Características polisomnográficas nocturnas y otras variables relacionadas, en pacientes adultos mayores / Nocturnal polysomnbnographic characteristics and other related variables in elderly patients

Se cree que los ancianos necesitan dormir menos. Sin embargo, no es la necesidad de sueño sino la capacidad de dormir lo que disminuye con la edad, en paralelo a la mayor prevalencia de enfermedades cardiovasculares o metabólicas, o de depresión. Poco se ha descripto sobre los hallazgos polisomnográficos de esta población. En el presente estudio analizamos los hallazgos polisomnográficos en pacientes mayores de 65 años. Se realizó un estudio descriptivo a partir del análisis de una base de datos de 551 pacientes mayores de 65 años evaluados entre junio de 2013 y diciembre de 2014. Todos los sujetos se realizaron una polisomnografía (PSG) nocturna de 6 horas de duración. Las variables analizadas fueron: latencia de sueño (LS), eficacia de sueño (ES), latencia de fase REM (Lat R), % de R, índice de apneas hipopneas (IHA) y movimientos periódicos de piernas durante el sueño (PLMS). Se dividió la población en 3 grupos: G1: de 65 a 70 años; G2: 71 a 75; G3: mayor de 75 años. Se analizaron los datos de la serie general y las diferencias intergrupos. El IHA se incrementó con la edad y resultó más severo en los pacientes mayores de 75 años en relación con el grupo de menor edad. El incremento del IAH no se asoció a un incremento del índice de masa corporal ni a mayor somnolencia diurna. (AU)

It is believed that the elderly need less sleep. However, it is not the need for sleep but the ability to sleep that decreases with age, in parallel to the increasing prevalence of cardiovascular or metabolic disease, or depression. Little has been described about the polysomnographic findings of this population, hypothesizing that there are several alterations that prematurely corrected could improve the quality of life as the years go by. We analyzed the polysomnographic findings in patients over 65 years of age. A descriptive study was carried out based on the analyses of a database of 551 patients over 65 years of age evaluated between June 2013 to December 2014. All subjects underwent nocturnal PSG of 6 hours duration. The polysomnographic variables analyzed were: sleep latency (LS), sleep efficiency (ES), latency R phase (Lat R), % R, Apneas Hypoapneas Index (AHI) and Periodic Limb Movements of Sleep (PLMS). The population was divided into 3 groups: G1: from 65 to 70 years G2: 71 to 75, G3 greater than 75. AHI increased with age, being more severe in patients over 75 years of age in relation to the younger age group. The increase in AHI was not associated with an increase in Body Mass Index (BMI) or greater daytime sleepiness. (AU)

Non-thermal continuous and modulated electromagnetic radiation fields effects on sleep EEG of rats

In the present study, the alteration in the sleep EEG in rats due to chronic exposure to low-level non-thermal electromagnetic radiation was investigated. Two types of radiation fields were used; 900 MHz unmodulated wave and 900 MHz modulated at 8 and 16 Hz waves. Animals has exposed to radiation fields for 1 month [1 h/day]. EEG power spectral analyses of exposed and control animals during slow wave sleep [SWS] and rapid eye movement sleep [REM sleep] revealed that the REM sleep is more susceptible to modulated radiofrequency radiation fields [RFR] than the SWS. The latency of REM sleep increased due to radiation exposure indicating a change in the ultradian rhythm of normal sleep cycles. The cumulative and irreversible effect of radiation exposure was proposed and the interaction of the extremely low frequency radiation with the similar EEG frequencies was suggested

Plasma levels of TNF in obstructive sleep apnea syndrome [OSA] before and after surgical intervention

Prior studies have shown that biomarkers of inflammation, including TNF-alpha, are raised in patients with sleep apnea. TNF-alpha is one of important risk factors for atherosclerosis, stroke, and cardiovascular disease in OSA patients. To determine whether TNF-alpha blood levels are elevated in OSA syndrome and whether they are reversible after surgical intervention. Among the patients who had visited the ENT clinic for evaluation of sleep problems, 70 subjects were selected. Polysomnography [PSG] and morning venous blood serum for levels of TNF- alpha were performed in all the subjects and 35 patients were diagnosed as having OSAS. All patients with OSA had surgical intervention according to individual cases. Laser assisted uvulopalatoplasty [LAUP], extended LAUP [LAUP and laser assisted tonsillar ablation], or laser assisted uvuloplasty were done using a CO[2] laser. Sleep apnea monitoring, clinical evaluation and TNF-alpha level were then compared before and 3 months after intervention. We compared thirty five patients with OSA [21 males and 14 females], mean age [46.6 +/- 12.4], with 35 control subjects [11males and 24 females], mean age [34.2 +/- 9.6]. The mean [SD] plasma level of TNF-alpha was significantly higher in patients with OSAS than in control group [[5.77 +/- 4.04 pg/ ml vs. 2.24 +/- 1.5 pg/ml respectively, [P = 0.039]], and TNF-alpha level significantly decreased to [[3.22 +/- 3.4 pg/ml] [P = 0.001]] after treatment. In addition, TNF-alpha levels showed a statistically significant positive correlation with the AHI before treatment and with neck circumference after treatment. Our results suggest that TNF may be prognostic factors for comparing patients with OSAS before and after treatment

effect of chronic intermittent hypoxia in the evolution of NASH

Obstructive sleep apnea [OSA] causes chronic intermittent hypoxia [CIH] during sleep. OSA is associated with nonalcoholic steatohepatitis [NASH] in obese individuals and may contribute to progression of nonalcoholic fatty liver disease [NAFLD] from steatosis to steatohepatitis. To assess the potential role of hypoxia in the development of NASH in obstructive sleep apnea patients. Nocturnal polysomnography was performed in 60 consecutive patients for clinical suspicion of OSA. We investigated fasting blood glucose, serum insulin, TNF-alpha, ABG and liver enzymes for 30 patients with nocturnal polysomnographic recording of OSA and for 15 patients without recording OSA used as controls. Liver biopsy was offered to 15 of 30 patients with elevated liver enzymes. Patients with OSA had significantly higher levels of insulin and were more insulin-resistant according to HOMA-IR than in controls. We found that the parameters which significantly correlated with AHI were elevated liver enzyme, BMI, ultrasound grading, TNF-alpha and HOMA-IR in patients group but did not find a similar correlation in controls. Liver biopsy showed steatosis with lobular necrosis or hepatocyte ballooning in the 15 patients, associated with fibrosis in 5 patients. Hypoxic stress of obstructive sleep apnea may be implicated in the evolution of insulin resistance and steatohepatitis in obese individuals

Sleep-related breathing disorders in patients with Schistosomal cor-pulmonale

Schistosmiasis has long been an endemic disease in Egypt and an important cause of pulmonary hypertension. We aimed to investigate the clinical and polysomnographic features of sleep-related breathing disorders [SRBD] in patients with schistosomal cor-pulmonale and to evaluate their effects on pulmonary hemodynamics. We studied 10 stable patients diagnosed with schistosomal pulmonary hypertension [7 males and 3 females their mean age was 43.7 +/- 8.04] and 10 healthy volunteers matched for age, sex and BMI. Patients' exclusion criteria were: smoking, morbid obesity, other secondary causes of pulmonary hypertension, systemic hypertension, ischemic or rheumatic heart disease or left heart failure. All patients underwent overnight polysomnography or ambulatory cardiorespiratory sleep studies, spirometry, ECG and echocardiography. Daytime sleepiness was also assessed using the Epworth sleepiness scale [ESS]. The mean AHI in patients group was 20.0 +/- 11.34/h while in the control group it was 2.3 +/- 1.16/h. 80% of the patients were found to have an AHI > 10/h and 60% had moderate to severe sleep apnea [AHI >/= 15/h]. In addition, the majority of the patients [80%] spent > 30% of the night with an arterial oxygen saturation <90%. SRBD were not correlated with anthropometric measures, spirometry nor with the typical symptoms of SA such as excessive sleepiness as assessed by ESS. More importantly, SRBD were significantly associated with measures of pulmonary hypertension severity, and patients with moderate to severe SA had more impaired cardiovascular function as indicated by more severe right ventricular dilatation [p = 0.036] than patients with mild sleep apnea. SRBD are highly prevalent in patients with schistosomal pulmonary hypertension [PH]. Also, the SA severity was correlated with more advanced PH and more severe cardiovascular impairment. Therefore in the evaluation of patients with schistosomal PH, polysomnography or an ambulatory cardiorespiratory sleep study seems justified to identify potentially treatable SRBD that may additionally challenge the already compromised cardiovascular system in these patients

Comparison of four sleep questionnaires for screening obstructive sleep apnea

The increased prevalence of obstructive sleep apnea [OSA] mandates the presence of simple but accurate tools to identify patients with this disorder for early detection and prevention of various serious consequences. This study aimed at comparing four sleep questionnaires as regards their predictive probabilities for OSA. A cross-sectional study included 234 patients presenting to the sleep clinic. Four sleep questionnaires [Berlin, Epworth Sleepiness Scale [ESS], STOP, and STOP-Bang] were administered to the patients and scoring of the results of the questionnaires was done. Overnight attended polysomnography [PSG] was done for all patients and was considered the gold standard for the diagnosis of OSA. The sensitivity, specificity, positive and negative predictive values of the four questionnaires were calculated. Of 234 screened patients; 87.1% had OSA, whereas 93.3%, 90.2%, 95.5%, and 68.3% were classified as being at high risk by the Berlin, STOP, STOP-Bang questionnaires and ESS, respectively. The STOP-Bang, Berlin and STOP questionnaires had the highest sensitivity to predict OSA [97.55%, 95.07% and 91.67%, respectively], moderate-to-severe OSA [97.74%, 95.48% and 94.35%, respectively] and severe OSA [98.65%, 97.3% and 95.95%, respectively], but with a very low specificity for OSA patients [26.32%, 25% and 25%, respectively], moderate-to-severe OSA patients [3.7%, 7.41% and 25.93%, respectively] and severe OSA patients [5.36%, 10.71% and 19.64%, respectively], while the ESS had the highest specificity to predict OSA, moderate-to-severe OSA and severe OSA [75%, 48.15% and 46.43%, respectively] but with the lowest sensitivity [72.55%, 75.71% and 79.73%, respectively]. The sensitivity of Berlin, STOP and STOP-Bang questionnaires was very high yet, the low specificity of these questionnaires results in increased false positives and failure of exclusion of individuals at low risk

Sleep pattern changes in patients with liver cirrhosis

Liver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. This study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. Our results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4 +/- 2.6 vs 11.1 +/- 1.8, P = 0.0001; 10.9 +/- 8.5 vs 2.4 +/- 1.6, P = 0.005 and 3.1 +/- 3.1 vs 1.1 +/- 0.9, P =0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9 +/- 12.9 vs 73.1 +/- 7.6 [P = 0.02]]. Also, the percentages of S1, S3-S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group [P = 0.01, 0.02 and 0.06, respectively] while the percentage of S2 was significantly lower [P = 0.02]. Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B [P = 0.001 for all]. Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. This study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis

Sleep apnea in kidney transplant patients: clinical correlates and comparison with pretransplant patients

Sleep disordered breathing [SDB] is a prevalent, but forgotten, cardiovascular [CV] risk factor in end-stage renal disease patients. Studies of SDB in renal transplant patients are few with mixed results. To assess the prevalence and clinical correlates of SA in patients who received a kidney transplant, and to compare the prevalence of SA between waiting list and transplant patients. Our study included 40 clinically stable renal transplant patients and 15 patients awaiting transplantation. Patients with morbid obesity, diabetes, pulmonary disease or symptomatic heart failure were excluded from the study. All patients underwent overnight polysomnography, demographic and clinical data were also collected. We found that the prevalence of SA was high in both the transplant and the waiting list groups [38% vs 47%]. The severity of SA didn't show significant difference in both groups [AHI = 9.6 vs 16.2]. Moreover, we found a significant association between impaired renal function and the AHI in Tx patients. Also, SA was associated with difficult-to-treat hypertension in Tx patients as we found a significant association between the AHI and the systolic blood pressure as well as the number of prescribed antihypertensive drugs. SA is as highly prevalent in Tx as in WL patients. Moreover, this high prevalence in the transplant patients could be a consequence of declining renal function. In addition, we propose that sleep apnea is a new risk factor for hypertension and cardiovascular events in kidney-transplanted patients

use of overnight pluse oximetry and phoniatrics parameters in the screening protocol of obstructive sleep apnea

Obstructive sleep apnea-hypopnea syndrome [OSAHS] is a major public health problem due to its high prevalence rate. Polysomnography is the current golden standard test for diagnosis of OSAHS. The studies with pulse oximetry reveal a high sensitivity and suggest that as a screening tool, these may exclude some patients with negative studies from further work-up for OSAHS. Acoustic analysis of snoring sounds would offer the advantage of a non-invasive technique that would be used to monitor normal sleep. The posterior vocal tract resonances [i.e. F1 and F2] of OSA patients would yield lower frequency values compared to non-OSA individuals. To determine the sensitivity and specificity of overnight oximetry and phoniatrics parameters in evaluation of OSAHS and to compare the results with those obtained from polysomnography [PSG] as the gold standard test. Twenty patients, were presented with presumptive clinical diagnosis of OSAHS, each patient was subjected to: Full history taking: including age, sex, complain and Epworth Sleepiness Scale [ESS]. Systemic examination: Including general examination and body mass index [BMI]. Standard ENT examination and fibroptic pharyngoscopy with Muller maneuver. Polysomnography was done using RESMED Apnea Link screening device. Other tests: Acoustic analysis of voice and acoustic analysis of snoring sounds using computerized speech lab [CSL]. Pulse oximetry: The overnight oximetry was analyzed using the Wrist Pulse Oximeter MD300W. Eighteen patients [90%] were found to have OSAHS and two patients [10%] were simple snorers. The sensitivity of overnight pulse oximetry for an apnea hypopnea index of >5, >15, and >30/h was 66.7%, 80%, and 100% respectively and the specificity was 50%. The formant frequencies of different vowels [i, u and a] in OSA patients and non-OSA snorers revealed that the mean F1 value for the vowel /i/ was significantly lowered in OSA patients. In addition, the mean F2 value of the vowel /i/ and /u/ was markedly lowered in OSA patients. There was significant increase in values of bandwidths [BW1 and BW2] for /i/ and /u/ vowels in OSA patients in comparison to non-OSA snorers. Acoustic analysis of snoring sounds revealed that; in the palatal snorers group, the average pitch was 105 +/- 8 Hz and in the tongue base snorers group the average pitch was 263 +/- 17 Hz; meanwhile the average pitch in the combined group was 160 +/- 14 Hz. The difference was highly significant between the 3 groups. However harmonic to noise ratio was increased in patients with tongue base obstruction. Polysomnography is the current golden standard test for diagnosis and evaluation of degree of OSA. Overnight pulse oximetry offers an inexpensive method of screening for and diagnosing OSAHS. Oximetry alone allowed confident recognition of moderate and severe cases of OSAHS. Acoustic analysis of snoring sounds and voice in patients with snoring and/or OSAHS is useful as a screening or supportive method with other investigations to diagnose the site of upper airway obstruction during sleep

Study of endothelial dysfunction and vascular inflammation in sleep apnea, obesity and aged humans

Obstructive sleep apnea [OSA] has been associated with cardiovascular complications. The overnight repetitive hypoxia represents a form of oxidative stress in the vasculature which may activate the oxidant-sensitive, proinflammatory transcription factor nuclear factor kjB [NF-kjB], affecting endothelial function and atherosclerosis. We investigated whether the endothelial alterations attributed to OSA rather than to other confounding factors. Also, the production of inflammatory cytokine nuclear factor-kappa beta [NFKbeta] was investigated as the molecular mechanism involved in vascular endothelial dysfunction with OSA. Sixty subjects underwent attended nocturnal polysomnography were grouped by apnea hypopnea index: control [AHI<5/h] and OSA cases [AHI>5/h] the cases were further classified according to age and BMI into subgroup IIA: OSA, non-obese, middle age [35-52 y], subgroup IIB: OSA, non-obese, older age group [55-68 y], subgroup IIIA: OSA, obese, middle age group [35-52 y] and subgroup IIIB: OSA, obese, older age group [55-68 y]. A morning venous blood sample was obtained. Neutrophils were isolated, and NF-kjB activity was determined. Plasma sVCAM-1 was assayed by enzyme-linked immunosorbent assay and flow-mediated dilation [FMD] was performed. NF-jB activation and plasma level of sVCAM-1 were significantly increased in OSA patients as compared to the control group and there was no significant difference between the obese and non-obese cases also no significant difference between the middle and old age cases. The degree of NF-kjB activation was positively correlated with indices of apnea severity[r = 0.938; p< 0.001]. FMD was significantly decreased in OSA patients as compared to the control group. These findings suggested that OSA is an independent risk factor for cardiovascular morbidity also that OSA leads to NF-kjB activation, which may constitute an important pathway linking OSA with systemic inflammation and cardiovascular disease

Effect of occupational noise on the nocturnal sleep architecture of healthy subjects.

BACKGROUND & OBJECTIVES: Noise is considered to be a non-specific stressor which generally causes physiological and psychological effects in an individual. Many occupations involve workers being subjected to loud noise levels without adequate protective measures. The study was done to document the changes, if any, in the nocturnal sleep architecture of healthy persons exposed to loud occupational noise during daytime. METHODS: The study was a retrospective cohort design wherein three groups of eight subjects each, exposed to continuous occupational background noise levels of > 75dB for 1-2 years, 5-10 years and > 15 years were selected. Corresponding age and gender matched healthy controls (eight for each group) who worked in a quiet atmosphere were also recruited. All night sleep polysomnography was done on all subjects. In the morning, subjects rated their quality of sleep on a Visual Analogue Scale. RESULTS: There is a strong association between occupational exposure to loud noise and poor sleep efficiency (Relative Risk 2.49; Confidence Interval 1.12 to 5.57; P = 0.01, Fisher's exact test). The group exposed to noise for 1-2 years had a decrease in Total Rapid Eye Movement Time, Non Rapid Eye Movement Time, Slow Wave Sleep Time, Sleep Onset Latency and Total Sleep Time. The other two groups showed lesser number of changes in sleep architecture. Subjectively there was a decrease for sleep continuity in Group I and an increase for sleep onset in Group II. There is no correlation between loudness of noise in the workplace and sleep efficiency. INTERPRETATION AND CONCLUSION: It can be concluded that workers exposed to loud background occupational noise are at an increased risk of having poor quality sleep but adaptation to this effect probably takes place after a few years.