Abstract 19496: Sleep Quality Change After Catheter Ablation in Paroxysmal Atrial Fibrillation and R

Authors:
Woohyeun Kim, Jin Oh Na

Reference:
American Heart Assn. Circulation. 2017;136:A19496

Objectives:
Sleep instability is highly prevalent in patients with cardiovascular disease (CVD) and evidence supports a causal association of sleep instability with CVD. We investigate the impact of radio-frequency catheter ablation (RFCA) on sleep instability in patients with paroxysmal atrial fibrillation (pAF) and the effect of sleep stability on recurrence of AF.

Conclusions:
Sleep quality was improved after RFCA in patients with pAF. Furthermore, the recurrence rate was significantly lower after RFCA in patient who had pre-RFCA sleep instability(LFC≥50.3%). These results suggest that RFCA can influence sleep quality and sleep quality assessment by analyzing routine 24-hr Holter study can be a predictable marker of recurrence after RFCA in patients with pAF.

Practical Significance:
This retrospective observational study was performed in pAF patients who underwent RFCA between October 2007 and January 2017. Of the total 445 patients, 24-hr Holter study was performed in 218 patients before and 6 months after RFCA. Sleep stability was assessed by 24-hr Holter study using cardiopulmonary coupling (CPC) analysis. We compared CPC parameter (high-frequency coupling[HFC], low-frequency coupling[LFC], very low-frequency coupling[VLFC], narrow-band, broad-band) before and after RFCA.

Sleep stability was significantly improved six-month after RFCA. HFC (marker of stable sleep) and VLFC (REM/wakefulness marker) was increased (29.84% to 36.15%, p<0.001, 26.20% to 28.76%, p=0.002, respectively) while LFC, unstable sleep marker, was decreased (41.25% to 32.13%, p<0.001) after RFCA. In the patients with pre-RFCA LFC<50.3%, the recurrence rate was higher than patients with pre-RFCA LFC≥50.3%. After adjusting for baseline characteristics (including age, CHA2DS2-VASC score, LAVI, creatinine, etc.), pre-RFCA LFC<50.3% remained a significant predictor of recurrence of AF (HR 8.24 (1.88-36.06), p=0.005) during 46.4 months of median follow-up.

View Publication:

 

Assessment of sleep quality using cardiopulmonary coupling analysis in patients with Parkinson’s dis

Authors:
Chen L, Liu C, Ye Z, Wang B, He S.

Reference:
Brain Behav.2018;8:e00970.

Objectives:
To assess the sleep quality of patients with Parkinson's disease (PD) and evaluate the effect of cardiopulmonary coupling (CPC) analysis on sleep quality and its correlation with subjective complaints in patients with PD.

Conclusions:
The sleep quality of patients with PD was generally decreased. CPC analysis can reflect the subjective sleep quality of patients with PD and serve as an effective sleep monitoring tool.

Practical Significance:
High‐frequency coupling (HFC) and sleep efficiency were significantly lower in the PD than in the control group, whereas very low‐frequency coupling (VLFC) and sleep latency were significantly higher in the PD than in the control group. PSQI scores were significantly higher in the PD than in the control group (all p < .05). The PSQI score showed a negative correlation with the HFC ratio in the PD group (r = −.478, p = .001). Factors related to the occurrence of PD with poor sleep quality were the unified Parkinson's disease rating scale (UPDRS) score and nocturia.

View Publication:

 

ECG-based cardiopulmonary coupling for sleep stability assessment in patients with amyotrophic lateral sclerosis [abstract]

Authors:
8. S. Mariani, P. Congiu, G. Milioli, G. Gioi, G. Borghero, F. Marrosu, R.J. Thomas, A.L. Goldberger, M. Puligheddu

Reference:
Mov Disord. 2016; 31 (suppl 2)

Objectives:
The goal of this preliminary study is to introduce the technique of CardioPulmonary Coupling (CPC) to visualize and quantify the sleep spectrograms of Amyotrophic Lateral Sclerosis (ALS) patients with different ages and pathology severity and estimate the percentage of stable sleep and unstable sleep during the night.

Conclusions:
Further studies are warranted to see if CPC provides a useful way to analyze sleep stability in ALS and if this method provides insights into autonomic dysfunction and overall prognosis. References: [1] Thomas, R. J., …, & Goldberger, A. L., (2005). An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep. Sleep, 28(9), 1151-1161. [2] Thomas, R. J., …, & Goldberger, A. L. (2014). Relationship between delta power and the electrocardiogram-derived cardiopulmonary spectrogram: possible implications for assessing the effectiveness of sleep.

Practical Significance:
ALS is a progressive neurodegenerative disease. Sleep quality and fragmentation in ALS patients have not yet been extensively studied. Electrocardiogram (ECG)-based (CPC) provides a graphical and computational method to represent the behavior of dynamical interactions between the cardio-autonomics and respiration during sleep. Introduced by Thomas, Goldberger and colleagues [1], CPC combines spectral information derived from inter-beat interval (RR) time series and an ECG-derived respiratory signal (EDR). The method reveals two distinct modes of cardiopulmonary interaction during non-REM sleep: one in the low frequency band [0.01 Hz-0.1 Hz] and the other in the high frequency band [0.1 Hz-0.4 Hz]. Prior studies have shown that former reflects unstable (more arousable) sleep, while the latter reflects stable (deeper) sleep.

We applied this method to ECG data from a cohort of 13 ALS patients (4 F, 9 M, age 46-79, mean 62.3 yrs) recorded at the Sleep Disorders Center of Cagliari. The patients underwent a full PSG exam, including a continuous ECG. The patient’s level of self-sufficiency was measured by means of the ALS functional rating scale (ALS-FRS), where 0=worst and 48=best.

Subjects with the most advanced pathology had the most unstable sleep patterns, with %HFC<4%. Mean reported values for healthy controls of similar age range are 56% [2], 50% and 48%.

View Publication:

 

Enhancement of sleep stability with Tai Chi exercise in chronic heart failure: preliminary findings using an ECG-based spectrogram method.

Authors:
Yeh GY, Mietus JE, Peng CK, Phillips RS, Davis RB, Wayne PM, Goldberger AL, Thomas RJ.

Reference:
Sleep Med. 2008 Jul;9(5):527-36. Epub 2007 Aug 3.

Objectives:
To assess the effects of a 12-week Tai Chi exercise program on sleep using the sleep spectrogram, a method based on a single channel electrocardiogram (ECG)-derived estimation of cardiopulmonary coupling, previously shown to identify stable and unstable sleep states.

Conclusions:
At 12 weeks, those who participated in Tai Chi showed a significant increase in HFC and significant reduction in LFC, compared to patients in the control group. Correlations were seen between improved sleep stability and better disease-specific quality of life.

Practical Significance:
Tai Chi exercise may enhance sleep stability in patients with chronic heart failure. This sleep effect may have a beneficial impact on blood pressure, arrhythmogenesis and quality of life.

View Publication:

 

Incidence of Sleep Disturbance and Evaluation of Sleep Quality in Patients Diagnosed with Cancer

Authors:
Visco D, Niesley M, Hughes A, Lewis M

Reference:
Clin Res Pulmonol 2015; 3(1): 1030

Objectives:
Sleep disorders affect 10-15% of the US population, which has significant implications for quality of life. Oncology patients often experience more prominent detrimental effects of sleep deprivation. Fatigue is one of the most debilitating symptoms, and occurs in 75% of patients with cancer.

Conclusions:
 The results of this study emphasize the importance of utilizing both subjective and objective assessments for sleep analysis. Assessing sleep with only one of these tools would not provide an accurate account of sleep disturbance. The ability to assess overall sleep quality, as well as low and high frequency coupling has proven valuable in determining further diagnostic testing or evaluations. The contradictions found between subjective, self-reported data and the objective data obtained through the SleepImage® device suggest other factors may contribute to patients feeling sleep deprived or well rested.

Practical Significance:
Eastern Regional Medical Center implemented a process by which subjective and objective sleep screening assessment is standard practice for all patients new to the center. Patients were provided both a combined sleep questionnaire and an at-home sleep screen device. This device links the physiology of autonomic, respiratory, and mathematically captures electro cortical activity collectively referred to as cardiopulmonary coupling.

This retrospective review encompassed a total 1,207 new patients seen between March 2013 and April 2014. They were stratified into three populations having completed: subjective questionnaires, objective screening, and both measures. For the 242 patients who completed the subjective questionnaire, 65% were considered to have a likelihood of sleep disturbance, and 68% of patients reported feeling tired/fatigued/sleepy during the day. The objective screening notes 71% of patients had poor sleep quality. Interestingly for both measures, patients who had poor scores subjectively actually outperformed their counterparts on the objective sleep assessment. 

View Publication:

 

On-Call Duty Effects on Sleep-State Physiological Stability in Male Medical Interns

Authors:
Yu-Hsuan Lin, Yen-Cheng Ho, Sheng-Hsuan Lin, Yao-Hsien Yeh, Chia-Yih Liu, Terry B. J. Kuo, Cheryl C. H. Yang, Albert C. Yang

Reference:
PLoS One. 2013 Jun 4;8(6):e65072.

Objectives:
To investigate sleep stability decreased in medical interns during on-call duty.

Conclusions:
The medical interns had significantly reduced stable sleep, and displayed increased latency to the first epoch of stable sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights.

Practical Significance:
The medical interns had significantly reduced stable sleep, and displayed increased latency to the first epoch of stable sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights.

View Publication:

 

Sleep abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a review

Authors:
Jackson, M.L., Bruck, D.

Reference:
J Clin Sleep Med 2012;8(6):719-728.

Objectives:
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a medically unexplained disabling illness, with prevalence estimates of between 0.007% and 2.8% of the general adult population. It is primarily characterized by persistent relapsing fatigue of at least 6 months in duration that reduces activity levels. Other key features of the disorder include post-exertion malaise of either physical or mental exertion, memory and concentration difficulties, muscle pain, headaches, tender lymph nodes, sore throat, and non-restorative sleep. Of direct relevance to the current review, patients often report daytime sleepiness, feeling unrefreshed upon waking despite sufficient or extended total sleep time, extended sleep including daytime napping, and other sleep-related symptoms, such as difficulty falling asleep and disturbed sleep. Since the late 1980s, research in the area of CFS/ME has begun to focus on examining and determining the cause of non-restorative sleep and sleep disturbance in CFS/ME, and how these symptoms may relate or contribute to patients' daytime fatigue. The current review aims to provide a comprehensive overview of these studies, describe where the field currently stands on this issue, and outline potential directions for future research.

Conclusions:
CFS/ME is a complex and severely debilitating condition. Non-restorative sleep, reduced sleep quality, and extended periods of sleep are commonly reported, however the basis of these symptoms are unclear. The heterogeneities associated with this disorder make it challenging for researchers to study and make cross-study comparisons difficult. While there is little evidence of sleep architecture differences between CFS/ME and healthy individuals, many patients subjectively report sleep disturbance and unrefreshed sleep, highlighting a potential disconnect between objective and subjective measures of sleep. There is preliminary evidence that alteration in sleep stage transitions and sleep instability, and other physiological mechanisms such as heart rate variability and altered cortisol profiles, may be implicated in the sleep difficulties of this population. Further research is required to investigate the cause of non-restorative sleep and fatigue in CFS/ME, which may aid understanding of this symptom in other medical conditions.

Practical Significance:
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a chronic, disabling illness that affects approximately 0.2% of the population. Non-restorative sleep despite sufficient or extended total sleep time is one of the major clinical diagnostic criteria; however, the underlying cause of this symptom is unknown. This review aims to provide a comprehensive overview of the literature examining sleep in CFS/ME and the issues surrounding the current research findings. Polysomnographic and other objective measures of sleep have observed few differences in sleep parameters between CFS/ME patients and healthy controls, although some discrepancies do exist. This lack of significant objective differences contrasts with the common subjective complaints of disturbed and unrefreshed sleep by CFS/ME patients. The emergence of new, more sensitive techniques that examine the microstructure of sleep are showing promise for detecting differences in sleep between patients and healthy individuals. There is preliminary evidence that alterations in sleep stage transitions and sleep instability, and other physiological mechanisms, such as heart rate variability and altered cortisol profiles, may be evident.

Future research investigating the etiology of non-restorative sleep in CFS/ME may also help us to undercover the causes of non-restorative sleep and fatigue in other medical conditions.

View Publication:

 

Sleep Quality among Female Hospital Staff Nurses

Authors:
Chien PL, Su HF, Hsieh PC, Siao RY, Ling PY, Jou HJ.

Reference:
Sleep Disord. 2013; 2013: 283490.

Objectives:
To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures.

Conclusions:
Among the staff nurses, 75.8% (117) had a PSQI score of ≥5 and 39.8% had an inadequate stable sleep ratio.

Practical Significance:
Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses.

View Publication:

 

The Sleep Quality Recovery of a Snorer's Bed Partner

Authors:
Schramm PJ, Neville AN, Baker D

Reference:
Respiratory Therapy Vol. 5 No. 3 June-July 2010 pg. 39

Objectives:
To demonstrate, through the use of CPC technology, the negative impact of snoring and Obstructive Sleep Apnea (OSA) and the response to PAP initiation the bed partner’s sleep quality.

Conclusions:
Both the snorer and his bed partner’s sleep quality improved significantly with the application of PAP therapy.

Practical Significance:
Proof to a reticent CPAP user of the benefit of CPAP compliance to their bed partner as well as themselves

View Publication: