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Background: Cerebrovascular diseases are the leading cause of cognitive decline and dementia. Therefore, the investigation of the potential ways to slow down the disease progression is an important research field. Periodic limb movements... more
Background: Cerebrovascular diseases are the leading cause of cognitive decline and dementia. Therefore, the investigation of the potential ways to slow down the disease progression is an important research field. Periodic limb movements in sleep (PLMS) are known to be associated with transient changes in heart rate and blood pressure. These changes might influence the course of cerebral small vessel disease (cSVD). Nevertheless, the clinical significance of PLMS, particularly its influence on cardiovascular diseases course, is still controversial and underinvestigated.Methods/design: Patients from 60 to 75 years old diagnosed with cSVD will undergo nocturnal polysomnography. Subjects with apnea/hypopnea index under 5 will be enrolled. Sleep quality and daytime functioning will be assessed at baseline with self-reported questionnaires. Brain MRI and cognitive assessment will be performed at baseline and in the 2-year follow-up. Progression of cSVD markers and cognitive dysfunction w...
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Background There are limited data on long-term mortality in sleep apnoea (SA) patients with and without positive airway pressure (PAP) therapy. This retrospective cohort study investigated long-term hospitalisation and mortality rates in... more
Background There are limited data on long-term mortality in sleep apnoea (SA) patients with and without positive airway pressure (PAP) therapy. This retrospective cohort study investigated long-term hospitalisation and mortality rates in SA patients from a German statutory health insurance (SHI) database who did versus did not receive PAP therapy. Methods Patients had continuous insurance coverage from 01 January 2008 to 31 December 2013, complete medical records and ≥1 SA-related diagnosis in 2009. Those receiving PAP were matched with a control group not treated with PAP. Outcomes (hospitalisations including stays in the sleep laboratory) were compared between groups the year prior to and the 4 years after SA diagnosis. Mortality was assessed in the 4 years after SA diagnosis. Results 2176 PAP therapy recipients were matched with 2176 controls. The PAP group had a higher rate of hospitalisation in the year before SA diagnosis than the control group (80.2% vs. 26.6%; p = 0.0016). A...
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Research Interests: Nonparametric Statistics, Medicine, Humans, Female, Male, and 14 moreBody Mass Index, Posture, Ambulatory, Polysomnography, Middle Aged, Body mass index (BMI), Oxygen, Ambulatory BP monitoring, Diagnostic Accuracy, Home Monitoring, Ambulatory Monitoring, Sleep Apnoea, Medical and Health Sciences, and supine position
Purpose Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been... more
Purpose Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been developed to increase the speed of diagnosis. However, most questionnaires such as the STOP-BANG questionnaire (SBQ) are limited due to low specificity. This study evaluated the value of SBQ to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. Methods This retrospective study included patients who completed the SBQ and underwent a night at the sleep lab or home sleep testing. The ODI was extracted from these sleep study reports. The combination of SBQ with ODI and their individual scores were compared with apnea–hypopnea index (AHI) in terms of their accuracy in diagnosing OSA. Sensitivity, specificity, and area under the curve (AUC) for different severities of OSA were calculated and compared. Results A...
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ZusammenfassungDie residuale Tagesschläfrigkeit tritt bei 12–65 % der Schlafapnoe-Patienten unter eingeleiteter Positivdrucktherapie („positive airway pressure“) auf. Eine häufige Ursache ist die geringe PAP-Nutzungszeit. Mögliche weitere... more
ZusammenfassungDie residuale Tagesschläfrigkeit tritt bei 12–65 % der Schlafapnoe-Patienten unter eingeleiteter Positivdrucktherapie („positive airway pressure“) auf. Eine häufige Ursache ist die geringe PAP-Nutzungszeit. Mögliche weitere Gründe sind ein hoher Rest-Apnoe-Hypopnoe-Index und eine vorhandene Komorbidität. Prädiktoren sind ein initial hoher Epworth-Schläfrigkeitsscore, jüngeres Alter und die erst kurze PAP-Nutzung. Gesichert wird die Restschläfrigkeit mittels objektiver Testverfahren (z. B. multipler Wachbleibetest oder Oxford Sleep Resistance Test [Osler-Test]). Eine der wesentlichen Ursachen für die residuale Schläfrigkeit nach Ausschluss konkurrierender Auslöser ist die stattgehabte intermittierende nächtliche Hypoxämie, die zu nervalen Zellschädigungen, zu hormonellen und genetischen Veränderungen und zu Änderungen des Mikrobioms führen kann.Die klinischen Beschwerden werden bestimmt durch eine ausgeprägte Tagesschläfrigkeit, depressive Verstimmung und eine Minderun...
Research Interests: Medicine and Gynecology
Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if... more
Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The contro...
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In this randomized, double-blind, placebo-controlled, two-period crossover study, the effect of the dual orexin receptor antagonist daridorexant was evaluated on nighttime respiratory function and sleep in 28 patients with mild and... more
In this randomized, double-blind, placebo-controlled, two-period crossover study, the effect of the dual orexin receptor antagonist daridorexant was evaluated on nighttime respiratory function and sleep in 28 patients with mild and moderate obstructive sleep apnea (OSA). In each period, 50 mg daridorexant or placebo was administered every evening for 5 days. The primary endpoint was apnea/hypopnea index (AHI) during total sleep time (TST) after the last dosing. Other endpoints included peripheral oxygen saturation (SpO2), sleep duration, latency to persistent sleep (LPS), wake after sleep onset (WASO), and sleep efficiency index (SEI). Pharmacokinetics, safety, and tolerability were also assessed. The mean treatment difference for AHI during TST (i.e. daridorexant − placebo) after the last dosing was 0.74 events/hour (90% confidence interval [CI]: –1.43, 2.92). The corresponding treatment difference for SpO2 during TST was 0.16% [90% CI: –0.21, 0.53]. Overall, there was no clinicall...
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Study Objectives Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large... more
Study Objectives Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical sample. Methods 1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates. Results Patients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to individuals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based ...
Research Interests: Cardiology, Medicine, Biological Sciences, Heart rate variability, Internal Medicine, and 10 moreObstructive sleep apnea, Frequency-domain analysis, Heart rate, Sleep, Wakefulness, Time Domain Analysis, Autonomic nervous activity, Nonlinear Dynamic Analysis, Psychology and Cognitive Sciences, and Medical and Health Sciences
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SummaryIn obstructive sleep apnea, patients’ sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime... more
SummaryIn obstructive sleep apnea, patients’ sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 209), moderate (n = 222) and severe (n = 272) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two‐step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two‐step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep‐states for power‐laws (exponent α) and exponential distributions (decay time τ) in dependency on obst...
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Sleep medicine has been an expanding discipline during the last few decades. The prevalence of sleep disorders is increasing, and sleep centers are expanding in hospitals and in the private care environment to meet the demands. Sleep... more
Sleep medicine has been an expanding discipline during the last few decades. The prevalence of sleep disorders is increasing, and sleep centers are expanding in hospitals and in the private care environment to meet the demands. Sleep medicine has evidence-based guidelines for the diagnosis and treatment of sleep disorders. However, the number of sleep centers and caregivers in this area is not sufficient. Many new methods for recording sleep and diagnosing sleep disorders have been developed. Many sleep disorders are chronic conditions and require continuous treatment and monitoring of therapy success. Cost-efficient technologies for the initial diagnosis and for follow-up monitoring of treatment are important. It is precisely here that telemedicine technologies can meet the demands of diagnosis and therapy follow-up studies. Wireless recording of sleep and related biosignals allows diagnostic tools and therapy follow-up to be widely and remotely available. Moreover, sleep research ...
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Research Interests: Cardiology, Medicine, Biological Sciences, Humans, Internal Medicine, and 15 moreObstructive sleep apnea, Female, Male, Anesthesia, Heart rate, Nocturnal, Polysomnography, Middle Aged, Apnea, Nop, Central Sleep Apnea, Continuous Positive Airway Pressure, Psychology and Cognitive Sciences, Medical and Health Sciences, and crossover study
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Research Interests: Algorithms, Medicine, Germany, Humans, Female, and 15 moreMale, Body Mass Index, Clinical Sciences, Adult, Odds ratio, Age Factors, Cross sectional Study, Cross Sectional Studies, Estradiol, Cohort Studies, Androstenedione, estrone, Epworth sleepiness scale, Paediatrics and reproductive medicine, and dehydroepiandrosterone sulfate
Research Interests: Cardiology, Medicine, Autonomic Nervous System, Heart rate variability, Humans, and 15 moreObstructive sleep apnea, Blood Pressure, Circadian Rhythm, Female, Male, Anesthesia, Heart rate, Heart, Clinical Sciences, Polysomnography, Aged, Middle Aged, Adult, Baroreflex, and Continuous Positive Airway Pressure
Research Interests: Arterial hypertension, Medicine, Electrocardiography, Autonomic Nervous System, Heart rate variability, and 15 moreHumans, Obstructive sleep apnea, Blood Pressure, Heart rate, Sleep, Electromyography, Risk factors, Respiration, Body Temperature, Haemodynamics, Analysis of Variance, Risk Factors, Detrended Fluctuation Analysis, Healthy Subjects, and Respiratory Mechanics
Research Interests: Psychology, Medicine, Humans, Europe, Obstructive sleep apnea, and 15 moreOtorhinolaryngology, Clinical Sciences, Polysomnography, Professional Practice, Questionnaires, Reimbursement, Certification, Obstructive sleep apnoea, Internationality, Head Public Health Service, Elsevier, Service Provider, HUMAN MEDICINE, Continuous Positive Airway Pressure, and Health Care Surveys
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Background There are studies about polysomnographic (PSG) characteristics of patients with either Obesity Hypoventilation Syndrome (OHS) or addiction. We aimed to investigate the PSG characteristics of OHS patients with opium addiction... more
Background There are studies about polysomnographic (PSG) characteristics of patients with either Obesity Hypoventilation Syndrome (OHS) or addiction. We aimed to investigate the PSG characteristics of OHS patients with opium addiction (OA) and those on methadone maintenance treatment (MMT) for treatment of addiction. Methods In this cross-sectional study, we enrolled 75 patients with OHS in Bamdad Respiratory and Sleep Research Center affiliated to Isfahan University of Medical Sciences between January 2020 and February 2021. The patients were categorized in three groups: OA, MMT, and non-addicts (NA). Demographic and PSG characteristics and obstructive sleep apnea screening questionnaires (Epworth Sleepiness scale, Berlin, and STOP-Bang) of patients were recorded and analyzed by SPSS v.24. Results A total of 75 OHS patients [54 men (72%) and 21 women (28%)] were studied in three groups of OA (30), MMT (15), and NA (30). Apnea hypopnea index (AHI) was not significantly different be...
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BACKGROUND We developed objective definitions of extreme phenotypes of obstructive sleep apnea (OSA) using a multivariate approach, and demonstrate their utility for identifying characteristics that confer predisposition towards or... more
BACKGROUND We developed objective definitions of extreme phenotypes of obstructive sleep apnea (OSA) using a multivariate approach, and demonstrate their utility for identifying characteristics that confer predisposition towards or protection against OSA in a new prospective sample. METHODS In a large international sample, we calculated race-specific liability scores from a weighted logistic regression including age, gender and body mass index (BMI). Extreme Cases were defined as individuals with an apnea-hypopnea index (AHI) ≥30 events/hour, but low likelihood of OSA based on age, gender and BMI (liability scores >90th percentile). Similarly, Extreme Controls were individuals with AHI<5, but high likelihood of OSA (liability scores <10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) and differences in photography-based craniofacial and intraoral phenotypes evaluated. RESULTS Retrospective data included 81,338 individuals. We identified 4,168 Extreme Cases and 1,432 Extreme Controls using liability scores. Extreme Cases were younger (43.1±14.7 years), overweight (28.6±6.8 kg/m2), and predominantly female (71.1%). Extreme Controls were older (53.8±14.1 years), obese (34.0±8.1 kg/m2), and predominantly male (65.8%). These objective definitions identified 29 Extreme Cases and 87 Extreme Controls among 1,424 SAGIC participants with photography-based phenotyping; comparisons suggest greater cervicomental angle increases risk for OSA in the absence of clinical risk factors and smaller facial widths are protective in the presence of clinical risk factors. CONCLUSIONS This objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic and physiological pathways to OSA.
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None Night-to-night variability (NNV) of the degree of obstructive sleep apnea (OSA) over the long term is not well investigated. In our case, we investigated the NNV of the apnea-hypopnea index (AHI) with regard to sleep structure.... more
None Night-to-night variability (NNV) of the degree of obstructive sleep apnea (OSA) over the long term is not well investigated. In our case, we investigated the NNV of the apnea-hypopnea index (AHI) with regard to sleep structure. Unattended polysomnography (PSG) at home was used to determine the AHI in the course of 4 weeks in a single patient with a mild-to-moderate OSA, by using the Somnocheck R&K system. The mean sleep period was 6.7 ± 1.1 hours and the mean AHI was 14.1 ± 5.7 events/h (range: 5.1-28.3 events/h; coefficient variability [CV] 40.4%). Independent of non-rapid eye movement and rapid eye movement (REM) sleep, the AHI in supine position (43.6 ± 16.9 events/h; CV 38.8%) was greater than during lateral-recumbent sleep (4.8 ± 4.1 events/h; CV 85.4%, P < .0001). A negative correlation was found for both: the AHI in supine position with the duration of supine position sleep (r = .59, P < .001), as well as the AHI in REM with the duration of REM sleep (r = -.37, P < .025). The AHI shows no rhythmicity neither from day to day nor from week to week. We found a high long-term NNV of the AHI, which was typically not influenced by the particular day of the week. Supine AHI is evidently dependent on the duration spent in that position throughout the night. We found it advisable to consider the existence of NNV in association with the degree of OSA, especially for patients with questionable therapeutic indication. Citation: Fietze I, Glos M, Zimmermann S, Penzel T. Long-term variability of the apnea-hypopnea index in a patient with mild to moderate obstructive sleep apnea. J Clin Sleep Med. 2020(16):XXX-XXX.
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Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive... more
Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. There were 234 (58.5%) males and 166 (41...
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Research Interests: Cardiology, Biotechnology, Hypoxia, Cell Biology, Medicine, and 15 moreCardiovascular Risk, Humans, COPD, Internal Medicine, Blood Pressure, Female, Male, Arterial stiffness, Aged, Middle Aged, Adult, Chronic obstructive pulmonary disease, Cardiovascular Diseases, Case Control Studies, and Cohort Studies
Research Interests: Medicine, Biological Sciences, Humans, Obstructive sleep apnea, Cerebral Cortex, and 15 moreFemale, Male, Anesthesia, Differential Diagnosis, Polysomnography, Middle Aged, Arousal, Oxygen, Adult, Apnea, Continuous Positive Airway Pressure, Airway resistance, Psychology and Cognitive Sciences, Multiple sleep latency test, and Medical and Health Sciences
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Background: Sleep-related breathing disorders may promote cardiovascular (CV) diseases. A novel and differentiated approach to overnight photoplethysmographic pulse wave analysis, which includes risk assessment and measurement of various... more
Background: Sleep-related breathing disorders may promote cardiovascular (CV) diseases. A novel and differentiated approach to overnight photoplethysmographic pulse wave analysis, which includes risk assessment and measurement of various pulse wave characteristics, has been evaluated in obstructive sleep apnea (OSA). Objectives: The purpose of this study was to assess if and which of the differentiated pulse wave characteristics might be influenced by OSA treatment with positive airway pressure (PAP). Methods: The study included two protocols. In the case-control study (group A), pulse wave-derived CV risk indices recorded during PAP therapy were compared with those obtained in age, body mass index, and CV risk class-matched patients with untreated OSA (n = 67/67). In the prospective PAP treatment study (group B), 17 unselected patients undergoing a full-night sleep test at baseline and after 23 ± 19 weeks of treatment were analyzed. Results: In untreated OSA patients (group A), the...
Research Interests: Hypoxia, Medicine, Humans, Internal Medicine, Obstructive sleep apnea, and 14 moreFemale, Male, Body Mass Index, Respiration, Polysomnography, Aged, Middle Aged, Cardiovascular Diseases, Sympathetic Nervous System, Cross Sectional Studies, Case Control Studies, Continuous Positive Airway Pressure, Cardiovascular medicine and haematology, and Pulse wave analysis
Noise is one of the factors that can seriously disturb sleep, and sound volume is an important factor in this context. One strategy involves avoiding exposure to sounds in the night, while entail the minimization of background noise in a... more
Noise is one of the factors that can seriously disturb sleep, and sound volume is an important factor in this context. One strategy involves avoiding exposure to sounds in the night, while entail the minimization of background noise in a bedroom. The goal of this study was to investigate the effect of systematic sound attenuation on nocturnal sleep by influencing sound volume and reverberation within the context of room acoustics. On this basis, we designed a randomized, controlled crossover trial investigating 24 healthy sleepers (15 men and 9 women, aged 24.9 ± 4.1 years) with a body mass index (BMI) of 21.9 ± 1.6 kg/m2. Each participant slept for three consecutive nights at three different locations: (a) at our sleep lab, (b) at the participant&amp;amp;#39;s home, and (c) at an acoustically isolated room. In addition to conduct of polysomnography (PSG), subjective sleep quality and nocturnal noise level were measured at each location. We likewise measured room temperature and relative humidity. Under conditions of equal sleep efficiency, a significant increase in deep sleep, by 16-34 min, was determined in an acoustically isolated room in comparison to the two other sleep locations. Fewer arousal events and an increase in rapid eye movement (REM) latency became evident in an acoustically isolated environment. Sleep in a domestic environment was subjectively better than sleep under the two test conditions. For healthy sleepers, room acoustics influence the microstructure of sleep, without subjective morning benefit. Reduction of noise level and of reverberation leads to an increase in the amount of deep sleep and to reduction of nocturnal arousal events, which is especially important for poor sleepers.
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The first German Charité Jet Lag Scale (CJS), based on the only validated English questionnaire, was introduced in a former study. In addition to providing further jet lag investigations, this second method-comparison study aims to... more
The first German Charité Jet Lag Scale (CJS), based on the only validated English questionnaire, was introduced in a former study. In addition to providing further jet lag investigations, this second method-comparison study aims to evaluate the CJS. Consistent interviewing methods are essential for future research in identifying possible cross-cultural tendencies, advancing jet lag definition, and establishing potential alleviation methods. Jet lag in 17 German chorus members (5 male, 12 female, mean age 42.35 ± 13.06 years) was monitored on their 2½-week trip from Germany to Argentina and back by use of actigraphy, sleep diaries, and the CJS. Cronbach's alpha, Pearson and Lin correlations, and Bland-Altman diagrams were applied to assess CJS reliability and validity between all measurement methods. CJS study analysis results reconfirmed the prevalence of jet lag at approximately 60%. Moreover, the study assessed high Cronbach's alpha values and significant positive correlat...
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ZusammenfassungFragestellung Die Beurteilung des Schlafes bei Patienten mit einem Obstruktiven Schlafapnoe-Syndrom (OSAS) orientiert sich an geschtzten Normwerten. Wie das Ausma eines OSAS den Schlaf beeinflusst, ist jedoch nicht... more
ZusammenfassungFragestellung Die Beurteilung des Schlafes bei Patienten mit einem Obstruktiven Schlafapnoe-Syndrom (OSAS) orientiert sich an geschtzten Normwerten. Wie das Ausma eines OSAS den Schlaf beeinflusst, ist jedoch nicht kalkulierbar, demzufolge auch nicht der Therapieeffekt. Ziel unserer studie ist die Analyse der Schlafstruktur vor und unter einer effektiven Therapie in Abhngigkeit vom Ausprgungsgrad der obstruktiven Schlafapnoe (OSA)Patienten und Methodik In die retrospektive Analyse
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Considering the effectiveness of craniofacial photographic analysis for diagnosis and management of obstructive sleep apnea-hypopnea syndrome (OSAHS) as well as ethnic differences in indexes measured by this method, this study designed to... more
Considering the effectiveness of craniofacial photographic analysis for diagnosis and management of obstructive sleep apnea-hypopnea syndrome (OSAHS) as well as ethnic differences in indexes measured by this method, this study designed to compare the surface facial dimensions, including nose width, intercanthal width and mandibular width of Iranian patients with mild, moderate and severe OSAHS. In this cross sectional study subjects with mild, moderate and severe OSAHS based on apnea-hypopnea index, were studied. To determine cephalometric measurements, face and neck digital photographs were taken from participants following a standardized procedure. Cephalometric measurements including face, intercanthal and mandibular widths were compared between studied groups. In this study, 100 participants enrolled. From which 20 (20.8%), 35 (36.45%) and 41 (42.7%) of them had mild, moderate and severe OSAHS, respectively. Mean of nose, intercanthal and mandibular width were significantly high...
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Obstructive sleep apnea (OSA) is a common but usually under-diagnosed sleep disorder. Objective diagnosis is based on polysomnography, which is an expensive test. We assessed the reliability and diagnostic accuracy of the Berlin... more
Obstructive sleep apnea (OSA) is a common but usually under-diagnosed sleep disorder. Objective diagnosis is based on polysomnography, which is an expensive test. We assessed the reliability and diagnostic accuracy of the Berlin questionnaire (BQ) in diagnosis of OSA in Iranian sleep clinic patients. A cross-sectional linguistic validation study was conducted on consecutive Iranian patients with Persian language attending one sleep clinic in Isfahan (Iran) were studied. Patients completed the Persian BQ (contains 10 questions in 3 categories), developed by forward-backward translation method. The patients underwent an overnight polysomnographic study at the clinic. Apneas/hypopnea index of >5/Hour was considered for diagnosis of OSA. One hundred and fifty seven patients (55.4% male, mean age = 52.3 ± 13.6 years) were evaluated. Sleep study confirmed OSA diagnosis in 91.7% of the studied patients. The reliability analysis of the BQ categories showed alpha Cronbach's as 0.70 an...
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Research Interests: Biomedical Engineering, Electroencephalography, Adolescent, Medicine, Humans, and 15 moreFemale, Male, Sleep, Electromyography, Medical Physiology, Actigraphy, Polysomnography, Aged, Middle Aged, Sleep Onset, Adult, Electrooculography, Electrical And Electronic Engineering, Sleep Stages, and slow wave sleep
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There are no published data regarding the prevalence of obstructive sleep apnea (OSA) in Iran. The purpose of this cross-sectional study was to identify individuals with a high likelihood to suffer from obstructive sleep apnea in the... more
There are no published data regarding the prevalence of obstructive sleep apnea (OSA) in Iran. The purpose of this cross-sectional study was to identify individuals with a high likelihood to suffer from obstructive sleep apnea in the Persian population. This was compared to similar studies in other countries. As a part of a population-based cross-sectional study, 3,600 randomly selected individuals aged 18 years or more, were invited to take part in the survey, 3,529 individuals (98%) agreed to fill out the Berlin sleep questionnaire. Based on the Berlin Criteria, 176 subjects (4.98%) were identified as suspicious for OSA. This group consisted of 74 (42%) males and 102 (58%) females. The prevalence of high-risk Berlin in men and women were not significantly different with chi-square test (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.2). But high-risk Berlin subjects also were increasing with age (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and increasing with obesity (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and decreasing with higher education (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) with chi-square test. Predictors of high risk for OSA-related symptoms were female sex, age more than 50 years, and body mass index. We identified persons with a high risk for OSA among a representative Iranian sample. It is concluded that the prevalence of sleep apnea syndrome symptoms is lower in our population as compared with western countries which can be attributed to the excessively young Iranian population.
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Research Interests: Respiratory Medicine, Medicine, Autonomic Nervous System, Heart rate variability, Humans, and 15 moreObstructive sleep apnea, Blood Pressure, Female, Male, Anesthesia, Heart rate, Body Mass Index, Clinical Sciences, Polysomnography, Middle Aged, Adult, Elsevier, Circadian Clocks, Case Control Studies, and Cardiovascular medicine and haematology
Research Interests: Medicinal Plants, Medicine, Insomnia, Phytotherapy, Humans, and 15 moreSleep Quality, Placebo, Female, Sleep disorders, Male, Sleep, Polysomnography, Middle Aged, Arousal, Sleep Onset, Adult, Rem Sleep, Sleep Stages, Pharmacology and pharmaceutical sciences, and Sleep initiation and maintenance disorders
Research Interests: Quality of life, Medicine, Germany, Humans, Female, and 6 moreMale, Young Adult, Sleep, Nursing Students, Shift Work, and Night
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To determine the short-term effects of non-invasive positive pressure ventilation (PPV) on spontaneous baroreflex sensitivity, we acquired time series of RR interval and beat-to-beat blood pressure in 55 healthy volunteers (mean age... more
To determine the short-term effects of non-invasive positive pressure ventilation (PPV) on spontaneous baroreflex sensitivity, we acquired time series of RR interval and beat-to-beat blood pressure in 55 healthy volunteers (mean age 46.5+/-10.5 years), who performed breathing tests on four occasions at frequencies of 12 and 15/min, with application of PPV of 5 mbar, and without positive pressure (control). Using spectral and transfer function analysis, we estimated RR interval variability (HRV) and systolic blood pressure variability (SBPV), as well as the gain (alpha-index) and phase shift (Phi) of the baroreceptor reflex for low- (LF) and high-frequency (HF) bands. Compared to control breathing, PPV at 12 and 15/min led to an increase in mean RR (p&amp;amp;amp;amp;amp;amp;lt;0.001) and blood pressure (p&amp;amp;amp;amp;amp;amp;lt;0.05). The alpha-index in the HF band increased significantly due to PPV for both respiratory frequencies (p&amp;amp;amp;amp;amp;amp;lt;0.05). Phase shifts did not show significant changes in response to pressure ventilation. These results indicate that short-term administration of PPV in normal subjects elicits significant enhancement in the HF index of baroreflex gain. These findings may contribute to understanding the mechanisms, indications, and effectiveness of positive pressure breathing strategies in treating cardiorespiratory and other disease conditions.
Research Interests: Algorithms, Biomedical Engineering, Medicine, Humans, Computer Simulation, and 15 moreBlood Pressure, Female, Male, Anesthesia, Heart rate, Middle Aged, Adult, Reflex, Reproducibility of Results, Baroreflex Sensitivity, Baroreflex, Respiratory Mechanics, Biomedizinische Technik, Cardiorespiratory Fitness, and Positive Pressure Ventilation
Sleep apnea is associated with increased risk of diabetes mellitus. However, no studies have compared sleep apnea symptoms in diabetic patients and their first degree relatives. The purpose of our study was to investigate high risk for... more
Sleep apnea is associated with increased risk of diabetes mellitus. However, no studies have compared sleep apnea symptoms in diabetic patients and their first degree relatives. The purpose of our study was to investigate high risk for sleep apnea syndrome, in diabetics and their first degree relatives for prevention of diabetes in family. As a part of a cohort study, all of diabetic and their first degree relatives who came for glucose control in diabetes clinic were invited to take part in the survey. Two thousand, four hundred and sixty-two individuals (82% of invited) agreed to fill out the Berlin and Epworth sleep questionnaire. Participants consisted of 2462 subjects of 15-70 years of age, both males and females with diabetes and family history of type 2 diabetes mellitus. A total of 1234 participants had diabetes and 11,231 were relatives of diabetic patients. High risk for sleep apnea regarding Berlin questionnaire and Epworth sleepiness scale, diabetic and relative were ana...
Research Interests: Preventive medicine, Medicine, Family history, Sleep Apnea, Internal Medicine, and 11 moreDiabetes mellitus, Obstructive sleep apnea, Pubmed, First Degree Relatives, Body Mass Index, Risk Factor, Preventive, Impaired Glucose Tolerance, ORIGINAL ARTICLE, Epworth sleepiness scale, and Medical and Health Sciences
The optimal approach to initiate positive-pressure therapy in patients with obstructive sleep apnea is still debated. Current options are autotitrating positive airway pressure (APAP) or manual titration with continuous positive airway... more
The optimal approach to initiate positive-pressure therapy in patients with obstructive sleep apnea is still debated. Current options are autotitrating positive airway pressure (APAP) or manual titration with continuous positive airway pressure (CPAP). Procedures differ by parameters and by algorithms used for adapting pressure. To evaluate the efficacy of attended automatic titration in a randomized crossover study compared with manual titration over 2 nights where the sequence of the titration mode was changed. Therapy outcome was controlled after 6 weeks. 21 sleep apnea patients were treated using manual CPAP versus automatic APAP titration. The mode used during the 2nd night was continued for 6 weeks. Cardiorespiratory polysomnography, Epworth Sleepiness Scale (ESS), SF-36 score and compliance were assessed. Apnea-hypopnea index reduction was equally effective at similar effective pressure independent of the titration mode. If APAP was applied during the 1st night, total sleep time was longer (384 vs. 331 min, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and sleep efficacy was higher (91 vs. 81%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) than after starting with manual titration with CPAP. Compliance was comparable in both groups (4.6 +/- 1.9 h). The ESS improved in both groups (from 12.9 to 6.5). SF-36 scores and therapeutic pressure did not much change. Taking the sequence of titration into account, we found equal effectiveness of CPAP and APAP. Sleep quality was better with initial application of APAP - which favors attended automatic titration if only 1 titration night is possible. Both modes are comparable after 6 weeks regarding therapeutic pressure, efficacy, compliance and quality of life.