Marie Bruyneel

Sleep efficiency during sleep studies: results of a prospective study comparing home‐based and in‐hospital polysomnography

To date, the clinical use of unattended home‐based polysomnography (PSG) is not recommended. To assess whether sleep efficiency is better at home, we have performed a prospective, crossover, single‐blind study comparing unattended home‐ versus attended in‐hospital PSG in a population referred for high clinical suspicion of obstructive sleep apnoea syndrome (OSA). Within 2 weeks, all the patients underwent both PSG performed by the same sleep technician, which were analysed by another blinded technician. Payments for each procedure were also calculated. Sixty‐six patients (mean age: 49 ± 13 years; mean body mass index: 30 ± 7; mean Epworth Sleepiness Scale: 10 ± 5) were included. The quality of recordings was poor in 1.5% of the attended PSG versus 4.7% for unattended PSG (P = 0.36). Sleep efficiency at home was better (82% versus 75%, P < 0.001), and sleep duration longer (412 min versus 365 min, P < 0.001). Sleep latency was also shorter at home (28 min versus 45 min, P = 0.004), and patients spent more time in rapid eye movement sleep (19% versus 16%, P = 0.006). Apnoea–hypopnoea index (23 versus 26, P = 0.08) was similar at home and in the sleep lab. Sixty‐seven per cent of patients preferred home‐based PSG. PSG payment was also lower at home (268 Euros versus 1057 Euros). We conclude that home‐based PSG is associated with a better sleep efficiency. It also appears as feasible and reliable in patients with high preclinical suspicion for OSA. It is also more comfortable for the patients whose sleep efficiency is better and allows cost saving related to the absence of hospitalization.

Real-time attended home-polysomnography with telematic data transmission

PURPOSE Home-polysomnography (HPSG) has been proposed as a cost-effective alternative for obstructive sleep apnea (OSA) diagnosis. We assessed, in a feasibility study, whether telematic transmission using the Dream® and Sleepbox® technologies was associated with low HPSG failure rate. METHODS Patients referred by chest physicians for clinical suspicion of OSA underwent one HPSG, using Dream® and Sleepbox® (Medatec, Belgium), which is a wireless system able to communicate with Dream®, and with Internet through a wi-fi/3G interface. It is equipped with a digital infrared camera, and with a speaker/microphone system for bidirectional audio/video communication via Skype®. The Sleep Lab nurse performed a remote discontinuous monitoring of the PSG. In case of sensor loss, she called the patient who had been previously educated to replace the sensors. RESULTS Twenty-one patients have been studied. 90% of the recordings were of excellent quality. We observed a 10% PSG failure rate: one failure of the Dream®, and one recording of poor quality. There were 2 successful Skype® interventions resulting in readjustment of the defective probes (nasal cannula and EEG). PSG signal visualization was possible in 90% of cases but Skype® connection was problematic in 19% of cases. However, patients could be reached by phone to solve the problem. CONCLUSIONS Real-time attended HPSG through telematic data transmission is feasible and could be an interesting perspective to decrease the failure rate of home sleep studies, even if some technical aspects need to be improved.

Detection of bed-exit events using a new wireless bed monitoring assistance

OBJECTIVES To assess, using complete polysomnography as the gold standard, the capability of Heasys(®), an innovative wireless bed monitoring assistance to record body movements and presence and to infer bed-exit events and body position changes at night. DESIGN Descriptive study. SETTINGS Sleep laboratory for patients recording and home for healthy volunteers. PARTICIPANTS Twelve patients referred for suspicion or treatment of sleep disordered breathing and 5 healthy subjects. MEASUREMENTS Complete polysomnography was recorded during one night in patients and during two nights in healthy volunteers. Heasys(®) sheet was placed under the fitted bed sheet to allow concomitant recording. During the second night, healthy subjects were asked to get out of bed at least 2 times for a minimal duration of 3 min. RESULTS Heasys(®) allowed the detection of all bed-exit events in patients and volunteers (sensitivity: 100%, and specificity: 85%). When bed-exit events were defined by the lack of the presence signal combined with absence of motion and a dip in temperature, sensitivity and specificity of Heasys(®) were 92 and 100%, respectively. In patients and volunteers, Heasys(®) detected body position changes recorded by polysomnography respectively, in 84 and 98% of the cases. Additional recorded motions were mainly related to leg movements or arousals. CONCLUSION In this small feasibility study, Heasys(®) seemed to be an effective innovative device allowing bed-exit events detection in adult patients and healthy volunteers.

Chronic Obstructive Pulmonary Disease: CT Quantification of Airway Dimensions, Numbers of Airways to Measure, and Effect of Bronchodilation.

PURPOSE To determine the effect of bronchodilation on airway indexes reflecting airway disease in patients with chronic obstructive pulmonary disease (COPD) and to determine the minimum number of segmental and subsegmental airways required. MATERIALS AND METHODS This study was approved by the local ethical committee, and written informed consent was obtained from all subjects. Twenty patients with COPD who had undergone pre- and postbronchodilator pulmonary function tests and computed tomographic (CT) examinations were prospectively included. Eight healthy volunteers underwent two CT examinations. Luminal area and wall thickness (WT) of third- and fourth-generation airways were measured twice by three readers. The percentage of total airway area occupied by the wall and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of pathologic status, session, reader, bronchodilation, and CT examination were assessed by using mixed linear model analyses. The number of airways to measure for a definite percentage error of √WAPi10 was computed by using a bootstrap method. RESULTS There were no significant session, reader, or bronchodilation effects on WT in third-generation airways and √WAPi10 in patients with COPD (P values ranging from .187 to >.999). WT in third-generation airways and √WAPi10 were significantly different in patients with COPD and control subjects (P = .018 and <.001, respectively). Measuring 12 third- or fourth-generation airways ensured a maximal 10% error of √WAPi10. CONCLUSION WT in third-generation airways and √WAPi10 are not significantly different before and after bronchodilation and are different in patients with COPD and control subjects. Twelve is the minimum number of third- or fourth-generation airways required to ensure a maximal 10% error of √WAPi10. (©) RSNA, 2015 Clinical trial registration no. NCT01142531 Online supplemental material is available for this article.

Sleep disturbances in menopausal women: Aetiology and practical aspects

Sleep deteriorates with age. The menopause is often a turning point for womens sleep, as complaints of insomnia increase significantly thereafter. Insomnia can occur as a secondary disorder to hot flashes, mood disorders, medical conditions, psychosocial factors, underlying intrinsic sleep disorders, such as obstructive sleep apnoea (OSA) or restless legs syndrome (RLS), or it can be a primary disorder. Since unrecognized OSA can have dramatic health-related consequences, menopausal women complaining of persisting sleep disturbances suggesting primary insomnia or intrinsic sleep disorders should be referred to a sleep specialist for a comprehensive sleep assessment. Patients suffering from primary insomnia will be preferentially treated with non-benzodiazepine hypnotics or melatonin, or with cognitive behavioural therapy. Insomnia related to vasomotor symptoms can be improved with hormone replacement therapy. Gabapentin and isoflavones have also shown efficacy in small series but their precise role has yet to be established. In patients suffering from OSA, non-pharmacological therapy will be applied: continuous positive airway pressure or an oral appliance, according to the severity of the disorder. In the case of RLS, triggering factors must be avoided; dopaminergic agonists are the first-line treatment for moderate to severe disease. In conclusion, persisting sleep complaints should be addressed in menopausal women, in order to correctly diagnose the specific causal disorder and to prescribe treatments that have been shown to improve sleep quality, quality of life and long-term health status.

Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study

BACKGROUND Unattended home-based polysomnography (H-PSG) is a reliable tool for the diagnosis of obstructive sleep apnoea (OSA). The quality of the recording can be influenced by several factors including the set-up location - at home versus in the sleep laboratory. Previous studies have suggested that the failure rate is higher when H-PSG is fitted in hospital. The aim of this study was to determine the influence of hook-up location on H-PSG recording quality. Feasibility and repeatability of H-PSG were also assessed. METHODS Consecutive patients suspected of OSA were selected. Each patient underwent two H-PSGs within two weeks, one fitted at home and one fitted in the sleep laboratory. The order of H-PSG was randomly assigned. RESULTS Among the 102 included patients, 95 completed the study. Ninety-three per cent of the 190 H-PSGs were satisfactory. The failure rate of H-PSG was similar for both the home set-up and the sleep laboratory set-up (p = 0.33). Seventy-nine per cent of patients opted to be fitted at home. OSA was diagnosed in 59%. The apnoea-hypopnoea index was similar for home and sleep laboratory set-up, resulting in a very good reproducibility (intraclass correlation coefficient of 0.85). No differences in total sleep time and sleep architecture were observed in both set-up protocols. Except for sleep duration, which was longer in the first H-PSG test, we did not observe any first-night effect during the first H-PSG. CONCLUSION The present study demonstrates that hospital hook-up is as effective as home hook-up for home-unattended polysomnography, and that feasibility and repeatability of H-PSG are very good.

Improvement of sleep architecture parameters in cirrhotic patients with recurrent hepatic encephalopathy with the use of rifaximin.

Background and aim Sleep disorders are frequently reported in patients with cirrhosis and hepatic encephalopathy (HE). This study assessed the effect of rifaximin on sleep architecture parameters in patients with recurrent HE. Patients and methods This sequential, prospective, and exploratory study involved all patients with cirrhosis and recurrent HE admitted between June 2014 and September 2015. HE was assessed according to the West-Haven Classification. Patients underwent 24-h polysomnography (PSG) and 7-day actigraphy. Rapid eye movement (REM) sleep was considered to be an indicator of good sleep quality. Patients completed questionnaires assessing the quality of sleep and sleepiness. After a 28-day course of rifaximin, the same assessment was repeated. Results Fifteen patients were included (nine men, mean age: 57±11 years). Child–Pugh scores ranged from B7 to C15. Before rifaximin, the mean HE score was 2.7±0.7. Data from PSG analysis indicated long total sleep time (TST): 571±288 min, and limited REM sleep: 2.5% TST (0–19). Seven-day actigraphy showed an impaired number of steps: 1690/24 h (176–6945). Questionnaires indicated that patients experienced impaired sleep quality and excessive daytime sleepiness. After rifaximin, HE scores decreased to 1.7±0.6 (P<0.001). REM sleep increased to 8.5% TST (0–25) (P=0.003). No changes were observed for TST, number of steps, and on questionnaires. Conclusion Patients with recurrent HE suffer from poor sleep quality and excessive daytime sleepiness. On 24-h PSG, rifaximin improves objective sleep architecture parameters with no changes in the subjective quality of sleep and sleepiness.

EXTRAPULMONARY SMALL CELL CARCINOMA FOLLOWING AUGMENTATION ENTEROCYSTOPLASTY

Abstract Tumours developing after urinary tract or bladder reconstruction with intestinal tissue have well been described. Adenocarcinomas and transitional cell carcinomas are the most frequent histological features. We report here a case of small cell carcinoma developing after augmentation enterocystoplasty. This rare observation is an opportunity to review the literature about extrapulmonary small cell carcinoma and tumours developing after uro-intestinal reconstruction surgery.

Relationship between the sensation of activity limitation and the results of functional assessment in asthma patients

ABSTRACT Objective: In asthma patients, the assessment of activity limitation is based on questions evaluating how limited the patient feels in their activities. However, the lack of functional data complicates the interpretation of the answers. We aimed to evaluate the intensity of relationships between the patients perception of activity limitation and the results of several functional tests. Methods: Twenty patients complaining of asthma exacerbation were invited to complete three scores (Chronic Respiratory Disease questionnaire, Asthma Control Questionnaire, Hospital Anxiety and Depression scale). They also underwent lung function measurements, a 6-minute walk test and a cardio-pulmonary exercise test. In addition, physical activity was studied by actigraphy. Spearmans rank correlation coefficients between the patients perception of activity limitation and each of the other parameters were analysed. Results: Five parameters were significantly correlated with the perception of activity limitation: ACQ question 4, related to dyspnea (rs 0.74, p < 0.001); Emotion domain of the Chronic Respiratory Disease questionnaire (rs −0.57, p = 0.02); HAD anxiety (rs 0.48, p = 0.032); HAD depression (rs 0.46, p = 0.041); ACQ question 6, related to reliever use (rs 0.46, p = 0.046). No parameters from the lung function test, 6MWT, CPET or actigraphy, were significantly correlated with the perception of activity limitation. Conclusions: In response to questions about limitation of activity, patients do not specifically answer mentioning physical limitation but rather the psychological burden associated with this constraint.

Reliability of commercially available sleep and activity trackers with manual switch-to-sleep mode activation in free-living healthy individuals

INTRODUCTION Wearable health devices have become trendy among consumers, but it is not known whether they accurately measure sleep and physical activity parameters. To address this question, we have studied the measured data of two consumer-level activity monitors (Up Move Jawbone® (U) and Withings Pulse 02® (W)) and compared it with reference methods for sleep and activity recordings, namely the Bodymedia SenseWear Pro Armband® actigraph (SWA) and home-polysomnography (H-PSG). METHODS Twenty healthy patients were assessed at home, during sleep, with the four devices. An additional 24-h period of recording was then planned during which they wore the 2 trackers and the SWA. Physical activity and sleep parameters obtained with the 4 devices were analyzed. RESULTS Significant correlations with H-PSG were obtained for total sleep time (TST) for all the devices: r=0.48 for W (p=0.04), r=0.63 for U (p=0.002), r=0.7 for SWA (p=0.0003). The best coefficient was obtained with SWA. Significant correlations were also obtained for time in bed (TIB) for U and SWA vs PSG (r=0.79 and r=0.76, p<0.0001 for both) but not for W (r=0.45, p=0.07). No significant correlations were obtained for deep sleep, light sleep, and sleep efficiency (SE) measurements with W, U and SWA. Sleep latency (SL) correlated with H-PSG only when measured against SWA (r=0.5, p=0.02). Physical activity assessment revealed significant correlations for U and W with SWA for step count (both r=0.95 and p<0.0001) and active energy expenditure (EE) (r=0.65 and 0.54; p=0.0006 and p<0.0001). Total EE was also correctly estimated (r=0.75 and 0.52; p<0.0001 and p=0.001). CONCLUSION Sleep and activity monitors are only able to produce a limited set of reliable measurements, such as TST, step count, and active EE, with a preference for U which performs globally better. Despite the manual activation to sleep mode, U and W were not suitable for giving correct data such as sleep architecture, SE, and SL. In the future, to enhance accuracy of such monitors, researchers and providers have to collaborate to write algorithms based reliably on sleep physiology. It could avoid misleading the consumer.