality Index (PSQI) in 1736 patients with OSA. REM-related OSA showed a significant association with increased PSQI in all adjusted models. In the subgroup analysis, the coefficients of all models were higher in female than in male patients with REM-related OSA. Insomnia should be considered an important complaint in patients with REM-related OSA, and its indicators, such as the PSQI, should be included in routine diagnostic testing.

Impact of Gender and Age on Rapid Eye Movement-Related Obstructive Sleep Apnea: A Clinical Study of 3234 Japanese OSA Patients.

Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. Previous studies have reported that REM-related OSA occurs more commonly in women and younger individuals. However, external validity of this tendency has not been confirmed in a large clinical sample. The objective of this study was to evaluate the effect of gender and age on REM-related OSA after adjustment for several covariates based on their established clinical relationships to gender difference in OSA. A total of 3234 Japanese patients with OSA were enrolled in this study. We confirmed that female sex is an important risk factor for REM-related OSA, as reported by previous studies. Moreover, we showed that women aged over 50 years were at a greater risk than those aged under 50 years. These results suggest that hormonal changes in women might play an important role in REM-related OSA and might reflect its unknown pathophysiological characteristics.

Massive pulmonary embolism with cardiac arrest in pregnancy: A case report.

A 39-year-old woman developed a pulmonary embolism at 28 weeks of gestation, after a 4-week period of bedrest, and required emergencycesarean section due to a decrease in fetal heart rate. Pulseless electrical activity (PEA) developed after intravenous anesthesia. The fetus was delivered 5 min after PEA onset, during cardiopulmonary resuscitation of the mother. Intravenous recombinant tissue-plasminogen activator injection, percutaneous cardiopulmonary support, and 24-h hypothermia therapy were administered to the mother, followed by inferior vena cava filter insertion, combined with catheter thrombus fragmentation and percutaneous thrombectomy. Both the patient and her baby survived. .

Five-hour sleep restriction for 7 days increases subjective sleepiness.

We investigated the effects of a 5-h sleep restriction for 7 d on subjective sleepiness in an ambulatory condition by comparing them with baseline conditions consisting of an 8-h sleep for 7 consecutive days. Subjects were 13 healthy male students (mean age 21.1 yr). Each subject was required to get 8 h of sleep (baseline, from 2300 to 0700) for 7 d, and 5 h of sleep (sleep restriction, from 0100 to 0600) for 7 d in an ambulatory condition. The order of the two sleep schedules was randomly assigned. Subjective sleepiness was assessed by a Visual Analog Scale (VAS) every 3 h at 0900, 1200, 1500, 1800, and 2100 for 7 successive days during each sleep schedule. The VAS score during sleep restriction gradually increased up to the 5th day and then reached a plateau. The patterns of time-course changes in the VAS score were similar to those at baseline. The VAS scores showed a peak at 0900, taking a dip at 1200, and then gradually increasing toward 2100. The mean VAS score of the last three days of the 5-h sleep restriction was significantly higher than that at baseline (p<0.001). A 5-h sleep restriction for 7 d in an ambulatory condition increased subjective sleepiness up to the 5th day and then reached a plateau. The patterns of the time-course changes in sleepiness of 5-h sleep restriction per day did not differ from that at baseline.

Neural and Genetic Correlates of the Social Sharing of Happiness.

Happiness is regarded as one of the most fundamental human goals. Given recent reports that positive feelings are contagious (e.g., the presence of a happy person enhances others' happiness) because of the human ability to empathize (i.e., sharing emotions), empathic ability may be a key factor in increasing one's own subjective level of happiness. Based on previous studies indicating that a single nucleotide polymorphism in the serotonin 2A receptor gene [HTR2A rs6311 guanine (G) vs. adenine (A)] is associated with sensitivity to emotional stimuli and several mental disorders such as depression, we predicted that the polymorphism might be associated with the effect of sharing happiness. To elucidate the neural and genetic correlates of the effect of sharing happiness, we first performed functional magnetic resonance imaging (fMRI) during a "happy feelings" evocation task (emotional event imagination task), during which we manipulated the valence of the imagined event (positive, neutral, or negative), as well as the presence of a friend experiencing a positive-valence event (presence or absence). We recruited young adult women for this fMRI study because empathic ability may be higher in women than in men. Participants felt happier (p < 0.01) and the mentalizing/theory-of-mind network, which spans the medial prefrontal cortex, temporoparietal junction, temporal poles, and precuneus, was significantly more active (p < 0.05) in the presence condition than in the absence condition regardless of event valence. Moreover, participants with the GG (p < 0.01) and AG (p < 0.05) genotypes of HTR2A experienced happier feelings as well as greater activation of a part of the mentalizing/theory-of-mind network (p < 0.05) during empathy for happiness (neutral/presence condition) than those with the AA genotype. In a follow-up study with a vignette-based questionnaire conducted in a relatively large sample, male and female participants were presented with the same imagined events wherein their valence and the presence of a friend were manipulated. Results showed genetic differences in happiness-related empathy regardless of sex (p < 0.05). Findings suggest that HTR2A polymorphisms are associated with the effect of sharing happiness by modulating the activity of the mentalizing/theory-of-mind network.

Psychosocial factors are preventive against coronary events in Japanese men with coronary artery disease: The Eastern Collaborative Group Study 7.7-year follow-up experience.

BACKGROUND: The Japanese Coronary-prone Behaviour Scale (JCBS) is a questionnaire developed by the Eastern Collaborative Group Study (ECGS), a multi-centre study of coronary-prone behaviour among Japanese men. Subscale C of the JCBS consists of 9 items that have been independently associated with the presence of coronary artery disease (CAD) in patients undergoing coronary angiography (CAG). There have been no reports of a relationship between any behavioural factor and the prognosis of CAD in Japan. The purpose of the current study was to investigate behavioural correlations with the prognosis of CAD as a part of the ECGS. METHODS: We examined the mortality and coronary events of 201 men (58 ± 10, 27-86 years) enrolled in the ECGS from 1990 to 1995, who underwent diagnostic coronary angiography and were administered the JCBS and the Japanese version of the Jenkins Activity Survey (JAS) Form C. Their health information after CAG was determined by a review of their medical records and by telephone interviews that took place from 2002 to 2003. RESULTS: Cardiac events during the follow-up period (7.7 ± 4.2 years) included 13 deaths from CAD, 25 cases of new-onset myocardial infarction, 26 cases of percutaneous coronary intervention, and 19 cases of coronary artery bypass graft surgery. There was no difference in established risk factors between groups with and without cardiac events. Seven factors were extracted by principal component analysis in order to clarify which factors were measured by the JCBS. Stepwise multivariate Cox-hazard regression analysis, in which 9 standard coronary risk factors were forced into the model, showed that Factor 4 from the JCBS (namely, the Japanese spirit of 'Wa') was independently associated with coronary events (hazard ratio: 0.21; p = 0.01). By other Cox-hazards regression analyses of coronary events using each set of JAS scores and the JCBS Scale C score instead of Factor 4 as selectable variables, the JAS scores or the JCBS Scale C score were not entered into the models. CONCLUSION: The Japanese spirit of 'Wa' is a preventive factor against coronary events for Japanese men with CAD.

Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids.

OBJECTIVE: Lipid peroxidation (LPO) is involved in oxidative tissue injuries. The present investigation examined the association between LPO and psychological depressive symptoms. METHODS: A cross-sectional study was conducted on 66 female volunteers aged 38-70. Lipid peroxides (LOOH) in serum were evaluated by hemoglobin-methylene blue (Hb-MB) method; additionally, serum antioxidants were also detected. To assess depressive symptoms, the Center for Epidemiologic Studies Depression (CES-D) Scale and a subscale in the 28-item General Health Questionnaire (GHQ) were applied. RESULTS: LOOH concentration displayed a significant positive correlation with CES-D and GHQ depression scores. Multiple regression analysis was performed in which LOOH concentration served as a dependent variable and CES-D scores and antioxidants as independent variables. Consequently, CES-D scores demonstrated significant positive correlation with LOOH. CONCLUSIONS: The positive relationship between depressive symptoms and LPO in a female population may support the hypothesis that LPO may affect depressive symptoms.

Psychosocial factors related to low back pain among school personnel in Nagoya, Japan.

Related factors of low back pain (LBP) among school personnel were investigated. We designed a cross-sectional study employing questionnaires, which included a Japanese version of the Job Content Questionnaire. Subjects consisted of 3306 male and 3184 female school personnel in all public schools and kindergartens operated by Nagoya City, Japan. Prevalence of LBP in each work category was compared to that in general teachers of each gender after adjusting for age. Male teachers at schools for the handicapped and in classrooms for the handicapped showed significantly higher LBP prevalence. Among female participants, teachers at schools for the handicapped, physical education teachers, kindergarten personnel and school nurses displayed higher LBP prevalence. In work categories which demonstrated high LBP prevalence, low social support and low job satisfaction were related to LBP of school nurses despite low physical loads. High job demand and physical loads correlated to LBP in kindergarten personnel.

Glucose intolerance in Japanese patients with obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) often accompanies obesity and diabetes mellitus. This study was performed to investigate the prevalence of glucose intolerance and to determine independent predictors for insulin resistance in patients with OSAS. METHODS: A cross-sectional study of 679 OSAS patients with an apnea-hypopnea index (AHI)>or=5/h and 73 controls subjects (AHI<5/h) was done in a tertiary university-based medical center. They were assessed by nocturnal polysomnography and underwent an oral glucose tolerance test. RESULTS: The prevalence of diabetes mellitus in OSAS patients was higher than that of the control group (25.9% vs. 8.2%, p<0.001) and 424 patients (62.4%) received a new diagnosis of impaired glucose tolerance or diabetes mellitus. The very severe OSAS group (AHI >or=45/h) had significantly higher homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA beta-cell function than the other OSAS groups (AHI<45/h) and the control group. In a logistic regression model adjusting for potential confounders: age, AHI, minimum SpO(2) and body mass index (BMI), only BMI was associated with insulin resistance (HOMA-IR>3) (odds ratio: 1.272, 95% confidence interval 1.206-1.343, p<0.0001). CONCLUSION: Glucose intolerance was more common in patients with OSAS. Insulin resistance was associated not with AHI but rather with BMI.

Depressive symptoms and life satisfaction in elderly women are associated with natural killer cell number and cytotoxicity.

Well-preserved natural killer (NK) cell cytotoxicity (NKCC) is associated with healthy aging. The objective of the survey was to investigate psychological factors related to NKCC and NK cell populations in elderly women. A cross-sectional study involving 181 participants was conducted using the Japanese version of the 28-item General Health Questionnaire (GHQ) and additional questions assessing psychological status and lifestyle. Spearman's rank test revealed a significant negative correlation between NKCC and the GHQ depression subscale (GHQ-D) scores. Significantly reduced NKCC was found in participants presenting high GHQ-D scores (12 < or = GHQ-D, n = 58) compared with those showing middle (8 < or = GHQ-D < or = 11, n = 55) or low (GHQ-D = 7, n = 68) scores. Adjusting for covariates regarding lifestyle, multiple logistic regression analysis was applied; consequently, significant associations were found between reduced NKCC and high depressive symptoms and between increased NK cell numbers and life satisfaction. These results indicated a clue to longitudinal studies in the future.

Coronary-prone behavior among Japanese men.

The Japanese Coronary-prone Behavior Scale (JCBS) is a questionnaire developed by the Eastern Collaborative Group Study (ECGS), a multi-center study of coronary-prone behavior among Japanese men in Japan. From the JCBS, a subscale was extracted consisting of 9 items that were independently associated with the presence of coronary artery disease (CAD) in patients undergoing coronary angiography (CAG). The subscale, named Scale C, represents job-centered lifestyle, social dominance, and suppressed overt type A behavior. To further validate the association of Scale C with CAD among Japanese men, the present study examined if such an association would be observed in a newly sampled population. The JCBS was carried out by 311 men undergoing CAG. The association between Scale C score and the presence of CAD was evaluated with logistic regression analysis that included established coronary risk factors. The Scale C score was significantly higher in subjects with CAD than in those without and stepwise multivariate logistic regression showed that the Scale C score was associated with the presence of CAD independent of age, low-density lipoprotein cholesterol, diabetes mellitus, and obesity. These results indicate that the Scale C score is independently associated with the presence of CAD even among a newly sampled population of Japanese men undergoing CAG. Scale C may reflect an important feature of coronary-prone behavior among Japanese men.