Large Body Movements on Video-Polysomnography are Associated with Daytime Dysfunction in Children with Restless Sleep Disorder

Restless sleep disorder (RSD) is a newly defined sleep related movement disorder characterized by large muscle movements (LMM) in sleep. We examined the sleep study, clinical characteristics, and daytime functioning in children with RSD and compared them to children with Periodic Limb Movement Disorder (PLMD) or Restless Legs Syndrome (RLS). Video polysomnography from 47 children with restless sleep was retrospectively reviewed for LMM and age- and sex- matched to 34 children with PLMD and 12 children with RLS. Data examined included PSG characteristics, ferritin, Pediatric Quality of Life (PedsQL), and Epworth Sleepiness Scores (ESS). Fourteen children met the clinical criteria for RSD with a LMM index of 5 or more per hour of sleep . Mean ESS was elevated in RSD patients compared to either the PLMD or RLS groups though the result did not reach statistical significance (RSD = 10.20 ± 6.81, PLMD = 6.19 ± 4.14, RLS = 6.25 ± 4.90). The PedsQL score was significantly decreased in the RLS group compared to RSD and was reduced overall in all three groups (PedsQL Total RSD= 70.76 ± 18.05, PLMD = 57.05 ± 20.33, RLS = 53.24 ± 16.97). Serum ferritin values were similar in all three groups (RSD= 26.89 ± 10.29, PLMD = 33.91 ± 20.31, RLS = 23.69 ± 12.94 ng/mL, P= NS). Children with RSD demonstrate increased daytime sleepiness compared to PLMD or RLS and all three disease groups decreased quality of life. Further studies are needed to examine long term consequences of RSD.

The Sleep Benefit in Episodic Memory: An Integrative Review and a Meta-Analysis

People recall more information after sleep than after an equally long period of wakefulness. This sleep benefit in episodic memory has been documented in almost a century of research. However, an integrative review of hypothesized underlying processes, a comprehensive quantification of the benefit, and a systematic investigation of potential moderators has been missing so far. Here, we address these issues by analyzing 823 effect sizes from 271 independent samples that were reported in 177 articles published between 1967 and 2019. Using multilevel meta-regressions with robust variance estimates, we found a moderate overall sleep benefit in episodic memory (g = 0.44). Moderator analyses revealed four important findings: First, the sleep benefit is larger when stimuli are studied multiple times instead of just once. Second, for word materials, the effect size depends on the retrieval procedure: It is largest in free recall, followed by cued recall and recognition tasks. Third, the sleep benefit is stronger in pre-post difference measures of retention than in delayed memory tests. Fourth, sleep benefits are larger for natural sleep and nighttime naps than foralternative sleep-study designs (e.g., SWS-deprived sleep, daytime naps). Although there was no obvious evidence for selective reporting, it is a potential threat to the validity of the results. When accounting for selective reporting bias, the overall effect of sleep on episodic memory is reduced but still significant (g = 0.28). We argue that our results support an integrative, multi-causal theoretical account of sleep-induced episodic memory benefits and provide guidance to increase their replicability.

Prevalence and impact of visual aura in migraine and probable migraine: a population study

Visual aura (VA) presents in 98% of cases of migraine with aura. However, data on its prevalence and impact in individuals with migraine and probable migraine (PM) are limited. Data from the nation-wide, population-based Circannual Change in Headache and Sleep Study were collected. Participants with VA rating scale scores ≥ 3 were classified as having VA. Of 3,030 participants, 170 (5.6%) and 337 (11.1%) had migraine and PM, respectively; VA prevalence did not differ between these cohorts (29.4% [50/170] vs. 24.3% [82/337], p = 0.219). Participants with migraine with VA had a higher headache frequency per month (4.0 [2.0–10.0] vs. 2.0 [1.0–4.8], p = 0.014) and more severe cutaneous allodynia (12-item Allodynia Symptom Checklist score; 3.0 [1.0–8.0] vs. 2.0 [0.0–4.8], p = 0.046) than those without VA. Participants with PM with VA had a higher headache frequency per month (2.0 [2.0–8.0] vs. 2.0 [0.6–4.0], p = 0.001), greater disability (Migraine Disability Assessment score; 10.0 [5.0–26.3] vs. 5.0 [2.0–12.0], p < 0.001), and more severe cutaneous allodynia (12-item Allodynia Symptom Checklist score, 2.5 [0.0–6.0] vs. 0.0 [0.0–3.0], p < 0.001) than those without VA. VA prevalence was similar between migraine and PM. Some symptoms were more severe in the presence of VA.

Independent Role of Nasal Congestion in Positive Airway Pressure Compliance for OSA Treatment

Objective To determine the independent role of nasal congestion in positive airway pressure (PAP) therapy compliance and factors associated with an unfavorable shift of PAP compliance. Study Design Prospective cohort study. Setting Tertiary care center. Methods This follow-up study comprised 174 patients with newly diagnosed obstructive sleep apnea (OSA) who accepted PAP therapy from January 2017 to June 2019. Information was collected on basic demographics, comorbidities, sleep-related symptoms, nasal symptoms, and upper airway assessment. PAP adherence data were collected at the end of the first week and the third month. Results After 3 months of follow-up, 147 participants were included for final data analysis. The proportion of nasal congestion (29.2% vs 52.0%, P = .005) and its severity (mean rank, 58.5 vs 75.1; P = .007) were significantly higher in the noncompliance group as compared with the compliance group. After adjustment for basic demographics, comorbidities, sleep-related symptoms or sleep study parameters, and Friedman clinical staging, multinomial logistic regression models showed that nasal congestion (all odds ratios >2.0, P < .05) was independently associated with a higher odds of PAP noncompliance. Patients with an unfavorable shift of PAP compliance were younger (mean ± SD, 47.5 ± 10.6 vs 53.1 ± 12.6 years; P = .021) and had a lower body mass index (27.2 ± 3.7 vs 29.3 ± 5.0, P = .027) than those who consistently complied. OSA severity was associated with PAP compliance, initially and in the long term. Conclusion Nasal congestion is an independent predictor of PAP noncompliance. Younger patients with lower BMI were more likely to have an unfavorable shift of PAP compliance. Initial and long-term adherence to PAP therapy was affected by OSA severity.

Rest-Activity Rhythm Patterns and Physical Functional Performance in Community-Dwelling Older Men

Sleep and activity patterns have been linked to physical performance in older adults. Traditional parametric models of 24-hour activity rhythms fail to adequately capture specific diurnal sleep and wake patterns; functional principal components analysis (fPCA) is a non-parametric approach that addresses this limitation. Using fPCA, we modeled accelerometry data from n = 2,960 participants in the Osteoporotic Fractures in Men (MrOS) ancillary sleep study (mean age 77y) and examined cross-sectional associations with gait speed and grip strength measurements. Lower daytime activity (expected difference = -0.049 [-0.072, -0.028] m/s), increased sleep duration and a reduced midday dip in activity (-0.015 [-0.035, 0.006] m/s) were modestly associated with worsening gait speed. A modest association between both later sleep and wake times and increased sleep duration with worsening grip strength outcomes was observed (-1.11 [-1.90, -0.32] kg). Specific daily activity patterns may serve as predictive biomarkers for changing physical function in aging populations.

A Noninferiority Analysis of 3- vs 2-Incision Techniques for Hypoglossal Nerve Stimulator Implantation

Objective The only hypoglossal nerve stimulation (HNS) device available for US clinical use is implanted through 3 incisions. A recently proposed 2-incision modification moved the respiratory sensing lead from the fifth to the second intercostal space to eliminate the third lower chest incision. This study compared perioperative data and therapeutic outcomes between the techniques. Study Design Noninferiority cohort analysis of a retrospective and prospective registry study. Setting Tertiary care and community surgical centers. Methods Patients with obstructive sleep apnea underwent HNS implantation via a modified 2-incision technique (I2). A cohort previously implanted via the standard 3-incision technique (I3) were 1:1 propensity score matched for a noninferiority analysis of postoperative outcomes. Results There were 404 I3 patients and 223 I2 patients across 6 participating centers. Operative time decreased from 128.7 minutes (95% CI, 124.5-132.9) in I3 patients to 86.6 minutes (95% CI, 83.7-97.6) in I2 patients ( P < .001). Postoperative sleep study data were available for 76 I2 patients who were matched to I3 patients. The change in apnea-hypopnea index between the cohorts was statistically noninferior (a priori noninferiority margin: 7.5 events/h; mean difference, 1.51 [97.5% CI upper bound, 5.86]). There were no significant differences between the cohorts for baseline characteristics, perioperative adverse event rates, or change in Epworth Sleepiness Score ( P > .05). Conclusion In a multicenter registry, a 2-incision implant technique for a commercially available HNS device had a statistically noninferior therapeutic efficacy profile when compared with the standard 3-incision approach. The 2-incision technique is safe and effective for HNS implantation.

A direct comparison of wrist actigraphy and sleep diaries in measuring sleep in healthy adults.

Measuring sleep and sleep quality is an important diagnostic and monitoring tool, and a number of different methods for measurement have been developed over the last half-century. Two prevalent methods include wrist actigraphy and sleep diaries. Both methods can be applied in different circumstances, but both have strengths and weaknesses. This study aimed to identify the extent to which there is congruence in the scores achieved by each method of sleep measurement. Sixty-eight respondents were asked to wear a wrist actigraphy and complete a sleep diary over the course of five days. There was a significant difference between the mean scores achieved using each measurement method, with actigraphy scores indicating lower total sleep time (TST) than diaries. However, this difference was not consistently present when the scores were compared on a day by day basis. Participant adherence is likely to fluctuate over the course of a sleep study and may undermine the accuracy of sleep diaries.