Publications
181 results found
Wimms AJ, Kelly JL, Turnbull CD, et al., 2024, Mild obstructive sleep apnoea in females: post hoc analysis of the MERGE randomised controlled trial, ERJ Open Research, Vol: 10, ISSN: 2312-0541
BACKGROUND: A post hoc analysis of the MERGE trial was conducted, to investigate whether sex differences are evident at the mildest end of the disease spectrum, for symptoms associated with obstructive sleep apnoea (OSA) and the response to continuous positive airway pressure (CPAP) treatment. METHODS: MERGE participants with mild OSA (apnoea-hypopnoea index 5-15 events·h-1; American Academy of Sleep Medicine 2012 criteria) were randomised to either CPAP plus standard care (sleep hygiene counselling) or standard care alone for 3 months. Quality of life (QoL) was measured by questionnaires completed before and after the 3 months. This post hoc analysis of participants of the MERGE trial compared the symptom presentation, and response to CPAP, between the sexes. RESULTS: 233 patients were included; 71 (30%) were female. Females were more symptomatic at baseline in all QoL questionnaires. Specifically, females had lower 36-item Short-Form Health Survey (SF-36) Vitality scores (mean±sd 39.1±10.1 versus 44.8±10.3) and higher Epworth Sleepiness Scale (ESS) scores (mean±sd 11.0±4.2 versus 9.5±4.4). Both sexes experienced snoring, but more females reported fatigue and more males reported witnessed apnoeas. All symptoms improved with CPAP for both sexes; however, females had larger improvements in SF-36 Vitality scores, which was the primary outcome of the MERGE trial (mean change 9.4 (95% CI 6.8-12.0) versus 6.0 (95% CI 4.3-7.7); p=0.034), and ESS (mean change -4.1 (95% CI -5.1- -3.0) versus -2.5 (95% CI -3.1- -1.8); p=0.015), after adjustment for baseline scores and CPAP usage. CONCLUSIONS: Sex differences are apparent in patients with mild OSA. Females experience worse QoL symptoms than males at presentation to the sleep clinic; however, these improve significantly with CPAP treatment.
Kemp P, Bradshaw J, Pandya B, et al., 2023, The validity of Engagement and Feedback Assessments (EFAs): identifying students at risk of failing, BMC Medical Education, Vol: 23, ISSN: 1472-6920
Background:Imperial College School of Medicine, London UK, introduced a new curriculum in 2019, with a focus on the GMC outcomes for graduates, and pedagogy best practice. The new curriculum included formative assessments, named engagement and feedback assessments (EFAs), to support learning, and attainment in the summative examinations. The aims of this study were to assess the validity of EFAs and to determine whether they have utility as a modified form of programmatic assessment to inform decision-making regarding possible interventions by measuring and analysing attendance at and performance in these formative events.Methods:Seven hundred and sixty-one students were included in the study and assessment results were included for academic years 2019/20 to 2020/21. Forty-one data points per student, (27 in Year 1 and 14 in Year 2) were used, to compare EFA scores with the summativeperformance. Attendance was monitored through engagement with the EFAs.Results:Cohort 1 (enrolled 2019): In year 1, EFAs were associated with summative exam scores (overall r =0.63, p<0.001). Year 2, EFA scores were also associated with summative scores (overall r=0.57, p<0.001), including the clinical practical assessment (r=0.45, p<0.001).Missing two or more EFAs was associated with a significant increase in the likelihood of failing one or more summative examinations in the first year (OR: 7.97, 95% CI 2.65-34.39) and second year (OR: 3.20, 95% CI 1.74-5.95). Missing more than two EFAs in their first year was also associated with a higher risk of failing a summative examination in the second year (OR: 2.47, 95% CI 1.33-4.71). Students who increased their attendance between year 1 and 2 fared better in summative assessment than those who maintained38poor attendance, whereas those that reduced their attendance fared worse than those that maintained high attendance.Cohort 2 (enrolled 2020): Analysis of cohort 2 supported these findings and in this cohort missing two or more EFAs
Alqarni ASS, Turnbull CD, Morrell M, et al., 2023, The efficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnoea: a systematic review and meta-analysis, Thorax, Vol: 78, Pages: 1126-1134, ISSN: 0040-6376
Introduction: Vibrotactile positional therapy (PT) devices are a new treatment modality forpositional obstructive sleep apnoea (POSA). This review aimed to determine theeffectiveness of vibrotactile PT on the apnoea hypopnoea index (AHI) and the percentage oftime spent in the supine position (%Tsupine) in patients with POSA, compared to baseline.Secondary aims were to investigate the effect on daytime sleepiness, quality of life, and sleepquality.Methods: A systematic review and meta-analysis were performed of randomised controlledtrials (RCTs) and cohort studies that investigated the effect of vibrotactile PT in POSApatients. Searches were performed via MEDLINE, CENTRAL, and Embase up to October29, 2022.Results: 1119 studies were identified, 18 studies met the inclusion criteria (10 RCTs, 8cohort studies). The use of vibrotactile PT significantly reduced the AHI at follow-upcompared to baseline (mean difference (95% CI), -9.19 events/hr (-11.68, -6.70); p-value<0.00001). The mean %Tsupine was also significantly reduced (mean difference (95% CI), -32.79%, (-38.75, -26.83); p-value <0.00001). The percentage changes in the AHI and%Tsupine were 43% and 70%, respectively. Secondary outcomes were daytime sleepiness,quality of life and sleep indices. These showed minimal change, although follow-up wasshort.Conclusion: Vibrotactile PT devices are effective in treating POSA; reducing both AHI and%Tsupine. The effect on sleep quality, daytime sleepiness and disease-specific quality of lifewas minimal. However, there were limited data and follow-up was often brief, meaning thatfurther research is needed to determine the effect of vibrotactile PT on patient-centredoutcomes.
Donovan LM, Hoyos CM, Kimoff RJ, et al., 2023, Strategies to Assess the Effect of Continuous Positive Airway Pressure on Long-Term Clinically Important Outcomes among Patients with Symptomatic Obstructive Sleep Apnea An Official American Thoracic Society Workshop Report, ANNALS OF THE AMERICAN THORACIC SOCIETY, Vol: 20, Pages: 931-943, ISSN: 1546-3222
Alsaif SS, Kelly JL, Little S, et al., 2022, Virtual consultations for patients with Obstructive Sleep Apnoea: systematic review and meta-analysis, European Respiratory Review, Vol: 31, ISSN: 0905-9180
Background: The COVID-19 pandemic has accelerated the adoption of virtual care strategies for the management of patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome.Research question: What is the effectiveness of virtual consultations compared to in-person consultations for the management of Continuous Positive Airway Pressure therapy in adult patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome?Methods: A systematic review and meta-analysis (PROSPERO; CRD42022297532) based on six electronic databases plus manually selected journals was conducted in January 2022. Two researchers independently selected, quality appraised, and extracted data. The co-primary outcomes were patient-reported sleepiness, assessed by the Epworth Sleepiness Scale, and reported cost-effectiveness.Findings: 12 studies (n=1823 adults) were included in the review. Seven studies (n=1089) were included in the meta-analysis which showed no difference in the magnitude of improvement in patient-reported sleepiness scores between virtual and in-person consultations (MD [95%CI], -0.39 [-1.38 to 0.60]; p=0.4), though Epworth Sleepiness Scale scores improved in both groups. Virtual care strategies modestly increased Continuous Positive Airway Pressure therapy adherence and were found to be less costly than in-person care strategies in the three Spanish trials that reported cost-effectiveness. Conclusion: The findings of this review suggest that virtual care delivered by telephone or video consultations is as effective as in-person consultations for improving subjective sleepiness in patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome treated with Continuous Positive Airway Pressure. This clinical management strategy may also improve Continuous Positive Airway Pressure adherence without increasing the costs, supporting its potential as a follow-up management strategy, where patients prefer this approach.
Alsaif SS, Douglas W, Steier J, et al., 2022, MANDIBULAR MOVEMENT MONITOR FOR THE DIAGNOSIS OF OBSTRUCTIVE SLEEP APNOEA: CLINICAL APPLICATION, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A75-A75, ISSN: 0040-6376
Kelly JL, Wimms AJ, Turnbull CD, et al., 2022, Increasing adherence to CPAP in mild OSA using remote monitoring: the merge randomised controlled trial, Publisher: WILEY, ISSN: 0962-1105
Wimms A, Kelly J, Turnbull C, et al., 2022, THE EFFECT OF CPAP ON QUALITY OF LIFE IN FEMALES WITH MILD OSA: POST HOC ANALYSIS FROM THE MERGE RANDOMISED TRIAL, Publisher: OXFORD UNIV PRESS INC, Pages: A342-A342, ISSN: 0161-8105
Kelly JL, Ben Messaoud R, Joyeux-Faure M, et al., 2022, Diagnosis of sleep apnoea using a mandibular monitor and machine learning analysis: one-night agreement compared to in-home polysomnography, Frontiers in Neuroscience, Vol: 16, Pages: 1-10, ISSN: 1662-453X
Background: The capacity to diagnose obstructive sleep apnoea (OSA) must be expanded to meet an estimated disease burden of nearly one billion people worldwide. Validated alternatives to the gold standard polysomnography (PSG) will improve access to testing and treatment. This study aimed to evaluate the diagnosis of OSA, using measurements of mandibular movement (MM) combined with automated machine learning analysis, compared to in-home PSG.Methods: 40 suspected OSA patients underwent single overnight in-home sleep testing with PSG (Nox A1, ResMed, Australia) and simultaneous MM monitoring (Sunrise, Sunrise SA, Belgium). PSG recordings were manually analysed by two expert sleep centres (Grenoble and London); MM analysis was automated. The Obstructive Respiratory Disturbance Index calculated from the MM monitoring (MM-ORDI) was compared to the PSG (PSG-ORDI) using intraclass correlation coefficient and Bland-Altman analysis. Receiver operating characteristic curves (ROC) were constructed to optimise the diagnostic performance of the MM monitor at different PSG-ORDI thresholds (5, 15, and 30 events/hour).Results: 31 patients were included in the analysis (58% men; mean (SD) age: 48 (15) years; BMI: 30.4 (7.6) kg/m2). Good agreement was observed between MM-ORDI and PSG-ORDI (median bias 0.00; 95% CI −23.25 to + 9.73 events/hour). However, for 15 patients with no or mild OSA, MM monitoring overestimated disease severity (PSG-ORDI < 5: MM-ORDI mean overestimation + 5.58 (95% CI + 2.03 to + 7.46) events/hour; PSG-ORDI > 5–15: MM-ORDI overestimation + 3.70 (95% CI −0.53 to + 18.32) events/hour). In 16 patients with moderate-severe OSA (n = 9 with PSG-ORDI 15–30 events/h and n = 7 with a PSG-ORD > 30 events/h), there was an underestimation (PSG-ORDI > 15: MM-ORDI underestimation −8.70 (95% CI −28.46 to + 4.01) events/hour). ROC optimal cut-off values for PSG-ORDI thresholds of 5, 15, 30 events/hour were: 9.53, 12.65 and 24.81
Davies DJ, McLean PF, Kemp PR, et al., 2022, Assessment of factual recall and higher-order cognitive domains in an open-book medical school examination, Advances in Health Sciences Education, Vol: 27, Pages: 147-165, ISSN: 1382-4996
Open-book examinations (OBEs) will likely become increasingly important assessment tools. We investigated how access to open-book resources affected questions testing factual recall, which might be easy to look-up, versus questions testing higher-order cognitive domains. Few studies have investigated OBEs using modern Internet resources or as summative assessments. We compared performance on an examination conducted as a traditional closed-book exam (CBE) in 2019 (N = 320) and a remote OBE with free access to Internet resources in 2020 (N = 337) due to COVID-19. This summative, end-of-year assessment focused on basic science for second-year medical students. We categorized questions by Bloom’s taxonomy (‘Remember’, versus ‘Understand/Apply’). We predicted higher performance on the OBE, driven by higher performance on ‘Remember’ questions. We used an item-centric analysis by using performance per item over all examinees as the outcome variable in logistic regression, with terms ‘Open-Book, ‘Bloom Category’ and their interaction. Performance was higher on OBE questions than CBE questions (OR 2.2, 95% CI: 2.14–2.39), and higher on ‘Remember’ than ‘Understand/Apply’ questions (OR 1.13, 95% CI: 1.09–1.19). The difference in performance between ‘Remember’ and ‘Understand/Apply’ questions was greater in the OBE than the CBE (‘Open-Book’ * ‘Bloom Category’ interaction: OR 1.2, 95% CI: 1.19–1.37). Access to open-book resources had a greater effect on performance on factual recall questions than higher-order questions, though performance was higher in the OBE overall. OBE design must consider how searching for information affects performance, particularly on questions measuring different domains of knowledge.
Gnoni V, Ilic K, Drakatos P, et al., 2022, Obstructive sleep apnea and multiple facets of a neuroinflammatory response: a narrative review, Journal of Thoracic Disease, Vol: 14, Pages: 564-574, ISSN: 2072-1439
Background: Obstructive sleep apnea (OSA) is a chronic, highly prevalent, multi-system and sleep disorder, which may contribute to cognitive impairment and a variety of structural and neurophysiologic changes. The focus on OSA is warranted given its recognized links with major psychiatric and neurologic disorders, including Alzheimer’s disease. Some preliminary studies suggest a dual effect of the inflammatory response in OSA. Neuroinflammation may present with initial, potentially adaptive and homeostatic, and later, a more distinctly maladaptive, precipitating and perpetuating role.Objective: We here propose and argue in favour of the inflammatory process in the brain as a likely binding mechanism behind at least some effects that OSA may have on the brain and its function. Several OSA-triggered molecular and cellular events, that could lead to a neurodegenerative cascade, are similarly discussed.Methods: This perspective reviews the body of literature that investigates potential links between the inflammatory processes in the brain and the OSA. A special emphasis is placed on a potential role for neuroplastin, a novel transmembrane synaptic protein involved in the neuroplasticity and known to be differentially regulated in the OSA.Conclusions: The intricate interplay between neuroinflammation and other mechanistic correlates of OSA add to the evidence that neuroinflammation may be a key target for future therapeutic strategies in a number of comorbid disorders. The future studies will need to answer whether it is sleep fragmentation (SF) or intermittent hypoxia (IH) which may drive any such neuroinflammation.
Badger K, Morrice R, Buckeldee O, et al., 2022, "More than just a medical student”: a mixed methods exploration of a structured volunteering programme for undergraduate medical students, BMC Medical Education, Vol: 22, ISSN: 1472-6920
Background As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to illuminate the experiences of volunteers, mechanisms of learning and draw lessons for future emergencies and curriculum improvements. Methods Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This gathered nominal demographic information and qualitative data related to motivations, experiences, insights into learning, processual and contextual factors. Qualitative responses were coded, thematically organised, and categorised into an overarching framework. Mann-Whitney U tests determined whether volunteers’ overall rating of the experience varied according to demographic features and modulating factors. Spearman’s rank correlation assessed the relationship between aspects of induction and supervision, and overall volunteering rating. Follow up interviews were carried out with students to check back findings and co-create conclusions. Results Modulating factors identified through thematic analysis include altruistic motivation, engaged induction and supervision, feeling valued, having responsibility and freedom from the formal curriculum. Statistically significant positive correlations are identified between volunteers overall rating and being a year 1 or 2 student, ability to discuss role and ask questions during induction, being male, and having regular meetings and role support from supervisors. Qualitatively reported impacts include improved wellbeing, valuable contribution to service and transformative learning. Transformative learning effects included reframing of role within the multidisciplinary team, view of effective learning and view of themselves as competent clinicians. The number of weeks, number of shifts per week, and the role the volunteers performed
Alqurashi YD, Dawidziuk A, Alqarni A, et al., 2021, A visual analog scale for the assessment of mild sleepiness in patients with obstructive sleep apnea and healthy participants, ANNALS OF THORACIC MEDICINE, Vol: 16, Pages: 141-147, ISSN: 1817-1737
- Author Web Link
- Cite
- Citations: 3
Kelly J, Wimms A, Turnbull C, et al., 2020, The effect of CPAP on quality of life in patients with 'very' mild Obstructive Sleep Apnoea (OSA): Results from a subset of the MERGE Randomised Trial, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
- Author Web Link
- Cite
- Citations: 2
Rosenzweig I, Mitrecic D, Petanjek Z, et al., 2020, Does damage to hypothalamic paraventricular nucleus underlie symptoms of ultradian rhythm disorder and an increased anxiety in coronavirus disease 2019?, Croatian Medical Journal, Vol: 61, Pages: 377-380, ISSN: 0353-9504
Polsek D, Cash D, Veronese M, et al., 2020, The innate immune toll-like-receptor-2 modulates the depressogenic and anorexiolytic neuroinflammatory response in obstructive sleep apnoea, SCIENTIFIC REPORTS, Vol: 10, ISSN: 2045-2322
- Author Web Link
- Cite
- Citations: 5
Wimms AJ, Kelly JL, Turnbull CD, et al., 2020, Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial, The Lancet Respiratory Medicine, Vol: 8, Pages: 349-358, ISSN: 2213-2600
BACKGROUND: The evidence base for the treatment of mild obstructive sleep apnoea is limited and definitions of disease severity vary. The MERGE trial investigated the clinical effectiveness of continuous positive airway pressure in patients with mild obstructive sleep apnoea. METHODS: MERGE, a multicentre, parallel, randomised controlled trial enrolled patients (≥18 years to ≤80 years) with mild obstructive sleep apnoea (apnoea-hypopnoea index [AHI] ≥5 to ≤15 events per h using either AASM 2007 or AASM 2012 scoring criteria) from 11 UK sleep centres. Participants were assigned (1:1) to either 3 months of continuous positive airway pressure plus standard care (sleep counselling), or standard care alone, by computer-generated randomisation; neither participants nor researchers were blinded. The primary outcome was a change in the score on the Short Form-36 questionnaire vitality scale in the intention-to-treat population of patients with mild obstructive sleep apnoea diagnosed using the American Academy of Sleep Medicine 2012 scoring criteria. The study is registered with ClinicalTrials.gov, NCT02699463. FINDINGS: Between Nov 28, 2016 and Feb 12, 2019, 301 patients were recruited and randomised. 233 had mild obstructive sleep apnoea using AASM 2012 criteria and were included in the intention-to-treat analysis: 115 were allocated to receive continuous positive airway pressure and 118 to receive standard care. 209 (90%) of these participants completed the trial. The vitality score significantly increased with a treatment effect of a mean of 10·0 points (95% CI 7·2-12·8; p<0·0001) after 3 months of continuous positive airway pressure, compared with standard care alone (9·2 points [6·8 to 11·6] vs -0·8 points [-3·2 to 1·5]). Using the ANCOVA last-observation-carried-forward analysis, a more conservative estimate, the vitality score also significantly increased with a treatment effect of a
Nakamura T, Alqurashi Y, Morrell M, et al., 2020, Hearables: automatic overnight sleep monitoring with standardised in-ear EEG sensor, IEEE Transactions on Biomedical Engineering, Vol: 67, Pages: 203-212, ISSN: 0018-9294
Objective: Advances in sensor miniaturisation and computational power have served as enabling technologies for monitoring human physiological conditions in real-world scenarios. Sleep disruption may impact neural function, and can be a symptom of both physical and mental disorders. This study proposes wearable in-ear electroencephalography (ear- EEG) for overnight sleep monitoring as a 24/7 continuous and unobtrusive technology for sleep quality assessment in the community. Methods: Twenty-two healthy participants took part in overnight sleep monitoring with simultaneous ear-EEG and conventional full polysomnography (PSG) recordings. The ear- EEG data were analysed in the both structural complexity and spectral domains; the extracted features were used for automatic sleep stage prediction through supervised machine learning, whereby the PSG data were manually scored by a sleep clinician. Results: The agreement between automatic sleep stage prediction based on ear-EEG from a single in-ear sensor and the hypnogram based on the full PSG was 74.1% in the accuracy over five sleep stage classification; this is supported by a Substantial Agreement in the kappa metric (0.61). Conclusion: The in-ear sensor is both feasible for monitoring overnight sleep outside the sleep laboratory and mitigates technical difficulties associated with scalp-EEG. It therefore represents a 24/7 continuously wearable alternative to conventional cumbersome and expensive sleep monitoring. Significance: The ‘standardised’ one-size-fits-all viscoelastic in-ear sensor is a next generation solution to monitor sleep - this technology promises to be a viable method for readily wearable sleep monitoring in the community, a key to affordable healthcare and future eHealth.
Benjafield AV, Ayas NT, Eastwood PR, et al., 2019, Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis, The Lancet Respiratory Medicine, Vol: 7, Pages: 687-698, ISSN: 2213-2600
BackgroundThere is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea.MethodsWe searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30–69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries).FindingsReliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903–970) adults aged 30–69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399–450) adults aged 30–69 years have moderate to s
Alqurashi YD, Nakamura T, Goverdovsky V, et al., 2018, A novel in-ear sensor to determine sleep latency during the Multiple Sleep Latency Test in healthy adults with and without sleep restriction, Nature and Science of Sleep, Vol: 10, Pages: 385-396, ISSN: 1179-1608
Objectives: Detecting sleep latency during the Multiple Sleep Latency Test (MSLT) using electroencephalogram (scalp-EEG) is time-consuming. The aim of this study was to evaluate the efficacy of a novel in-ear sensor (in-ear EEG) to detect the sleep latency, compared to scalp-EEG, during MSLT in healthy adults, with and without sleep restriction.Methods: We recruited 25 healthy adults (28.5±5.3 years) who participated in two MSLTs with simultaneous recording of scalp and in-ear EEG. Each test followed a randomly assigned sleep restriction (≤5 hours sleep) or usual night sleep (≥7 hours sleep). Reaction time and Stroop test were used to assess the functional impact of the sleep restriction. The EEGs were scored blind to the mode of measurement and study conditions, using American Academy of Sleep Medicine 2012 criteria. The Agreement between the scalp and in-ear EEG was assessed using Bland-Altman analysis.Results: Technically acceptable data were obtained from 23 adults during 69 out of 92 naps in the sleep restriction condition and 25 adults during 85 out of 100 naps in the usual night sleep. Meaningful sleep restrictions were confirmed by an increase in the reaction time (mean ± SD: 238±30 ms vs 228±27 ms; P=0.045). In the sleep restriction condition, the in-ear EEG exhibited a sensitivity of 0.93 and specificity of 0.80 for detecting sleep latency, with a substantial agreement (κ=0.71), whereas after the usual night’s sleep, the in-ear EEG exhibited a sensitivity of 0.91 and specificity of 0.89, again with a substantial agreement (κ=0.79).Conclusion: The in-ear sensor was able to detect reduced sleep latency following sleep restriction, which was sufficient to impair both the reaction time and cognitive function. Substantial agreement was observed between the scalp and in-ear EEG when measuring sleep latency. This new in-ear EEG technology is shown to have a significant value as a convenient measure for sleep lat
Morrell MJ, 2018, Controlling for Obesity in OSA: Results from Dynamic MR Imaging., Am J Respir Crit Care Med
Patel S, Kon S, Nolan C, et al., 2018, The Epworth sleepiness scale: minimum clinically important difference in obstructive sleep apnea, American Journal of Respiratory and Critical Care Medicine, Vol: 197, Pages: 961-961, ISSN: 1073-449X
Brill A-K, Pickersgill R, Moghal M, et al., 2018, Mask pressure effects on the nasal bridge during short-term noninvasive ventilation, ERJ Open Research, Vol: 4, ISSN: 2312-0541
The aim of this study was to assess the influence of different masks, ventilator settings and body positions on the pressure exerted on the nasal bridge by the mask and subjective comfort during noninvasive ventilation (NIV). We measured the pressure over the nasal bridge in 20 healthy participants receiving NIV via four different NIV masks (three oronasal masks, one nasal mask) at three different ventilator settings and in the seated or supine position. Objective pressure measurements were obtained with an I-Scan pressure-mapping system. Subjective comfort of the mask fit was assessed with a visual analogue scale. The masks exerted mean pressures between 47.6±29 mmHg and 91.9±42.4 mmHg on the nasal bridge. In the supine position, the pressure was lower in all masks (57.1±31.9 mmHg supine, 63.9±37.3 mmHg seated; p<0.001). With oronasal masks, a change of inspiratory positive airway pressure (IPAP) did not influence the objective pressure over the nasal bridge. Subjective discomfort was associated with higher IPAP and positively correlated with the pressure on the skin. Objective measurement of pressure on the skin during mask fitting might be helpful for mask selection. Mask fitting in the supine position should be considered in the clinical routine.
Polsek D, Gildeh N, Cash D, et al., 2018, Obstructive sleep apnoea and Alzheimer's disease: in search of shared pathomechanisms, Neuroscience and Biobehavioral Reviews, Vol: 86, Pages: 142-149, ISSN: 0149-7634
Alzheimer’s disease (AD) is a significant public health concern. The incidence continues to rise, and it is set to be over one million in the UK by 2025. The processes involved in the pathogenesis of AD have been shown to overlap with those found in cognitive decline in patients with Obstructive Sleep Apnoea (OSA). Currently, the standard treatment for OSA is Continuous Positive Airway Pressure. Adherence to treatment can, however, be an issue, especially in patients with dementia. Also, not all patients respond adequately, necessitating the use of additional treatments. Based on the body of data, we here suggest that excessive and prolonged neuronal activity might contribute to genesis and acceleration of both AD and OSA in the absence of appropriately structured sleep. Further, we argue that external factors, including systemic inflammation and obesity, are likely to interfere with immunological processes of the brain, and further promote disease progression. If this hypothesis is proven in future studies, it could have far-reaching clinical translational implications, as well as implications for future treatment strategies in OSA.
Malhotra A, Morrell MJ, Eastwood PR, 2018, Update in respiratory sleep disorders: Epilogue to a modern review series, RESPIROLOGY, Vol: 23, Pages: 16-17, ISSN: 1323-7799
- Author Web Link
- Cite
- Citations: 4
Patrick Y, Lee A, Raha O, et al., 2017, EFFECTS OF SLEEP DEPRIVATION ON COGNITIVE AND PHYSICAL PERFORMANCE IN UNIVERSITY STUDENTS, Publisher: ELSEVIER SCIENCE BV, Pages: E182-E183, ISSN: 1389-9457
Bucks RS, Olaithe M, Rosenzweig I, et al., 2017, Reviewing the relationship between OSA and cognition: Where do we go from here?, RESPIROLOGY, Vol: 22, Pages: 1253-1261, ISSN: 1323-7799
- Author Web Link
- Cite
- Citations: 77
Goverdovsky V, von Rosenberg W, Nakamura T, et al., 2017, Hearables: multimodal physiological in-ear sensing, Scientific Reports, Vol: 7, ISSN: 2045-2322
Future health systems require the means to assess and track the neural and physiological function of a user over long periods of time, and in the community. Human body responses are manifested through multiple, interacting modalities – the mechanical, electrical and chemical; yet, current physiological monitors (e.g. actigraphy, heart rate) largely lack in cross-modal ability, are inconvenient and/or stigmatizing. We address these challenges through an inconspicuous earpiece, which benefits from the relatively stable position of the ear canal with respect to vital organs. Equipped with miniature multimodal sensors, it robustly measures the brain, cardiac and respiratory functions. Comprehensive experiments validate each modality within the proposed earpiece, while its potential in wearable health monitoring is illustrated through case studies spanning these three functions. We further demonstrate how combining data from multiple sensors within such an integrated wearable device improves both the accuracy of measurements and the ability to deal with artifacts in real-world scenarios.
Nakamura T, adjei T, alqurashi Y, et al., 2017, Complexity science for sleep stage classification from EEG, IEEE International Joint Conference on Neural Networks (IJCNN) 2017, Publisher: IEEE, Pages: 4387-4394, ISSN: 2161-4407
Automatic sleep stage classification is an importantparadigm in computational intelligence and promises consider-able advantages to the health care. Most current automatedmethods require the multiple electroencephalogram (EEG) chan-nels and typically cannot distinguish the S1 sleep stage fromEEG. The aim of this study is to revisit automatic sleep stageclassification from EEGs using complexity science methods. Theproposed method applies fuzzy entropy and permutation entropyas kernels of multi-scale entropy analysis. To account for sleeptransition, the preceding and following 30 seconds of epoch datawere used for analysis as well as the current epoch. Combiningthe entropy and spectral edge frequency features extracted fromone EEG channel, a multi-class support vector machine (SVM)was able to classify 93.8% of 5 sleep stages for the SleepEDFdatabase [expanded], with the sensitivity of S1 stage was 49.1%.Also, the Kappa’s coefficient yielded 0.90, which indicates almostperfect agreement.
Nakamura T, Goverdovsky V, Morrell M, et al., 2017, Automatic sleep monitoring using ear-EEG, IEEE Journal of Translational Engineering in Health and Medicine, Vol: 5, ISSN: 2168-2372
The monitoring of sleep patterns without patient’s inconvenience or involvement of a medical specialist is a clinical question of significant importance. To this end, we propose an automatic sleep stage monitoring system based on an affordable, unobtrusive, discreet, and long-term wearable in-ear sensor for recording the Electroencephalogram (ear-EEG). The selected features for sleep pattern classification from a single ear-EEG channel include the spectral edge frequency (SEF) and multiscale fuzzy entropy (MSFE), a structural complexity feature. In this preliminary study, the manually scored hypnograms from simultaneous scalp-EEG and ear-EEG recordings of four subjects are used as labels for two analysis scenarios: 1) classification of ear-EEG hypnogram labels from ear-EEG recordings and 2) prediction of scalp-EEG hypnogram labels from ear-EEG recordings. We consider both 2-class and 4-class sleep scoring, with the achieved accuracies ranging from 78.5% to 95.2% for ear-EEG labels predicted from ear-EEG, and 76.8% to 91.8% for scalp-EEG labels predicted from ear-EEG. The corresponding Kappa coefficients range from 0.64 to 0.83 for Scenario 1, and indicate Substantial to Almost Perfect Agreement, while for Scenario 2 the range of 0.65 to 0.80 indicates Substantial Agreement, thus further supporting the feasibility of in-ear sensing for sleep monitoring in the community.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.