The use of topical nasal steroids to improve continuous positive airway pressure compliance in patients with obstructive sleep apnea: An updated systematic review and meta-analysis of randomized control trials.

BACKGROUND: Nasal steroids are commonly prescribed to reduce nasal side effects, which are the primary cause of continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea (OSA) patients. OBJECTIVE: We conducted a systematic review and meta-analysis of OSA patients to assess the effect of nasal steroids on CPAP compliance and nasal symptoms. METHODS: PubMed, Scopus, Ovid, and Cochrane Library were searched through March 2022. Randomized controlled trials (RCTs) evaluating the effects of nasal steroids on CPAP compliance in adult patients, which reported quantitative data on CPAP use and nasal symptoms, were included. RESULTS: Three RCTs (224 patients) were eligible for the meta-analysis. At the 4-week follow-up, the study did not demonstrate a statistically significant difference in CPAP compliance (average hours of CPAP use per night: mean difference 0.45; 95% confident interval (CI) (-0.01, 0.90); P = 0.06, percentage of nights device used: mean difference 1.79; 95%CI (-2.59, 6.17); P = 0.42). There was also no difference in overall nasal symptoms (mean difference 0.47, 95%CI (-0.00, 0.94); P = 0.05), with significantly more sneezing and rhinorrhea among patients with nasal steroids (sneezing: mean difference 0.64, 95%CI (0.23, 1.05); P = 0.002, rhinorrhea: mean difference 0.78, 95%CI (0.24, 1.31); P = 0.005). CONCLUSIONS: At the 4-week follow-up, the pooled results did not demonstrate significant benefits of nasal steroids on CPAP compliance. There was also no significant benefit for relieving nasal symptoms. To further explore the benefit of nasal steroids on CPAP use, additional, longer-term studies are required.

MetaSleepLearner: A Pilot Study on Fast Adaptation of Bio-Signals-Based Sleep Stage Classifier to New Individual Subject Using Meta-Learning.

Identifying bio-signals based-sleep stages requires time-consuming and tedious labor of skilled clinicians. Deep learning approaches have been introduced in order to challenge the automatic sleep stage classification conundrum. However, the difficulties can be posed in replacing the clinicians with the automatic system due to the differences in many aspects found in individual bio-signals, causing the inconsistency in the performance of the model on every incoming individual. Thus, we aim to explore the feasibility of using a novel approach, capable of assisting the clinicians and lessening the workload. We propose the transfer learning framework, entitled MetaSleepLearner, based on Model Agnostic Meta-Learning (MAML), in order to transfer the acquired sleep staging knowledge from a large dataset to new individual subjects (source code is available at https://github.com/IoBT-VISTEC/MetaSleepLearner). The framework was demonstrated to require the labelling of only a few sleep epochs by the clinicians and allow the remainder to be handled by the system. Layer-wise Relevance Propagation (LRP) was also applied to understand the learning course of our approach. In all acquired datasets, in comparison to the conventional approach, MetaSleepLearner achieved a range of 5.4% to 17.7% improvement with statistical difference in the mean of both approaches. The illustration of the model interpretation after the adaptation to each subject also confirmed that the performance was directed towards reasonable learning. MetaSleepLearner outperformed the conventional approaches as a result from the fine-tuning using the recordings of both healthy subjects and patients. This is the first work that investigated a non-conventional pre-training method, MAML, resulting in a possibility for human-machine collaboration in sleep stage classification and easing the burden of the clinicians in labelling the sleep stages through only several epochs rather than an entire recording.

Sleep Quality of Hospitalized Patients, Contributing Factors, and Prevalence of Associated Disorders.

BACKGROUND: Data in the literature has shown poor sleep quality to be frequently observed in hospitalized patients and known to be associated with poor treatment outcome. Many factors may impact poor sleep quality, and there is currently limited available data. We aim to determine the prevalence of poor sleep quality and associated factors in patients admitted to internal medicine wards as well as the change of sleep quality over time after admission. METHODS: An analytic observational study was conducted at the internal medicine wards at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index and screening questionnaires for the common diseases associated with poor sleep quality were also utilized. The logistic regression analysis was used to determine the independent factors which led to poor sleep quality. RESULTS: Data were collected from 96 patients during the period of June 2015 to February 2016. The mean age of the patients was 50.8 ± 16.7 years, and 51% were male. Infectious disease was the most common principal diagnosis accounted for 29.2%. The results show high prevalence of poor sleep quality after the first night of admission compared to baseline sleep quality at home (50% vs. 18.8%; p < 0.001). After 3 days of admission, the prevalence of poor sleep quality was reduced to the level close to baseline sleep quality at home (28.1% vs. 18.8%; p = 0.13). Multivariate analysis demonstrated that light exposure and pain were the main independent factors for poor sleep quality on the first day (odds ratio 6.68; 95% CI 2.25-19.84) and on the third day (odds ratio 3.47; 95% CI 1.24-9.71), respectively. CONCLUSIONS: This is the first study conducted on the sleep quality of hospitalized patients that included the follow-up period during hospital admission. Our study demonstrated high prevalence of poor sleep quality in hospitalized patients on the first day. Interestingly, the sleep quality was partly improved during hospitalization. Light exposure and pain were demonstrated to be the factors associated with poor sleep quality.

Adenotonsillectomy in children with syndromic craniosynostosis: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis in children with syndromic craniosynostosis, to evaluate the effect of adenotonsillectomy for the treatment of obstructive sleep apnea (OSA). STUDY DESIGN: A systematic review and meta-analysis. SEARCH METHODS: Data sources: a comprehensive search of PubMed, SCOPUS, Ovid Medline, and Web of science databases was performed through June 22nd, 2018. Manual searches and subject matter expert input were also obtained. This article includes studies assessing the effectiveness of adenotonsillectomy in syndromic craniosynostosis children, in which apnea-hypopnea index (AHI) or oxygen desaturation index (ODI) was reported. RESULTS: A total of 3 retrospective studies (24 patients) met the inclusion criteria. Pooled random effect analysis did not identify a statistically significant difference between preoperative and postoperative AHI. But there was an overall reduction of AHI of 5.00 events per hour [95% confidence interval (CI) (- 17.79, 7.79); P = 0.44]. However, the fixed effect model demonstrated a statistically significant difference between preoperative and postoperative ODI with an overall reduction of 8.5 per hour [95% CI (- 15.01, - 1.99); P = 0.01]. CONCLUSION: Adenotonsillectomy showed benefits for the treatment of OSA in syndromic craniosynostosis children, in terms of AHI and ODI. However, only ODI, but not AHI, reached statistical significance. Data were based on meta-analysis of retrospective reviews. Further studies that are conducted at multiple centers are needed to confirm the benefits of adenotonsillectomy for the treatment of OSA in syndromic craniosynostosis children.

Lingual tonsillectomy with palatal surgery for the treatment of obstructive sleep apnea in adults: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate effects of lingual tonsillectomy with palatal surgery as a combined procedure for the treatment of obstructive sleep apnea (OSA) in adults. SEARCH METHODS: Data source: a comprehensive search of MEDLINE, Scopus, Ovid, Web of Science, and the Cochrane Library was performed through November 2017. Manual searches and subject matter expert input were also obtained. This review includes studies assessing efficacy of lingual tonsillectomy with palatal surgery as a combined procedure for the treatment of OSA in adults, who had multilevel obstruction including lingual tonsil hypertrophy, in which apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) were reported. RESULTS: A total of four studies (107 patients) met our inclusion criteria. Pooled random effects analysis demonstrated a statistically significant improvement of polysomnographic respiratory events postoperatively, with average AHI reduction of 18.51 events per hour, [95% confidence interval (CI) (- 31.72, - 5.31); P = 0.006] and increase in minimal arterial oxygen saturation of 5.26 [95% CI (0.10, 10.42); P = 0.05]. The result also showed that the procedures significantly improved sleepiness resulting in an average Epworth Sleepiness Scale (ESS) reduction of 5.44 [95% CI (- 8.69, - 2.18); P = 0.001]. CONCLUSION: A combination of lingual tonsillectomy with palatal surgery may offer benefits in a selected group of OSA adults, in terms of apnea/hypopnea index, minimal arterial oxygen saturation and Epworth Sleepiness Scale. Data were based on meta-analysis of all case series with 2-6 months' follow-up.

The effects of topical nasal steroids on continuous positive airway pressure compliance in patients with obstructive sleep apnea: a systematic review and meta-analysis.

OBJECTIVES: The purpose of the study was to conduct a systematic review and meta-analysis in patients with obstructive sleep apnea (OSA), evaluating effects of topical nasal steroids on continuous positive airway pressure (CPAP) machine use and nasal symptoms. SEARCH METHODS: Data source: A comprehensive search of Pubmed, Scopus, Web of Science, and the Cochrane Library was performed through April 2016. Manual searches and subject matter expert input were also obtained. Studies assessing effects of nasal steroids on CPAP machine use in adults, which reported quantitative outcome data of CPAP compliance, were included. RESULTS: Two studies (144 patients) met inclusion criteria. Both were randomized, placebo-controlled clinical trials (RCT). Pooled fixed effects analysis did not identify a statistically significant difference between both the groups for average duration of CPAP machine use per night. But there was an overall increase in the usage of 0.4 h (95 % confidence interval (CI) (-0.20, 1.00); P = 0.19) in favor of nasal steroids. Difference of percentage of nights with CPAP use was not demonstrated (mean difference 0.06, 95 % CI (-0.27, 0.39); P = 0.71). There was also no significant difference in nasal symptoms (mean difference 0.63, 95 % CI (-0.11, 1.36), P = 0.1). CONCLUSION: Nasal steroids showed benefits on CPAP use, but did not reach statistical significance. Data was based on meta-analysis of RCTs of 4-week follow-up in unselected OSA patients. Future controlled studies with selected group and longer follow-up duration are needed to confirm the benefits of nasal steroid on CPAP compliance in OSA patients.