Sleep Apnea

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that affects both women and men. The aim of this study was to characterize and investigate the differences in terms of anxiety, depression, illness perception, and quality of life between female and male OSAS patients from a total of 111 patients (33 women and 78 men) who were recently diagnosed with OSAS in an outpatient clinic of a University Hospital in Portugal. They underwent a standardized protocol that included evaluation to assess of psychological morbidity (anxiety and depression -Hospital Anxiety and Depression Scale), illness representations (Brief Illness Perception Questionnaire), and quality of life (Sleep Apnea Quality of Life Index). The most significant differences between female and male OSAS patients result of apnea/hypopnea index (AHI), after controlling for body mass index (p 5 0.05); anxiety (p ¼ 0.000) and depression (p 5 0.005); consequences (p 5 0.005), identity (p ¼ 0.000), coherence (p 5 0.01), and emotional representation (p 5 0.005) of OSAS; and for daily functioning (p ¼ 0.000), emotional (p ¼ 0.001), and symptoms (p 5 0.05) domains of quality of life. Data suggest that women revealed more psychological morbidity associated with OSAS. Therefore, it seems extremely important to look at women as potential patients for sleep apnea and avoid looking up for a pattern of symptoms that rely on men as a norm to which women are compared.

The hyperpnea that accompanies arousal at the end of obstructive apnea is believed to be due to the progressive build-up in chemical drive during the apnea and a state-related decrease in upper airway resistance. We postulated the existence of a third component: a state-related transient increase in neural drive to the ventilatory pump muscles. To quantify this contribution, we measured the ventilatory response to arousal (VRA) in eight patients with obstructive sleep apnea (OSA) during continuous positive airway pressure (CPAP) therapy, applied at individually titrated levels. CPAP application reduced total pulmonary resistance (RL) to approximately normal levels, stabilizing ventilation and sleep state. Transient arousal from stage 2 sleep was induced using 5-sec tones (60-90 dB). Mean inspiratory flow increased above control on the second and third post-arousal breaths (P B 0.05), with a peak increase of 7.89 2.9 L/min while the accompanying changes in RL were significant. The time-course of VRA measured in three normal subjects under CPAP was similar to that observed in the OSA patients. However, elimination of CPAP prolonged the VRA time-course. Taken together, these findings demonstrate that: (1) during arousal, the increase in state-related neural respiratory drive is short-lived but not substantial; and (2) the resulting VRA time-course is shaped by the dynamics of the upper airway response to arousal.

Purpose The purpose of this study was to investigate apnea–hypopnea index (AHI) across two polysomnographies (PSGs) to examine AHI variability and impact on clinical diagnosis. Materials and methods Two-night PSGs of 193 sleep clinic patients were reviewed, and the AHI variability was analyzed. Anonymized records from five patients with significant night-to-night AHI variability were used in this study: the two-night PSGs from two patients were represented as four individual PSGs; the two-night PSG for two others were represented as being obtained from two different sleep clinics; the last patient’s PSG was shown as a two-night study. Twenty-two sleep experts attending the Associated Professional Sleep Societies meeting were recruited to make diagnoses based on the PSGs. They were told that the PSGs were from seven patients: four with single-night PSG; two with two PSGs, each one from a different clinic; and one patient with a two-night PSG. Results Twenty-one percent of the 193 sle...

OBJECTIVE: We tested whether polysomnography (PSG) indexes were associated with sleepiness, quality of life, or reaction times at baseline and as outcome measures following surgical or sham treatment for patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND METHODS: Mild-moderate OSAS subjects were measured before and 8 weeks after surgical or sham treatment in this prospective longitudinal study. Measures included standard PSG indexes, sleepiness, quality of life, and reaction times. Associations were examined with Spearman correlations and multivariate linear regression. RESULTS: Correlations between baseline PSG and non-PSG measures ranged from ؊0.22 to 0.25 (n, 87 subjects; mean correlation, 0.00 ؎ 0.11), with one positive association significant of 56 tested (arousal index and SF36 Mental Component Summary, r, 0.25; P ‫؍‬ 0.03). Correlations between change in PSG and non-PSG measures ranged from ؊0.37 to 0.35 (n, 54 subjects; mean correlation, ؊0.05 ؎ 0.19), with no significant positive association of 56 tested. Regression analyses confirmed these results. CONCLUSIONS: PSG indexes are not consistently associated with sleepiness, quality of life, or reaction time, both at baseline and as outcome measures in patients with mild-moderate OSAS. PSG in-dexes may not quantify some important aspects of OSAS disease burden or treatment outcome. Clinically important outcomes should be measured directly. EBM rating: A. (Otolaryngol Head Neck Surg 2005;132:255-62.)

Flow limitation during sleep occurs when the rise in esophageal pressure is not accompanied by a flow increase which results in a non-rounded inspiratory flow shape. Short periods of flow limitation ending in an arousal or in a fall in SaO 2 (hypopnea or upper airway resistance syndrome) are detrimental but the role of prolonged periods of flow limitation (PPFL) has not yet been clarified. This is important not only for diagnosis but also for nasal continuous positive airway pressure (CPAP) titration, especially for the automatic devices that need to be setup. The aim of this study was to analyze the effects of PPFL. We compared the behavior of the mean end-expiratory systemic blood pressure (SBP), end-tidal CO 2 , esophageal pressure and the pattern of breathing during a period of normal breathing at optimal (CPAP) and during PPFL at suboptimal CPAP in 14 patients with sleep apnea/hypopnea syndrome during a full polysomnography CPAP titration. The mean values of the parameters studied, at optimal and suboptimal CPAP were (1) SBP 92713 vs. 91715 mmHg (P: ns). At suboptimal CPAP, swings of blood pressure were associated with changes in pleural pressure; (2) SaO 2 97.571.2 vs. 96.571.6 (P: 0.03), end-tidal CO 2 43.574 vs. 49.574 (P : 0:001); (4) oesophageal pressure, 10.574 vs. 37.6715 cmH 2 O (P : 0:001) and (5) pattern of breathing: minute ventilation 6.671.4 vs. 6.171.2 L/min (P: ns) and inspiratory time 1.2470.3 vs. 1.6670.4 s (P : 0:001). It can be concluded that PPFL induces significant physiological changes. Nevertheless, given the scant literature, clinical studies are warranted to elucidate the clinical role of these physiological changes. (J.M. Montserrat Canal).

Sleep apnea, and particularly obstructive sleep apnea, is a common disorder that is characterized by repetitive partial or complete cessation of air flow, associated with oxyhemoglobin desaturation and increased effort to breath. Middle-aged obese men are at particular risk but the disorder is also present in women and young children. Because individuals with narrow airways and/or craniofacial anomalies may have increased risk for obstructive sleep apnea/hypopnea syndrome, dentistry can play a pivotal role in the identification and possible treatment of patients with this syndrome. This article reviews some of the basic aspects of this sleep-related disorder, its diagnosis, treatment, and consequences in both adults and children. (Semin Orthod 2004;10:63-72.)

We hypothesized that the increased arousal threshold to upper airway occlusion exhibited by patients with obstructive sleep apnea (OSA) is in part secondary to the disease process itself. To test this hypothesis, we studied the effects of withdrawal of three nights of nasal continuous positive airway pressure (CPAP) treatment on arousal in six male patients with severe OSA who were using nasal CPAP on a long-term basis. During the control week, patients slept with nasal CPAP at home and on the first of 2 nights in the sleep laboratory (night CI, CPAP; night C2, no CPAP). During the apnea week, patients slept without nasal CPAP for 2 nights at home and 2 nights in the sleep lab¬ oratory (API, AP2). The control and apnea weeks were consecutive and in random order. The mean (±SEM) apnea+hypopnea index was 76.9±7.1 on API vs 3.1 ±1.0 events per hour on CI (p<0.05). Thus, the laboratory night (and presumably the 2 nights at home) preceding AP2 had dramatic in¬ creases in apnea compared with the nights preceding C2. The apnea duration during nonrapid eye movement sleep on nights following apnea was greater (AP2: 28.7±1.5 vs C2: 25.5±1.7 s; p<0.05) and the arousal threshold as reflected by the maximum esophageal pressure deflection preceding arousal was higher (DPmax) (AP2: 55.1 ±5.7 vs C2: 45.3±6.4 cm H20; p<0.005). We conclude that prior sleep apnea increases the arousal threshold to upper airway occlusion on subsequent nights and prolongs the apneic events. (CHEST 1996; 109:1490-96)

Our objective was to characterize sleep-disordered breathing in 88 children with achondroplasia aged 1 month to 12.6 years. At the time of their initial polysomnography, five children had previously undergone tracheostomy, and seven children required supplemental oxygen. Initial polysomnography demonstrated a median obstructive apnea index of 0 (range, 0 to 19.2 apneas/hr). The median number of central apneas with desaturation per study was 0.5 (0 to 49), the median oxygen saturation nadir was 91% (50% to 99%), and the median peak end-tidal pCO2 was 47 mm Hg (36 to 87 mm Hg). Forty-two children (47.7%) had abnormal initial study results, usually caused by hypoxemia. Two children with severe obstructive sleep apnea eventually required continuous positive airway pressure therapy, and three additional children required tracheostomies. (1) Children with achondroplasia often have sleep-related respiratory disturbances, primarily hypoxemia. (2) The majority do not have significant obstructive or central apnea; however, a substantial minority are severely affected. (3) Tonsillectomy and adenoidectomy decreases the degree of upper airway obstruction in most but not all children with achondroplasia and obstructive sleep apnea. (4) Restrictive lung disease can present at a young age in children with achondroplasia.

Purpose No studies have assessed the prevalence of fatigue, depression, sleepiness, and the risk of obstructive sleep apnea (OSA) among commercial airlines pilots in the Gulf Cooperation Council (GCC). Methods This was a quantitative crosssectional study conducted among pilots who were on active duty and had flown during the past 6 months for one of three commercial airline companies. We included participants with age between 20 and 65 years. Data were collected using a predesigned electronic questionnaire composed of questions related to demographic information in addition to the Fatigue Severity Scale (FSS), the Berlin Questionnaire, the Epworth Sleepiness Scale (ESS), and the Hospital Anxiety and Depression Scale (HADS). Results The study included 328 pilots with a mean age ± standard deviation of 41.4 ± 9.7 years. Overall, 224 (68.3%) pilots had an FSS score ≥ 36 indicating severe fatigue and 221 (67.4%) reported making mistakes in the cockpit because of fatigue. One hundred and twelve (34.1%) pilots had an ESS score ≥ 10 indicating excessive daytime sleepiness and 148 (45.1%) reported falling asleep at the controls at least once without previously agreeing with their colleagues. One hundred and thirteen (34.5%) pilots had an abnormal HADS depression score (≥ 8), and 96 (29.3%) pilots were at high risk for OSA requiring further assessment. Conclusion Fatigue, sleepiness, risk of OSA, and depression are prevalent among GCC commercial airline pilots. Regular assessment by aviation authorities is needed to detect and treat these medical problems.

This article examines the neurocognitive sequelae of repeated exposure to hypoxemia in apnea (breath-hold) divers. A brief review of the literature on the physiological and neurological adaptations involved in the ''human diving reflex'' is presented. The results from a neuropsychological investigation of N ¼ 21 elite apnea divers are evaluated. Standard neuropsychological tests, with known sensitivity to mild brain insults, included speed of visuo-motor responding, speed of language comprehension, response inhibition, and visual and verbal attention and recall tasks. Results indicated that the breath-hold divers performed tasks within the average range compared to norms on all tests, suggesting that 1-20 years of repeated exposure to hypoxemia including multiple adverse neurological events did not impact on performance on standard neuropsychological tasks. The results are discussed in relation to implications for clinical conditions such as sleep apnea, respiratory disorders, altitude sickness, and recreational apnea activities.

Deficits in daytime performance due to sleep loss are experienced universally and associated with a significant social, financial, and human cost. Microsleeps, sleep attacks, and lapses in cognition increase with sleep loss as a function of state instability. Sleep deprivation studies repeatedly show a variable (negative) impact on mood, cognitive performance, and motor function due to an increasing sleep propensity and destabilization of the wake state. Specific neurocognitive domains including executive attention, working memory, and divergent higher cognitive functions are particularly vulnerable to sleep loss. In humans, functional metabolic and neurophysiological studies demonstrate that neural systems involved in executive function (i.e., prefrontal cortex) are more susceptible to sleep deprivation in some individuals than others. Recent chronic partial sleep deprivation experiments, which more closely replicate sleep loss in society, demonstrate that profound neurocognitive d...

A persons' health subsequently depends upon the level of his body composition. Its consist percentage of fat, bone, water, and muscle. Many health consultants around the world agreed that there is a health danger if the level of fat is too high in the human body. Presently it is clear that the factors of body composition are wide and involve multiple interfaces of cultural, environmental, social and lifestyle factors. A high level of fat percentage associated with a threat for health problems for stance high blood pressure, high blood cholesterol, diabetes, and sleeping disorder. Numerous studies found that there is an effect of sleep on body composition. Sleep is a natural process that allows the body and brain to rest and recover. Irregular sleep patterns, inadequate sleep quality, and insufficient sleep play a significant role to determine the health status of individuals. Quality of Sleep is not only effective as an indicator of health but also a key component of quality of life [1]. American adults reported around 27.5% to 29, 1% short sleep duration [2]. Numerous studies have investigated the relationship between obesity and sleep. Sleep apnea has an estimated prevalence of 9% to 28% among females and 27% to 34% among males, 30 to 70 years of age [3]. Every person requires sleep; both genders experiences sleep differently throughout their lifetimes. They face different challenges to sleep. Females are more prone to insomnia, while males are more likely to suffer from a sleep disorder like sleep apnea and snoring. Galland BC et al., reported poor sleep quality by 56% of participants and were more common in girls (63.1%) than in boys (44.5%), and sleep hygiene was significantly worse in females [4]. The symptoms for insomnia prevalence increased in females from 3.4% to 12.2% and in males from 4.3% to 9.1% [5]. The studies on sleep and body composition in the Saudi region on adolescent found that there is an inverse relationship between poor sleep duration (less than seven hours per day) and obesity/ overweight [6,7]. Mahfouz MS et al., revealed that university female students have poor sleep quality (69.1%) as they slept a mean of 4.77 hours/night [8]. In particular, epidemiological studies had shown a contrary correlation between sleep duration and BMI [9]. Sleep medicine in Saudi Arabia emphasising that there are many demands for further sleep studies to discuss the issues on the prevalence of numerous sleep disorders amongst Saudi population related to lifestyle and body composition [10]. Although longitudinal research is needed to confirm study results, researchers observed a counter relationship between duration of sleep and risk towards obesity development in children. In addition, every 30 minutes of sleep disruption leads to a 3% decline in daytime activity. Overall, study results indicate that sufficient duration and quality of sleep are significant factors for childhood obesity prevention [11]. Researchers found significant prediction between sleep duration in overweight male and z-score of BMI, where the long duration of sleep was linked with risk for overweight and lower BMI. In both regression models calculated for female adolescents, the duration of sleep is not a predictor for the risk of overweight or BMI z-score, indicating a gender difference in BMI and duration of sleep [12]. Many types of research are necessary to estimate how sleep effects on body composition, Inadequate sleep may also increase the chances to eat more, particularly if time spent in an inactive way, like browsing the internet, playing video games, watching television, even taking unhealthy foods habits. Daily routine work at home that leads to reduced sleep and increased food intake. However, the latest evidence linking BMI with sleep for a different population. There is little evidence for body fat, but not for the total body water with sleep habits for male and female students. In the present study authors investigated about body composition (BMI, body fat, and body water) and sleep habits amongst male and female students which would be helpful in identifying the effect of sleep habits on the body composition and adopt the preventive strategies for obesity and abnormal sleep. ABSTRACT Introduction: Elevated body composition is associated with many health hazards and it is also strongly associated with sleep habits of individuals.

The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.

Sleep apnea syndrome is a common pathology with negative consequences on cardiovascular and metabolic diseases. The relationship between obesity and OSAS is complex, multifactorial and bidirectional; that leads to a negative mutual influence of the two pathologies. The main purpose of this study is to evaluate the risk associated with obesity and the occurrence of the apnea phenomenon, as well as, to compare the various polysomnographic parameters and to compare them with obesity. 100 patients took part to this study. 60 % of the patients were diagnosed with OSAS. 71 % of the patients had varying degrees of obesity. Significant statistic differences were revealed between: the Mean variation of the BMI in patients with and without apnea (T Test p= 0,007 &lt; 0,05); the dorsal AHI Mean of the non-obese group as against to the dorsal AHI Mean of the obese group (T Test p= 0,002), the AHI Mean in other positions of the non-obese group as against to the AHI Mean in other positions of the...

People suffering from migraines, sleep apnea, glaucoma, memory loss, stroke, ADHD, and even impotence may benefit from new sleep research, which has discovered how sleep position impacts brain and head circulation, and can create many problems whose cause is considered unknown by medicine, which has been ignoring sleep position in brain disease research and treatment.

The issue has to do with the effect of gravity on the body, which is different when standing versus lying down. Medicine has ignored this effect, which is essential for understanding diseases of the brain.

The answer to many health problems may all be in our bed.

PhysioBank, PhysioToolkit, and PhysioNet : Components of a New Research http://circ.ahajournals.org/cgi/content/full/101/23/e215 located on the World Wide Web at: The online version of this article, along with updated information and services, is http://www.lww.com/reprints Reprints: Information about reprints can be found online at Abstract-The newly inaugurated Research Resource for Complex Physiologic Signals, which was created under the auspices of the National Center for Research Resources of the National Institutes of Health, is intended to stimulate current research and new investigations in the study of cardiovascular and other complex biomedical signals. The resource has 3 interdependent components. PhysioBank is a large and growing archive of well-characterized digital recordings of physiological signals and related data for use by the biomedical research community. It currently includes databases of multiparameter cardiopulmonary, neural, and other biomedical signals from healthy subjects and from patients with a variety of conditions with major public health implications, including life-threatening arrhythmias, congestive heart failure, sleep apnea, neurological disorders, and aging. PhysioToolkit is a library of open-source software for physiological signal processing and analysis, the detection of physiologically significant events using both classic techniques and novel methods based on statistical physics and nonlinear dynamics, the interactive display and characterization of signals, the creation of new databases, the simulation of physiological and other signals, the quantitative evaluation and comparison of analysis methods, and the analysis of nonstationary processes. PhysioNet is an on-line forum for the dissemination and exchange of recorded biomedical signals and open-source software for analyzing them. It provides facilities for the cooperative analysis of data and the evaluation of proposed new algorithms. In addition to providing free electronic access to PhysioBank data and PhysioToolkit software via the World Wide Web (http://www.physionet.org), PhysioNet offers services and training via on-line tutorials to assist users with varying levels of expertise. (Circulation. 2000;101:e215-e220.)

Background: Studies on families with sleepwalking are uncommonly published but can give further information on the phenotype of patients with chronic sleepwalking. Subjects and methods: Out of 51 individuals referred for chronic sleepwalking during a 5-year period, we obtained sufficient information on 7 families with direct relatives who reported sleepwalking with or without sleep terrors. Among 70 living direct family members, we obtained questionnaire responses from 50 subjects and identified 34 cases with a history of sleepwalking. Of the 50 subjects, 16 completed only questionnaires, while all the others also completed a clinical evaluation and nocturnal sleep recordings. Results: There was a positive history of sleepwalking on either the paternal or maternal side of the family over several generations in our 7 families. Thirty-three clinically evaluated subjects had evidence of sleep-disordered breathing (SDB), with associated craniofacial risk factors for SDB (particularly maxillary and/or mandibular deficiencies). There was a complete overlap with the report of parasomnias and the presence of SDB. In cases with current sleepwalking, treatment of SDB coincided with clear improvement of the parasomnia. Conclusion: All of our subjects with parasomnias presented with familial traits considered as risk factors for SDB. These anatomical risk factors are present at birth and even subtle SDB can lead to sleep disruption and instability of NREM sleep. The question raised is: are factors leading to chronic sleep disruption the familial traits responsible for familial sleepwalking? Ó

There's one big problem with sleeping that most people never think about. This is an important issue, since we spend on average one third of our lives in bed. It has to do with gravity, and the pull it has on your body when it is lying flat in bed. Let's say you weight 150 pounds. When you are standing, gravity pulls your 150-pound body weight down towards your feet, which must support that weight. When standing, gravity also pulls your blood down towards your feet, and resisted the return of blood from your feet back to your heart. As a result, some people feel extra fluid pressure in their lower legs and feet by the end of the day from this pull of gravity. But the feet are designed to withstand this pressure and weight, especially since we take breaks from this pressure and weight when we lie down to rest. What happens then? Does the effect of gravity disappear when we lie down? Of course, not. Instead, when you lie your 150-pound body down, the first thing that happens is that gravity pulls your body into the mattress. This means that the weight of your body presses on the lower edge of your body that is touching the mattress. Essentially, you are compressing your body into the bed. This means that it is very important to consider your body position while sleeping. Depending on how you sleep, there will be compression of parts of your body from the weight of your body pressing you into the mattress. This can lead to compression injuries, which involve reduced blood and lymph circulation, nerve injuries, joint injuries, and problems with your brain, eyes, ears, face, and sinuses, depending on your sleep position. This is one reason why people toss and turn while sleeping. Circulation is impaired from the pressure of sleeping on your body, so you unconsciously move to restore circulation. Leaning on anything for 8-hours straight, day after day, can cause compression injuries. But there are certain sleep positions which are worse than others when it comes to these injuries.

Objectives: In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services.

This review attempts to assemble the characteristics of a distinct variant of sleepwalking called sexsomnia/sleepsex from the seemingly scarce literature into a coherent theoretical framework. Common features of sexsomnia include sexual arousal with autonomic activation (e.g. nocturnal erection, vaginal lubrication, nocturnal emission, dream orgasms). Somnambulistic sexual behavior and its clinical implications, the role of precipitating factors, diagnostic, treatment, and medico-legal issues are also reviewed. The characteristics of several individuals described in literature including their family/personal history of parasomnia as well as the abnormal behaviors occurring during sleep are reported.

Purpose: No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h.
Methods: Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence.
Results: The mean age was 54.8±14.6 years, and the mean BMI was 45.9±12.2 kg/m2. Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry,  and a significantly higher time with SpO2<90 % (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033-1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups.
Conclusions: The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA.

What does lying down in bed for about 1/3 of your life do to your body and brain?  Are your sleep habits making you sick?  We show how common sleep positions can cause migraines, glaucoma, stroke, sleep apnea, sinus congestion, ear infections, facial distortion, and many other problems, which are reversible by changing the way you sleep.

Overweight and obesity are rampant, affecting 97 million adults in the United States. The problem is complex, involving genetic, metabolic, physiological, cultural, social, and behavioral factors. 2 On the surface, the solution seems straightforwarddecrease the number of calories consumed, and increase the number of calories used, and weight loss will result. However, as one begins to examine the approach to weight management more closely, it becomes clear that our current interventions are often unsatisfactory, leading us to dig more deeply.

Purpose: This article focuses on recent evidence linking Rapid eye movement (REM) obstructive sleep apnea (OSA) (REM-OSA) to neurocognitive dysfunction and mood changes, the proposed mechanisms for increased risk of neurocognitive dysfunction in REM-OSA, and future research prospects.

Methods: PubMed and Google Scholar records were examined for articles utilizing predefined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered.

Results: REM-OSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REM-OSA and non-stage-specific OSA, current findings indicate that REM-OSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares.

Conclusion: Currently available evidence indicates that REM-OSA may present with insomnia and nightmares and could affect cognitive function and mood.

Obstructive sleep apnea (OSA) is a disorder characterized by repeated episodes of complete (apneas) or partial (hypopneas) cessations of breathing while sleeping. While continuous positive airway pressure (CPAP) treatment is commonly chosen to treat OSA, various conservative behavioral therapies are also used, particularly in patients unable to tolerate or benefit from CPAP or who have mild OSA. The principal purpose of these behavioral measures is to reduce risk factors which may underlie or exacerbate the disorder (e.g., weight reduction, smoking cessation, reduction/elimination of alcohol consumption, change in sleeping posture and sleep hygiene). Numerous studies have been conducted to evaluate the efficacy and/or effectiveness of CPAP in treating a wide range of OSA symptomatology. The present study consists of an exhaustive bibliographic search in Medline, PsycINFO, and Cochrane Review (1994-2007) databases and selection of works which have evaluated the efficacy and/or effectiveness of CPAP vis-a-vis daytime sleepiness, depression and cognitive functioning in OSA patients. The selected studies include randomized clinical trials in which CPAP was compared with more conservative measures, sham CPAP and oral placebos. The most important studies which evaluate the efficacy of behavioral treatments for OSA are also reviewed and the most remarkable results are presented. Various conclusions derived from the studies are discussed.

The nose and pharynx begin the upper airway system and represent a continuum. This is the biologic basis for the mutual influences of rhinitis and obstructive sleep apnea (OSA). Sleep-disordered breathing has a large differential diagnosis that includes snoring, upper airway resistance syndrome, and severe OSA. Nasal obstruction is an independent risk factor for OSA, but there is no correlation of daytime nasal resistance with the severity of OSA. However, nasal resistance was an independent predictor of apnea-hypopnea index in a recent study of nonobese OSA patients. Rhinitis alone is associated with mild OSA, but commonly causes microarousals and sleep fragmentation. Reduction of nasal inflammation with topical treatment improves sleep quality and subsequent daytime sleepiness and fatigue. Patient compliance with the nasal continuous positive airway pressure (nCPAP) device is relatively low, in part due to adverse nasal effects.

Force Sensing Resistors (FSR) are ultra-thin, low-cost, pressure sensors, which exhibit change in their electrical resistance when force is applied on their surface. The FSR has been used in wide ranging applications in the automotive industry, musical instruments, touch-buttons, portable electronic devices, etc. The FSR is also proving to be promising device for developing applications in healthcare. The present work reviews the reported work on developing novel applications of FSR in non-invasive diagnosis, and monitoring of patients undergoing treatment. The techniques used in biosignal acquisition and its subsequent processing after using FSR, as reported in the literature are briefly reviewed. This is followed by review of the recently reported innovations in diagnostic technology using FSR. The applications of the FSR for diagnosis and monitoring of several major medical disorders are described. The merits and of using FSR are highlighted. The limitations of the technology using FSR are also noted for future advancement. It is observed that application of FSR, despite its present limitations of the technology, opens new opportunities for developing novel applications in bio-medical instrumentation and healthcare.

Majority of the physiological processes in the human organism are rhythmic. The most common are the diurnal changes that repeat roughly every 24 hours, called circadian rhythms. Circadian rhythms disorders have negative influence on human functioning. The aim of this article is to present the current understanding of the circadian rhythms physiological role, with particular emphasis on the circadian rhythm sleep-wake disorders (CRSWD), principles of their diagnosis and chronobiological therapy. The guidelines are based on the review of
recommendations from the scientific societies involved in sleep medicine and the clinical experiences of the authors. Researchers participating in the preparation of guidelines were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the
Polish Psychiatric Association, based on their significant contributions in circadian rhythm research and/or clinical experience in the treatment of such disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies. CRSWD have a significant negative impact on human health and functioning. Standard methods used to assess CRSWD are sleep diaries and sleep logs, while the actigraphy, when available, should be also used. The most effective methods of CRSWD treatment are melatonin administration and light therapy. Behavioral interventions are also recommended. A fourteen-day period of sleep-wake rhythm assessment in CRSWD enables accurate diagnosis, adequate selection of chronobiological interventions, and planning adequate diurnal timing of their application. This type of assessment is quite easy, low-cost, and provides valuable indications how to adjust the therapeutic approach to the circadian phase of the particular patient.

This study investigated the relationship between health status (i.e., physical well-being and quality of life), sleep disorders (e.g., insomnia, sleep-related depression and anxiety), and musculoskeletal pain in the craniomandibular and cervical spinal regions. The number of painful body areas below the cervical spine (i.e., widespread pain) was also taken into account. Two questionnaires, viz., the RAND 36-item Health Survey Questionnaire and the Dutch Sleep Disorders Questionnaire (SDQ), were administered to 103 persons who could unequivocally be classified into one of four mutually exclusive groups: No pain, craniomandibular pain (CMP), cervical spinal pain (CSP), and both CMP and CSP. Body drawings were used for the self-report of widespread pain. Multivariate analysis of variance showed effects of gender, group, and widespread pain on the questionnaire scales; not of age. As shown by univariate analysis of variance, men suffered more from sleep apnea than did women. No other gender differences were found. Simple contrast analyses following univariate analyses of the group and widespread pain effects showed that, in general, more questionnaire scales, both of the RAND-36 and of the SDQ, reached statistical significance with an increase in the number of painful areas. It was concluded that both musculoskeletal pain in the trigemino-cervical area and widespread body pain are associated with an increased impairment of health status. Also, sleep disorders are frequently found in patients with chronic pain in the craniomandibular and cervical spinal regions as well as in patients with widespread pain. The more painful areas there are, the likelier it is that sleep disorders are present.

Traditional epidemiologic studies of insomnia provide valid but fairly rudimentary information regarding the presence, frequency, duration and evolution of sleep problems. Standardized tools such as validated questionnaires (e.g., Pittsburgh Sleep Quality Index and sleep logs) help assess the presence and severity of sleep problems, while other methods (e.g., SLEEP L system) address insomnia diagnoses. Other instruments (e.g., Structured Clinical Interview for DSM-IV [SCID], Short-Form 36 , Epworth Sleepiness Scale [ESS]) provide insights into insomnia consequences and co-morbidities. Sleep laboratory studies using polysomnography (PSG) have also provided useful findings (e.g., relating to sleep apnea and excessive daytime sleepiness) in experimental and population-based patient samples containing subgroups enriched for certain variables under investigation. These methods have significantly increased our knowledge about insomnia. Critically, longitudinal studies are needed to further our understanding of the pathophysiology and morbidity of insomnia, defining roles for risk factors, hyperarousal and co-morbidities and the effects of treatment in long-term disease progression. This review summarizes the current available data on the evolution of insomnia and proposes a model that warrants further research attention and discussion.

Sleep apnea patients' nocturnal breathing disturbances cause daytime sleepiness and cognitive impairments. Attentional capacity and vigilance deficits have often been observed. Moreover, some studies have suggested executive dysfunction, usually assumed to be related to (pre)frontal lobe dysfunction caused by intermittent hypoxemia. However, sleep disruption itself has a pervasive influence on cognitive function and affects not only underlying 'lower-level' processes such as arousal and alertness, but also 'higher-level' cognitive processes such as executive attention. This methodological caveat has not been fully taken into account in the sleep apnea literature. In order to be able to disentangle these cognitive processes on different levels, sound theoretical neurocognitive frameworks are needed to attain careful analyses and interpretations of neuropsychological data. Therefore, this paper firstly presents an overview of relevant theoretical concepts and models of arousal, attention, and executive function. Then, it is being argued that these theoretical considerations have important methodological implications. These methodological concerns are being addressed by specific experimental and statistical approaches, illustrated by some well-known neuropsychological tests. It can be concluded that the reported executive deficits in sleep apnea patients should be regarded as tentative, and that more case-controlled studies are needed using fine-grained analyses to parcel complex cognitive abilities into their subcomponents. q

Among 27,000 infants studied prospectively to characterize their sleep-wake behavior, 38 infants died suddenly and unexpectedly under 6 months of age. Of these, 26 died from sudden infant death syndrome (SIDS), 5 from congenital cardiac abnormalities, 2 from infected pulmonary dysplasia, 2 from septic shock with multi-organ failure, 1 from a prolonged seizure, 1 from prolonged neonatal hypoxemia, and 1 from meningitis and brain infarction. The frequency and duration of apneas recorded some 3-12 weeks prior to the infants' death were analyzed. The brainstem materials were collected and studied in an attempt to elucidate the relationship between sleep apnea, and prone sleep position and gliosis in some nuclei associated with cardiorespiratory characteristics, such as nucleus ambiguus in the medulla oblongata and the solitary nucleus, as well as structures associated with arousal phenomenon, such as the reticular formation, the superior central nucleus and the nucleus raphe magnus in the pons, the dorsal raphe nuclei in the midbrain and medulla oblongata, periaqueductal gray matter in midbrain, and locus ceruleus. Gliosis was estimated as the density of glial fibrillary acidic protein (GFAP)-positive reactive astrocytes. Variant-covariant analyses were carried out using the characteristics of apnea as an independent variable and sleep position and gliosis as dependent variables. A significant association was found only in the frequency of obstructive apnea and prone position (P < 0:001) and gliosis in the raphe nuclei in the midbrain (P < 0:001).