The association between retinal thickness variations and restless leg syndrome (RLS)

Response to: The association between retinal thickness variations and restless leg syndrome (RLS)

The effect of continuous positive airway pressure (CPAP) treatment on serum levels of proBDNF and mature BDNF in patients with obstructive sleep apnea

A false alarm of narcolepsy: obstructive sleep apnea masquerading as narcolepsy and depression Abstract Purpose We report a case with symptoms and signs of obstructive sleep apnea (OSA), depression, and narcolepsy. Polysomnographic (PSG) and multiple sleep latency test (MSLT) findings, clinical characteristics, and diagnostic challenges in this case are discussed. Methods A 23-year-old single male presented with excessive daytime sleepiness, low mood, lack of energy, and snoring for 3 years. In addition, he reported excessive weight gain, lack of interest in work, partial loss of muscle tone during excitations, and sleep attacks during work and driving. He had experienced three episodes of sleep paralysis. The patient underwent a sleep study including PSG and MSLT. Results On baseline PSG, he had an apnea/hypopnea index (AHI) of 72.8/h. The MSLT showed a mean sleep latency of 3.8 min and two sleep-onset rapid eye movement periods (SOREMPs). On admission, he had an Epworth Sleepiness Scale (ESS) score of 21, and positive findings for depression in the clinical interview and psychometric scales. He was treated with continuous positive airway pressure without any medication. Follow-up PSG and MSLT were performed after 1 week, which showed an AHI of 0/h without SOREMPs. After 1 month, there was no sign of depression. Conclusions This study reflects that OSA can present with cataplexy-like features and false positive MSLT results for narcolepsy, as well as depressive symptoms. The case highlights the complexity in which OSA can present to physicians, and emphasizes that clinicians should be aware that OSA can mimic narcolepsy and present with depressive symptoms.

Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial Abstract Purpose Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month’s use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask. Methods A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask. Results There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment. Conclusions Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort. Trial registration NCT01889472

Do T90 and SaO 2 nadir identify a different phenotype in obstructive sleep apnea? Abstract Introduction Severity of obstructive sleep apnea (OSA) is commonly based upon the apnea-hypopnea index (AHI). However, patients with similar AHIs may demonstrate widely varying comorbidities and risk for cardiovascular disease. These varying manifestations of disease may be related to nocturnal hypoxia and not AHI. We hypothesize that parameters of oxygenation may identify a different phenotype in OSA. Purpose To explore potential associations between lowest SaO2 (SaO2 nadir) and total sleep time spent with arterial oxygen saturation (SaO2) < 90% (T90) with comorbidities and mortality in patients with moderate and severe OSA. Method This was a retrospective study of patients between 2009 and 2014, with a new diagnosis of moderate-to-severe OSA without a concomitant respiratory disease. Data collection included demography, comorbidities, sleep study parameters, and mortality over a 5-year interval. Patients were categorized into two groups for analysis, group 1: SaO2 nadir < 75%, and group 2: T90 > 20%. Results Of the 365 patients, 163 (45%) recorded SaO2 nadir < 75% and 127 (35%) recorded T90 > 20%. These oxygenation parameters were associated with more severe OSA by AHI (p < 0.001). T90 > 20% was associated with an increased risk of hypertension (HT) OR 2.95 (CI 1.87–4.76, p < 0.001) in patients with both moderate and severe OSA. T90 > 20% was also associated with an increased risk of type 2 diabetes mellitus (T2DM) OR 2.14 (CI 1.35–3.38, p = 0.001) and mortality 2.70 (CI 1.37–5.22, p = 0.0048). Conclusion The findings demonstrate a correlation between SaO2 nadir < 75% and T90 > 20% and increased severity of OSA. The findings also show a strong association between SaO2 nadir < 75% and T90 > 20% and increased risk for comorbidities of HT and T2DM as well as mortality at 5 years. This analysis suggests that parameters of oxygenation should be used to describe a high-risk phenotype of OSA.

Benefits of selenium in the treatment of depression and sleep disorders

Melatonin prevents chronic intermittent hypoxia-induced injury by inducing sirtuin 1-mediated autophagy in steatotic liver of mice Abstract Background Hepatic steatosis that occasionally results in nonalcoholic steatohepatitis (NASH) is related to obstructive sleep apnea (OSA). Many studies have shown that autophagy exerts protective effects on liver damage caused by various diseases and melatonin exhibits hepatoprotective properties. However, the mechanisms of liver injury induced by chronic intermittent hypoxia (CIH) and the effect of melatonin on the regulation of liver injury remain unclear. Purpose This study was aimed to evaluate the role of CIH in steatohepatitis progression and the regulatory function of melatonin on fatty liver sensitivity to CIH injury, mainly focusing on autophagy signaling. Methods A high-fat diet (FD)-induced obesity mouse model was subjected to intermittent hypoxia/normoxia events for approximately 8 h per day using an autophagy agonist, rapamycin, or an inhibitor, 3-methyladenine (3-MA), and SRT1720, a sirtuin 1 (SIRT1) activator, or sirtinol, a SIRT1 inhibitor, with or without melatonin for a total of six successive weeks, followed by assessment of expression of autophagy-related genes and activity of serum aminotransferase as well as histological evaluation of tissue morphology. Results Neither FD nor CIH alone causes significant liver injury; however, the combination yielded higher serum aminotransferase activities and more severe histological changes, accompanied by a decrease in autophagy activity. Melatonin markedly inhibited FD/CIH-stimulated liver injury by enhancing autophagy. In contrast, SIRT1 inhibition resulted in a decrease in the expression of melatonin-induced autophagy-related genes as well as diminished its protective effects on FD/CIH-induced liver injury. Conclusion These results suggest that melatonin could ameliorate FD/CIH-induced hepatocellular damage by activating SIRT1-mediated autophagy signaling.

Relationship between neuroticism and sleep quality among asthma patients: the mediation effect of mindfulness Abstract Objective The aims of this study were to investigate the prevalence of sleep disturbance; to validate the associations between neuroticism, mindfulness, and sleep quality; and to further examine whether mindfulness mediates the relationship between neuroticism and sleep quality among asthma patients. Methods This study was conducted with 193 asthma patients from outpatient clinics. They completed questionnaires including the neuroticism subscale of the Big Five Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), and the Mindful Attention Awareness Scale (MAAS). Structural equation model was used to analyze the relationships among neuroticism, mindfulness, and sleep quality, with mindfulness as a mediator. Results The mean global PSQI score was 7.57 (SD = 3.25), and 69.9% of asthma patients reported poor sleep quality (cutoff score > 5). Structural equation model analysis showed that neuroticism was significantly associated with global PSQI scores (β = 0.198, P = 0.006), and mindfulness (β = − 0.408, P < 0.001), respectively; mindfulness was associated with global PSQI scores (β = − 0.250, P = 0.006). Furthermore, mindfulness mediated the relationship between neuroticism and global PSQI scores, in which the mediation effect was 0.102 (− 0.408 × − 0.250), and the bootstrapped 95% CI did not include zero (0.032, 0.208, P = 0.021). Conclusions Sleep disturbance is a serious health concern among asthma patients. This study illuminated the latent mediating mechanism of mindfulness on neuroticism and sleep quality, and implied that intervention and prevention programs on mindfulness might be beneficial in improving sleep quality in asthma patients.

Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea Abstract Objective Airway inflammation plays an important role in obstructive sleep apnea (OSA); exhaled nitric oxide is regarded as a noninvasive marker of airway inflammation. The aim of this study was to evaluate fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in patients with OSA. Methods Seventy-five patients with OSA and 30 health controls were enrolled in this study. FeNO and nNO were measured before and after sleep. Nasal lavage was performed in 31 non-smoking individuals immediately after NO measurement in the morning. The sample of nasal lavage was taken for cell classification and analyzing interleukin 6 (IL-6) and interleukin 8 (IL-8). Results Both FeNO and nNO were significantly higher in OSA (before sleep FeNO 21.08 ± 8.79 ppb vs.16.90 ± 6.86 ppb, p = 0.022; after sleep FeNO 25.57 ± 15.58 ppb vs.18.07 ± 6.25 ppb, p = 0.003; before sleep nNO 487.03 ± 115.83 ppb vs. 413.37 ± 73.10 ppb, p = 0.001; after sleep nNO 550.07 ± 130.24 ppb vs. 460.43 ± 109.77 ppb, p < 0.001). Furthermore, in non-smoking OSA, nNO levels were positively correlated with apnea hypopnea index (AHI) and average decrease of pulse arterial oxygen saturation (SpO2); after sleep, nNO was also positively associated to recording time with SpO2 < 90% and negatively associated to minimum SpO2. Both before and after sleep nNO levels were positively correlated with the percentage of neutrophils in nasal lavage (r = 0.528, p = 0.014; r = 0.702, p < 0.001, respectively). Additionally, before sleep nNO was also positively associated with IL-6 (r = 0.586, p = 0.005) and IL-8 (r = 0.520, p = 0.016) concentration. Conclusion This study sustains the presence of airway inflammation in OSA patients with the increase of FeNO and nNO. The data suggests nNO might have greater value than FeNO since it positively correlated with OSA severity, and nNO is a potential bio-marker of nasal inflammation in non-smoking OSA patients.