Simulator of Heart Rate and Respiratory Rate for Monitoring Accuracy of Intelligent Sleep Monitoring Devices / 中国医疗器械杂志

OBJECTIVE@#Invent a simulator which provides a simulation of heart rate and respiratory rate to the intelligent sleep monitoring devices based on precision pressure sensors.@*METHODS@#The simulator was composed of control part and simulated silicone doll. The simulated silicone doll contains heartbeat simulator and breathing simulation airbag. Heartbeat and breathing combination pressure signal can be produced according to frequency set values. Frequencies of pressure signal of the simulator were compared with the monitoring results of intelligent sleep monitoring devices with known accuracy to verify the frequency accuracy of pressure signal of the simulator. Verified the repeatability and stability of the simulator with a stopwatch.@*RESULTS@#The heart rate of the simulator was with in ±2 beats per minute of the monitoring results of intelligent sleep monitoring devices and the respiratory rate of the simulator was with in ±2 times per minute of the monitoring results. The repeatability and stability of the simulator was better than ±5% according to results with a stopwatch.@*CONCLUSIONS@#It's practicable to use the simulator which provides a simulation of heart rate and respiratory rate to the accuracy test of the intelligent sleep monitoring devices based on precision pressure sensor.

Discussion on safety and related pharmacological mechanism of compound anshen essential oil in relieving sleep disorders / 中国药理学通报

Aim To study the hypnotic effect and safety of compound anshen essential oil. Methods Gas chromatograph-mass spectrometer (GC-MS) was used to analyze the main active components of compound anshen essential oil. The mouse model of insomnia was established by intraperitoneal injection of para-chloro-phenyl alanine ( PC PA ) , combined with pentobarbital sodium sleep experiment and EEG characteristic monitoring in rats to study the hypnotic effect and mechanism. The safety of compound anshen essential oil was evaluated by acute toxicity test, skin irritation/allergy test and 90-day repeated administration toxicity test. The clinical effect and safety were evaluated by using the sleep monitoring technology for micro-motion sensitive mattress. Results Four components, including Atractylone (34.61%), (+) -Limonene (17.80%) , Linalool (11.63%), and Ocimene (11.67%) , were detected as the main active components of compound anshen essential oil. Compound anshen essential oil in-halation administration for seven days could effectively reduce the autonomic activity of insomnia mice, shorten the sleep latency (P <0.05) , improve the sleep duration, increase of neurotransmitters such as 5-hydroxy tryptamine (5-HT) and -γ-aminobutyric acid (GABA) in brain of mice with insomnia, and the medium dose group had better hypnotic effect. There was no death or adverse reaction in the safety evaluation test. The sleep balance index of 10 subjects with difficulty in falling a-sleep significantly increased (P <0.05), sleep latency was significantly shortened (P <0.05) , total sleep duration and sleep efficiency were improved, and no ad¬verse reactions were found after using the compound anshen essential oil for two days. Conclusions The compound anshen essential oil developed by the research team is safe and effective in relieving sleep disorders, which may be closely related to the co-regulation of the levels of neurotransmitters such as 5-HT and GABA by the four main active components.

Are physical inactivity, sitting time and screen time associated with obstructive sleep apnea in adults? A cross-sectional study

Abstract BACKGROUND: Sitting time, screen time and low physical activity (PA) levels have been associated with several diseases and all-cause mortality. PA is related to better sleep quality and absence of daytime sleepiness, along with lower risks of obstructive syndrome apnea (OSA). However, studies on the relationship between sitting time, screen time and OSA are scarce in the literature. OBJECTIVE: To analyze associations between PA levels, sitting time, screen time and OSA among adults with suspected sleep disorder. DESIGN AND SETTING: Cross-sectional study conducted at Hospital Israelita Albert Einstein. METHODS: Data were collected from 369 adults with suspected sleep disorders who visited the hospital's neurophysiology clinic between August 2015 and January 2017. RESULTS: Correlations between hypopnea and PA indicators were demonstrated for total sitting time (0.123; P = 0.019) and total screen time (0.108; P = 0.038). There was also a correlation between latency for rapid-eye-movement sleep (REM_LAT) and total sitting time (0.103; P = 0.047) and a negative correlation between mean oxyhemoglobin saturation (SaO_Avg) and total PA time (-0.103; P = 0.048). There were no associations between PA parameters and apnea-hypopnea index. After adjusting for confounding factors (body mass index, age and gender), sitting time and screen time were not associated with OSA. CONCLUSION: After adjusting for anthropometric and clinical factors, excessive sitting time or screen time was not associated with OSA in adults suspected of sleep disorders. Age, gender, hypertension, body mass index and waist circumference were associated with OSA.

Smart technologies toward sleep monitoring at home

With progress in sensors and communication technologies, the range of sleep monitoring is extending from professional clinics into our usual home environments. Information from conventional overnight polysomnographic recordings can be derived from much simpler devices and methods. The gold standard of sleep monitoring is laboratory polysomnography, which classifi es brain states based mainly on EEGs. Single-channel EEGs have been used for sleep stage scoring with accuracies of 84.9%. Actigraphy can estimate sleep effi ciency with an accuracy of 86.0%. Sleep scoring based on respiratory dynamics provides accuracies of 89.2% and 70.9% for identifying sleep stages and sleep effi ciency, respectively, and a correlation coeffi cient of 0.94 for apnea–hypopnea detection. Modulation of autonomic balance during the sleep stages are well recognized and widely used for simpler sleep scoring and sleep parameter estimation. This modulation can be recorded by several types of cardiovascular measurements, including ECG, PPG, BCG, and PAT, and the results showed accuracies up to 96.5% and 92.5% for sleep effi ciency and OSA severity detection, respectively. Instead of using recordings for the entire night, less than 5 min ECG recordings have used for sleep effi ciency and AHI estimation and resulted in high correlations of 0.94 and 0.99, respectively. These methods are based on their own models that relate sleep dynamics with a limited number of biological signals. Parameters representing sleep quality and disturbed breathing are estimated with high accuracies that are close to the results obtained by polysomnography. These unconstrained technologies, making sleep monitoring easier and simpler, will enhance qualities of life by expanding the range of ubiquitous healthcare.

Diagnosis and Effect of Maxillary Expansion in Pediatric Sleep-Disordered Breathing / 대한소아치과학회지

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023).In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

Design of Remote Sleep Monitoring Mobile Devices / 中国医疗器械杂志

In view of the multiple and diversity of sleep disorders, this paper develops and designs mobile portable devices based on remote monitoring and assessment of sleep quality. Using psychological scale, the patient's vital signs, sleeping data collection, statistics, and information transfer through remote signals to self-developed software for information entry and calculation, which could objectively display the quality of patient's sleep, so that medical staff might manage the patient's sleep better. Due to the features of portable device, such as its convenient to carry about, low price and else, the remote device can provide timely and effective information to help the majority of insomnia patients sleep therapy.

Accuracy Analysis of Embletta X100 for the Diagnosis of Obstructive Sleep Apnea and the Assessment of Sleep Structure

BACKGROUND AND OBJECTIVES: To measure the accuracy of Embletta X100, a level 2 portable sleep monitoring device, for diagnosis of obstructive sleep apnea and assessment of sleep structure. MATERIALS AND METHOD: We enrolled 200 consecutive patients who had been referred due to habitual snoring or witnessed apnea during sleep and had undergone standard polysomnography (PSG). We created a simulated situation similar to that of the Embletta X100 using only data from PSG and scored the sleep stage and the apnea-hypopnea index (AHI). Thereafter, the results of PSG and simulated Embletta X100 were compared. RESULTS: Sensitivity, specificity, and positive and negative predictive values of simulated Embletta X100 based on PSG were nearly 100% at three different cutoff values of AHI (5, 15, and 30). Intraclass correlation (ICC) of simulated Embletta X100 based on PSG was also excellent (≥0.9) for most of the sleep-related parameters and respiratory index. However, ICC of sleep stage percent was variable according to sleep stage (>0.9 for N1 and N2, 0.664 for N3, and 0.864 for R). CONCLUSION: Although sleep staging is not very precise, Embletta X100 matches well with PSG overall.

Research on upper airway compliance in OSAHS patients with MSMSMS / 中国基层医药

Objective To investigate the application of fiberoscope on upper airway compliance in OSAHS patients with MSMSMS. Methods From May 2014 to December 2015,93 patients with OSAHS in Jinhua Central Hospital were detected by MSMSMS[including 32 mild cases (MI),31 moderate cases (MO),and 30 severe cases (SE)] underwent electronic nasopharyngeal examination combined with the Muller test. The course of 93 OSAHS patients were recorded,including body mass index (BMI),sleep apnea index (AHI),mean oxygen saturation. The degree of collapse in the patients' soft palate area,tongue,epiglottis after area were calculated by the software. The results were analyzed by SPSS15. 0 statistical software. Results The disease courses between the mild group and moderate group [(4. 93 ± 2. 91)years,(8. 91 ± 4. 87)years],as well as between the moderate group and severe group [(4. 93 ± 2. 91)years,(9. 27 ± 4. 75) years],had statistically significant differences (t = - 3. 97,P = 0. 001;t =- 4. 33,P < 0. 001). The pairwise intergroup comparison of AHI among the three groups[(7. 75 ± 2. 49) times, (23. 24 ± 3. 74)times,(53. 27 ± 13. 59)times] showed statistically significant differences(t = 15. 49,P = 0. 000;t =- 45. 52,P = 0. 000;t = - 30. 02,P = 0. 000). The differences of MSaO2 between the mild group and severe group [(94. 25 ± 1. 11)％ vs. (94. 45 ± 0. 72)％ ],as well as between the moderate group and severe group[(94. 45 ± 0. 721)％ vs. (91. 40 ± 3. 17)％ ] had statistically significant differences ( t = 2. 85,P = 0. 000;t = 3. 05,P =0. 000). In the SE,there was a positive correlation with mean oxygen saturation (r = 0. 45,P = 0. 007). The collapse of soft palate area among the three groups had statistically significant differences (t = 3. 74,P = 0. 005;t = - 8. 39, P = 0. 000;t = - 4. 65,P = 0. 001). The collapse of posterior tongue area between the moderate group and mild group [(72. 65 ± 1. 56)％ vs. (66. 69 ± 8. 64)％ ],the mild group and severe group[(66. 69 ± 8. 64)％ vs. (74. 33 ± 10. 96)％ ] had statistically significant differences (t = 5. 96,P = 0. 008;t = - 7. 65,P = 0. 001). There was no statistically significant difference between the moderate group and severe group in the collapse of posterior tongue area (P > 0. 05). There were statistically significant differences between the mild group and moderate group[(63. 84 ± 8. 81)％ vs. (75. 06 ± 5. 07)％ ],the mild group and severe group[(63. 84 ± 8. 81)％ vs. (76. 40 ± 7. 94)]in the collapse of epiglottic area (t = 11. 22,P = 0. 000;t = - 12. 56,P = 0. 000). There was no statistically significant difference between the moderate group and severe group in the collapse of epiglottic area(P > 0. 05). Conclusion Fiberoscope combined with Müller test can respond better upper airway compliance in OSAHS patients with MSMSMS. It is worth to promote in clinic.

Application of electrocardiogram-based cardiopulmonary coupling technique in sleep-related diseases / 上海交通大学学报（医学版）

Sleep problems have become a common health problem nowadays, and researches on sleep disorders have become a hot topic. Polysomnography (PSG) is the most commonly used method of sleep monitoring in sleep research, but its operation process is cumbersome and complicated, which is likely to cause "first night effect", affecting the compliance of the subjects and the reliability of the monitoring results. In 2005, the cardiopulmonary coupling (CPC) technique based on electrocardiogram signals was used for sleep assessment for the first time, and now it has been widely used in sleep monitoring and analysis of patients with sleep apnea syndrome, sleep disorders, insomnia, depression or other sleep-related diseases and the healthy people, to some extent making up for the lack of traditional PSG technology. It has the advantages of simplifying the operation and improving the sensitivity of the information effectively. However, CPC technique also has the limitations in target crowd, function and use, which can be improved by the developments of CPC algorithm and the cross-system integration of nerve in the future.

Application of electrocardiogram-based cardiopulmonary coupling technique in sleep-related diseases / 上海交通大学学报（医学版）

Sleep problems have become a common health problem nowadays,and researches on sleep disorders have become a hot topic.Polysomnography (PSG) is the most commonly used method of sleep monitoring in sleep research,but its operation process is cumbersome and complicated,which is likely to cause "first night effect",affecting the compliance of the subjects and the reliability of the monitoring results.In 2005,the cardiopulmonary coupling (CPC) technique based on electrocardiogram signals was used for sleep assessment for the first time,and now it has been widely used in sleep monitoring and analysis of patients with sleep apnea syndrome,sleep disorders,insomnia,depression or other sleep-related diseases and the healthy people,to some extent making up for the lack of traditional PSG technology.It has the advantages of simplifying the operation and improving the sensitivity of the information effectively.However,CPC technique also has the limitations in target crowd,function and use,which can be improved by the developments of CPC algorithm and the cross-system integration of nerve in the future.

Application of micro movement sensitive mattress sleep monitoring system in diagnosis of children with obstructive sleep apnea syndrome / 中华实用儿科临床杂志

Objective To evaluate the application value of the micro movement sensitive mattress sleep monitoring system(MSMSMS) in the diagnosis of children with obstructive sleep apnea syndrome (OSAS).Methods One hundred and twenty-nine children aged from 3 to 14 years who visited the sleep center of Beijing Children's Hospital Affiliated to Capital Medical University from June 2013 to June 2015 due to sleep snoring were enrolled.Children with acute respiratory infection,cranial facial abnormalities,chronic lung diseases and neuromuscular diseases were excluded.According to the criteria,36 children were diagnosed as OSAS with average age of (7.3 ± 2.5) years,including 28 males and 8 females.Ninety-three non-OSAS children were recruited with average age of (6.3 ± 2.3) years,including 61 males and 32 females.Subjects were monitored with polysomnography(PSG) and MSMSMS simultaneously.Apnea/hypopnea index (AHI) ＞ 5 or obstructive apnea index (OAI) ＞ 1 were used to define whether OSAS existed.The consistency between MSMSMS and PSG in the diagnosis of OSAS and the determination of sleep efficiency were compared.Results The Kappa consistency coefficient of MSMSMS and PSG in the diagnosis of OSAS was 0.70(95％ CI:0.57-0.84),Z =7.99,P ＜ 0.000 1,which indicated the consistency between PSG and MSMSMS was good.The consistency of sleep efficiency of MSMSMS and PSG were compared.Bland-Altman results showed that there were 3％ (5/129 cases)points out of 95％ consistency bound and the interclass correlation coefficient (ICC) was 0.69 which indicated the consistency of 2 methods was good in determination of sleep efficiency.MSMSMS was able to detect respiratory event that was associated with sub-cortical arousals with no electroencephalogram arousal or blood oxygen reduction.Conclusions There is an adequate consistency between MSMSMS and PSG in the diagnosis of children with OSAS and determination of sleep efficiency.The MSMSMS has an advantage in detection of sub-cortical arousals and respiratory event.

The Clinical Efficacy of Portable Monitoring Devices(MESAM IV and Edentec) in Evaluating Sleep Apnea Syndrome: A Comparative Study with Simultaneously Recorded Standard Polysomnography / 대한이비인후과학회지

BACKGROUND: Standard polysomnography is generally used in the diagnosis of sleep apnea syndrome. However, this technique is laborious, costly and inconvenient as a screening test or a test for epidemiological study. A simple screening test for sleep apnea, administered at home, would provide physicians with a convenient and less costly means of evaluating possible sleep apnea. OBJECTIVES: The aim of this study was to evaluate the validity of portable sleep monitoring devices. The validity of measurements made by the portable sleep monitoring devices was assessed by comparing respiratory parameters obtained using the portable sleep monitoring devices with those obtained using standard polysomnography. MATERIALS AND METHOD: Eighteen patients were collected and divided into two groups. Direct comparison was made between data obtained by the portable monitoring devices(MESAM IV in group 1 and Edentec in group 2) and data simultaneously obtained by standard polysomnographic techniques. RESULTS: In group 1, oxygen desaturation index(ODI) and heart variation index(HVI) in MESAM IV were significantly correlated with apnea index(AI) and respiratory disturbance index(RDI) in standard polysomnography. In group 2, AI and RDI in Edentec were significantly correlated with those in standard polysomnography. CONCLUSIONS: The results of this study suggest that portable monitoring devices(MESAM IV and Edentec) may be useful in screening test of sleep apnea syndrome.