BackgroundPost-stroke insomnia is a common and frequently occurring disease that has a significant impact on the quality of life of patients. TCM (traditional Chinese medicine) non-pharmacologic therapy is increasingly being used for patients with post-stroke insomnia. The purpose of this study is to evaluate the efficacy and safety of the TCM non-pharmacologic therapy for post-stroke insomnia.MethodsEnglish and Chinese databases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, VIP, and SinoMed were retrieved to collect randomized controlled trials (RCTs) comparing the TCM non-pharmacologic therapy with Western medicine in the treatment of post-stroke insomnia. The search was conducted until March 26, 2024. Data analysis was conducted using Stata15.0.ResultsThis study included a total of 60 RCTs, involving 5 TCM non-pharmacologic therapies and 4,587 patients. The results of the network meta-analysis unveiled that Western medicine combined with massage (SUCRA93.8), Western medicine combined with auricular point sticking (SUCRA80.5), and needle embedding (SUCRA71.5) were the top three measures in clinical efficacy. For improving the Pittsburgh Sleep Quality Index (PSQI), massage (SUCRA86.1) was the most effective, followed by Western medicine combined with auricular point sticking (SUCRA85.4), and Western medicine combined with needle embedding (SUCRA66.4). Regarding adverse reactions, the top three interventions were traditional acupuncture (SUCRA87.7), moxibustion (SUCRA63.2), and Western medicine combined with traditional acupuncture (SUCRA46.0).ConclusionsTCM non-pharmacologic therapy and Western medicine combined with TCM non-pharmacologic therapy can improve clinical efficacy in post-stroke insomnia, enhance sleep quality, and reduce adverse reactions. Due to the limitations of the included studies, the methodological quality is generally not high, and multicenter, large sample, high-quality RCTs are still needed for validation in the future.

PurposeBoth obstructive (OSA) and central sleep apnea (CSA) are associated with considerable cardiovascular morbidity which argues for treatment initiation with a positive airway pressure (PAP) device even in the absence of significant day-time sleepiness. While the long-term consequences of PAP treatment in patients with sleep disordered breathing have been investigated in several studies, less is known about the immediate hemodynamic effects. Therefore, the present study intended to investigate the immediate effect of PAP treatment on non-invasively measured hemodynamic parameters in 10 patients with either OSAS or CSA.MethodsDuring diagnostic and therapeutic conditions, the routine polysomnographic assessment was extended with an impedance cardiography (ICG) system. Statistical analysis was performed to find differences between both groups and conditions. In addition, the relationship between the treatment associated effect on stroke volume (SV) with biometric, polysomnographic, and cardiovascular parameters was assessed.ResultsComparing both subgroups, we found statistically significant differences for biometric, polysomnographic, and cardiovascular parameters. Patients with CSA were older (p = 0.0005) and had higher values for diagnostic (p = 0.015) and therapeutic (p = 0.029) pulse pressure and the pre-ejection period under diagnostic conditions (p = 0.031). In contrast to patients with CSA who exhibited a slight increase of SV and derived parameters under therapeutic conditions, a pronounced decrease was observed in patients with OSAS which was statistically significant for the cardiac index (p = 0.038).ConclusionOur results indicate that patients with OSAS and CSA who are characterized by unique clinical features may show a distinguishable hemodynamic response to PAP treatment that can be measured non-invasively with ICG.

PurposeThe effect of mandibular advancement device therapy on daytime sleepiness remains unclear. Here, we evaluate the effect of a mandibular advancement device on daytime sleepiness using the Karolinska Sleepiness Scale.MethodsWe randomized 88 snoring patients with an apnea-hypopnea index < 30 and daytime sleepiness to a mandibular advancement device or a sham device for four months. The Karolinska Sleepiness Scale, which measures grades of sleepiness from 1 (very alert) to 9 (very sleepy), was used for seven consecutive days, four times each day. The results were analyzed with quantile regression at quartiles controlling for baseline, age, body mass index (kg/m2), sex, apnea-hypopnea index, and full-time work.ResultsThe Karolinska Sleepiness Scale score was lower with the mandibular advancement device than with the sham device at specific time intervals. The positive effect of mandibular advancement device therapy occurred at wake up and before lunch during the whole week and before lunch on weekdays at the middle quartile. The adjusted differences between the interventions favored mandibular advancement device therapy by almost one unit and normalized the Karolinska Sleepiness Scale scores at wake up and before lunch. In addition, there were positive effects of mandibular advancement device therapy before dinner at the highest quartile during the whole week, on weekdays, and on the weekend.ConclusionMandibular advancement devices used for snoring and sleep apnea reduce daytime sleepiness, particularly at wake up and before lunch, but provide some benefit before dinner.

PurposeThis study aimed to investigate the alterations in sleep quality and sleep patterns among military personnel at altitudes ranging from 1500 to 4500 m, as well as the associated factors influencing their sleep.MethodsThis study employed a longitudinal prospective survey conducted over a period of six months, from November 2023 to June 2024. A total of 90 soldiers were recruited for participation. Initially, demographic data and sleep conditions were collected through a questionnaire administered to participants at an altitude of 1,500 m. Subsequently, participants were monitored continuously to gather data over seven days at an altitude of 4,500 m, specifically during the 7 days of the 6-month survey period), and the 1st month at an altitude of 4,500 m (on the 1st month of the six-month survey period. Spearman’s rank correlation was utilized to investigate the relationships among sleep quality, gastrointestinal symptoms, and mood states.ResultsThe total score of the Pittsburgh Sleep Quality Index (PSQI) exhibited an increase, indicating impaired sleep quality among soldiers stationed at an altitude of 4,500 m for durations 7 days, 1 month, 3 months, and 6 months. Notably, after 7 days of soldiers, there was a significant gradual in the number of military soldiers experiencing gastrointestinal symptoms, such as diarrhea, abdominal distention, and constipation, which subsequently stabilized with prolonged exposure to the altitude. Furthermore, a significant rise in the incidence of depression was observed after days of rapid exposure 4,500 above sea level, and the emotional state of military personnel tended to tend towards mild depression over the duration of time Correlation. Correlation analysis showed that the PSQI score was closely related to the Athens Insomnia Scale(AIS) total score, Epworth Sleepiness Scale(ESS) total score, Self-Rating Anxiety Scale(SAS) total score, Self-Rating Depression Scale(SDS) total score, difficulty in falling asleep, easy to wake up or wake up early at night, poor breathing and snoring (on the 1st month, the 3rd month and the 6th month at the altitude of 4500 m respectively: rs = 0.868, 0.648, 0.483, 0.459, 0.472, 0.364, 0.613, 0.75; rs = 0.856, 0.521, 0.481, 0.354, 0.768, 0.720, 0.511, 0.535; rs = 0.756, 0.490, 0.496, 0.352, 0.708, 0.737, 0.424, 0.408, p < 0.01 or p < 0.05); Positively correlated with heart rate (at 4500 m 7 days at altitude: rs = 0.233, p = 0.027), diarrhea (at 4500 m 1-month at altitude: rs = 0.237) bloating and constipation (at 4500 m 1 month and 3months respectively: rs = 0.472; rs = 0.364; rs = 0.341, 0.273, p < 0.05); and with age, sex, marital status, education were significantly positive correlation (rs = 0.463, 0.251, 0.255, 0.230, p < 0.05).ConclusionsThe impaired sleep quality, gastrointestinal symptoms, and anxiety and depression in military personnel changed with the extension of the time of stationing at 4500 m altitude, which was most prominent when stationed at high altitude for 7 days; the sleep quality of those stationed at high altitude had a close relationship with the gastrointestinal symptoms, the type of sleep(insomnia and drowsiness), and the heart rate, but it varied with the duration of the stationing at high altitude; our study provides new information for the prevention of sleep disturbance, gastrointestinal symptoms, and negative emotions in high-altitude military personnel.

PurposeThe increasing incidence of sleep apnea has led to an increased workload for healthcare professionals. Continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnea. To reduce the CPAP waiting list in public healthcare, we proposed a CPAP voucher for use in private clinics for CPAP initiation. This study evaluated the success rate of CPAP initiation via this voucher.MethodsWe selected patients from our sleep apnea clinic referred to CPAP initiation aged 18–80 years with no significant physical or psychological comorbidity. Three private clinics (A, B, C) accepted the CPAP voucher.ResultsA total of 1922 patients fulfilled CPAP voucher criteria. Of these, we included 1604 patients (38% women). Mean BMI was 32 kg/m2, mean age was 55 years, and mean apnea-hypopnea index was 34/h. Data were missing for 113 patients at the 1-year follow-up visit. Of the remaining 1491 patients, 1398 continued CPAP therapy beyond 1 year, indicating a CPAP therapy success rate of 94%. There were no significant differences between clinics in the number of patients staying on CPAP at 1 year after initiation.ConclusionA CPAP voucher may reduce the CPAP initiation waiting list in public healthcare with a good success rate.

BackgroundMandibular advancement devices (MAD) are a well-established treatment option for obstructive sleep apnea (OSA). MAD are considered preferably for patients with mild to moderate OSA presenting with a elevated night-to-night variability (NNV). This study aimed to determine the treatment effect of MAD on NNV considering different protrusion distances and patient related outcome (PRO).MethodsWe conducted a prospective cohort analysis of patients before MAD with 60% and 80% of the maximum protrusion. OSA severity was assessed using a home-sleep test for two consecutive nights. PRO contained the Epworth Sleepiness Scale (ESS) and sleep related quality of life (FOSQ).ResultsTwenty patients with a median overweight body-mass-index of 27.1 (interquartile range (IQR) 16.3 kg/m²), with a mainly mild to moderate OSA with an apnea -hypopnea index (AHI) of 18.3 / h (IQR 17.7) and elevated ESS of 12.5 (IQR 8.0) were included. As opposed to 80%, 60% protrusion significantly but not 80% relevantly reduced AHI (60%%: 11.2 (IQR 5.5)/h, p = 0.01; 80%: 12.9 (IQR18,0)/h, p = 0.32) and improved the ESS (60%: 8.0 (IQR 10,0); 80%: 10 (IQR 9.0)), with therapy settings. No correlation could be detected between NNV and ESS, and FOSQ changes. Higher baseline NNV was associated with severe OSA (p = 0.02) but not with gender, overweight, or status post-tonsillectomy.ConclusionsOSA improvement is associated with lower NNV; both OSA and NNV are connected to the degree of protrusion. Therefore, higher NNV does not justify the exclusion of candidates for MAD treatment. PRO changes are not visibly affected by NNV but by general OSA changes. These findings may help to define and optimize future study designs for the primary outcome decision between objective OSA parameters and PRO.

PurposeThis study aimed to develop an unobtrusive method for home sleep apnea testing (HSAT) utilizing micromotion signals obtained by a piezoelectric rubber sheet sensor.MethodsAlgorithms were designated to extract respiratory and ballistocardiogram components from micromotion signals and to detect respiratory events as the characteristic separation of the fast envelope of the respiration component from the slow envelope. In 78 adults with diagnosed or suspected sleep apnea, micromotion signal was recorded with a piezoelectric rubber sheet sensor placed beneath the bedsheet during polysomnography. In a half of the subjects, the algorithms were optimized to calculate respiratory event index (REI), estimating apnea–hypopnea index (AHI). In the other half of subjects, the performance of REI in classifying sleep apnea severity was evaluated. Additionally, the predictive value of the frequency of cyclic variation in heart rate (Fcv) obtained from the ballistocardiogram was assessed.ResultsIn the training group, the optimized REI showed a strong correlation with the AHI (r = 0.93). Using the optimal cutoff of REI ≥ 14/h, subjects with an AHI ≥ 15 were identified with 77.8% sensitivity and 90.5% specificity. When applying this REI to the test group, it correlated closely with the AHI (r = 0.92) and identified subjects with an AHI ≥ 15 with 87.5% sensitivity and 91.3% specificity. While Fcv showed a modest correlation with AHI (r = 0.46 and 0.66 in the training and test groups), it lacked independent predictive power for AHI.ConclusionThe analysis of respiratory component of micromotion using piezoelectric rubber sheet sensors presents a promising approach for HSAT, providing a practical and effective means of estimating sleep apnea severity.

The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients with obstructive sleep apnea (OSA) in relation to use time and if the device is used at night or day.Materials and methodA systematic review of the literature and meta-analysis was carried out in accordance with PRISMA guidelines. In the bibliographic search, a total of four databases were consulted: PubMed-Medline, Scopus, Web of Science, and Cochrane. Of the 622 articles initially revealed, 160 duplicates were eliminated. After applying the selection criteria, 17 articles were included for the qualitative analysis and 4 for the meta-analysis. The studies were combined using a random effects model with the inverse method of variance, determining the mean differences in systolic and diastolic pressure before and after treatment using the MAD splint as the effect size. Day/night circadian effect and treatment time were analyzed using meta-regression with a mixed-effects model.ResultsMAD treatment was not found to affect diastolic pressure. By combining the four studies with the control group in a meta-analysis (I2 = 75%; z = − 0.15; p-value = 0.882), the mean difference in diastolic pressure between the MAD group and the control group was estimated at − 0.06 (− 0.86; 0.74). The meta-regression also showed no significant effect of day/night (p = 0.560) or treatment time (p = 0.854) on diastolic pressure. When combining the four studies with the control group (I2 = 84%%; z = − 1.47; p-value = 0.142), a non-significant mean difference in systolic pressure between the MAD group and the control group of − 0.99 (− 2.31; 0.33) was estimated in the meta-analysis. However, when assessing the effect of day/night or treatment time on systolic blood pressure using a meta-regression, the latter showed significant covariates that reduce systolic blood pressure values in the model at night (p < 0.001) and in relation to treatment time (p < 0.001).ConclusionsOnly systolic pressure appears to be affected by the use of the MAD in patients with OSA, and this decrease in systolic pressure is greater at night and when treatment time is longer.

Obstructive sleep apnea (OSA) is a common clinical condition in which the upper airway partially or completely narrows or collapses during sleep. The objective of our research was to examine the relation between the abnormal internal carotid artery (ICA) and the pharyngeal wall among individuals suffering from OSA, and to compare it to a group of control subjects. In this retrospective study, the closest distances of the ICA to the pharyngeal walls and midlines were measured on CT images and compared between groups. The closest distance of the ICA to the right pharyngeal wall was 3.8 ± 2.4mm and the closest distance to the left pharyngeal wall was 4.1 ± 2.3mm in patients with OSA, which was significantly less than the controls (respectively, 4.4 ± 1.6mm and 14.4 ± 1.7mm) (p < 0.001). The closest distances of the ICA to the right and left pharyngeal walls (p = 0.001) and to the right and left midline (p = 0.00002) were significantly lower in patients with moderate to severe OSA compared to mild patients according to apnea / hypopnea index (AHI). In the retroglossal bifurcation of the common carotid artery (CCA), the closest distances of the ICA to the right (p = 0.027) and left pharyngeal walls (p = 0.018) and to the right (p = 0.01) and left midline (p = 0.012) were significantly lower than the retroepiglottic bifurcation of the CCA. We observed that the distance of the aberrant ICA to the pharyngeal wall is less in individuals with OSA than in individuals without OSA, the distance of the aberrant ICA to the pharyngeal wall decreased as the severity of AHI increased.

Post-stroke sleep disorders (PSSD) are an important part of post-stroke disability. PSSD is neglected as a part of stroke rehabilitation. We aimed to study the prevalence and determinants of PSSD in a hospital based, single center setting. In a cross-sectional study, adult patients (≥ 18years) with stroke (one month to one year after the onset), were enrolled in the study. Demographic, clinical, radiological, and motor and functional disabilities were assessed. Sleep quality was assessed with Pittsburg Sleep Quality Index (PSQI) and STOP BANG questionnaire (for obstructive sleep apnea [OSA]). Patients with poor sleep quality (PSQI > 5) were analyzed for risk factors. A total of 103 patients were recruited in the study period (January 2021 to June 2022). The self-reported prevalence of PSSD was 16% which increased to 72% when thePSQI was administered. High risk of OSA was present in 33%. In bivariate analysis, factors associated with PSQI > 5 were involvement of ≥ 2 lobes, lower body mass index (BMI), worse modified Rankin Scale (mRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Stroke Specific Quality of Life (SSQoL). In multivariate analysis, only depression was associated with PSQI > 5 (OR: 1.3 (1.0; 1.7); p-value = 0.03). PSSD had a prevalence of 72%. In multivariate analysis, the factor associated with PSQI > 5 was worse HAM-D score.