Publications
181 results found
Ayas NT, Drager LF, Morrell MJ, et al., 2017, Update in Sleep-disordered Breathing 2016, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 195, Pages: 1561-1566, ISSN: 1073-449X
Rosenzweig I, Morrell MJ, 2017, Hypotrophy versus Hypertrophy: It's Not Black or White with Gray Matter, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 195, Pages: 1416-1418, ISSN: 1073-449X
Khazaie H, Veronese M, Noori K, et al., 2017, Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI, NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS, Vol: 77, Pages: 219-231, ISSN: 0149-7634
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- Citations: 93
Brill A-K, Moghal M, Morrell MJ, et al., 2017, Randomized crossover trial of a pressure sensing visual feedback system to improve mask fitting in noninvasive ventilation., Respirology, Vol: 22, Pages: 1343-1349
BACKGROUND AND OBJECTIVE: A good mask fit, avoiding air leaks and pressure effects on the skin are key elements for a successful noninvasive ventilation (NIV). However, delivering practical training for NIV is challenging, and it takes time to build experience and competency. This study investigated whether a pressure sensing system with real-time visual feedback improved mask fitting. METHODS: During an NIV training session, 30 healthcare professionals (14 trained in mask fitting and 16 untrained) performed two mask fittings on the same healthy volunteer in a randomized order: one using standard mask-fitting procedures and one with additional visual feedback on mask pressure on the nasal bridge. Participants were required to achieve a mask fit with low mask pressure and minimal air leak (<10 L/min). Pressure exerted on the nasal bridge, perceived comfort of mask fit and staff- confidence were measured. RESULTS: Compared with standard mask fitting, a lower pressure was exerted on the nasal bridge using the feedback system (71.1 ± 17.6 mm Hg vs 63.2 ± 14.6 mm Hg, P < 0.001). Both untrained and trained healthcare professionals were able to reduce the pressure on the nasal bridge (74.5 ± 21.2 mm Hg vs 66.1 ± 17.4 mm Hg, P = 0.023 and 67 ± 12.1 mm Hg vs 60 ± 10.6 mm Hg, P = 0.002, respectively) using the feedback system and self-rated confidence increased in the untrained group. CONCLUSION: Real-time visual feedback using pressure sensing technology supported healthcare professionals during mask-fitting training, resulted in a lower pressure on the skin and better mask fit for the volunteer, with increased staff confidence.
Patrick Y, Lee A, Raha O, et al., 2017, Effects of sleep deprivation on cognitive and physical performance in university students, Sleep and Biological Rhythms, Vol: 15, Pages: 217-225, ISSN: 1446-9235
Sleep deprivation is common among university students, and has been associated with poor academic performance and physical dysfunction. However, current literature has a narrow focus in regard to domains tested, this study aimed to investigate the effects of a night of sleep deprivation on cognitive and physical performance in students. A randomized controlled crossover study was carried out with 64 participants [58% male (n = 37); 22 ± 4 years old (mean ± SD)]. Participants were randomized into two conditions: normal sleep or one night sleep deprivation. Sleep deprivation was monitored using an online time-stamped questionnaire at 45 min intervals, completed in the participants’ homes. The outcomes were cognitive: working memory (Simon game© derivative), executive function (Stroop test); and physical: reaction time (ruler drop testing), lung function (spirometry), rate of perceived exertion, heart rate, and blood pressure during submaximal cardiopulmonary exercise testing. Data were analysed using paired two-tailed T tests and MANOVA. Reaction time and systolic blood pressure post-exercise were significantly increased following sleep deprivation (mean ± SD change: reaction time: 0.15 ± 0.04 s, p = 0.003; systolic BP: 6 ± 17 mmHg, p = 0.012). No significant differences were found in other variables. Reaction time and vascular response to exercise were significantly affected by sleep deprivation in university students, whilst other cognitive and cardiopulmonary measures showed no significant changes. These findings indicate that acute sleep deprivation can have an impact on physical but not cognitive ability in young healthy university students. Further research is needed to identify mechanisms of change and the impact of longer term sleep deprivation in this population.
Atalla A, Carlisle TW, Simonds AK, et al., 2017, Sleepiness and activity in heart failure patients with reduced ejection fraction and central sleep-disordered breathing, SLEEP MEDICINE, Vol: 34, Pages: 217-223, ISSN: 1389-9457
Carlisle T, Ward NR, Atalla A, et al., 2017, Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure, Physiological Reports, Vol: 5, ISSN: 2051-817X
The increased prevalence of obstructive sleep apnea (OSA) in congestive heart failure (CHF) may be associated with rostral fluid shift. We investigated the effect of overnight rostral fluid shift on pharyngeal collapsibility (Pcrit), pharyngeal caliber (APmean), and apnea‐hypopnea index (AHI) in CHF patients. Twenty‐three optimally treated systolic CHF patients were studied. Neck circumference was measured immediately prior to sleep in the evening and immediately after waking in the morning as a marker of rostral fluid shift. Pcrit was measured during sleep, early and late in the night. APmean was measured using acoustic reflection at the same times as neck circumference measurements. 15/23 CHF patients experienced an overnight increase in neck circumference; overall neck circumference significantly increased overnight (mean±SD, evening: 41.7 ± 3.2 cm; morning: 42.3 ± 3.1 cm; P = 0.03). Pcrit increased significantly overnight (early‐night: −3.8 ± 3.3 cmH2O; late‐night: −2.6 ± 3.0 cmH2O; P = 0.03) and APmean decreased (evening: 4.2 ± 1.3 cm2; morning: 3.7 ± 1.3 cm2; P = 0.006). The total AHI correlated with neck circumference (r = 0.4; P = 0.04) and Pcrit (r = 0.5; P = 0.01). APmean correlated with neck circumference (r = −0.47; P = 0.02). There was no significant change in AHI between the first and second half of the night (first‐half: 12.9 ± 12.4/h; second‐half: 13.7 ± 13.3/h; P = 0.6). Overnight rostral fluid shift was associated with increased pharyngeal collapsibility and decreased pharyngeal caliber during sleep in CHF patients. Rostral fluid shift may be an important mechanism of OSA in this patient group.
Alqurashi Y, Moss J, Nakamura T, et al., 2017, The Efficacy Of In-Ear Electroencephalography (eeg) To Monitor Sleep Latency And The Impact Of Sleep Deprivation, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Eastwood PR, Morrell MJ, Malhotra A, 2016, Update in respiratory sleep disorders: Prologue to a modern review series, RESPIROLOGY, Vol: 22, Pages: 17-18, ISSN: 1323-7799
Looney D, Goverdovsky V, Rosenzweig I, et al., 2016, A Wearable In-Ear Encephalography Sensor for Monitoring Sleep: Preliminary Observations from Nap Studies, Annals of the American Thoracic Society, Vol: 13, Pages: 2229-2233, ISSN: 2329-6933
RATIONALE: To date the only quantifiable measure of neural changes that define sleep is electroencephalography (EEG). Although widely used for clinical testing, scalp-electrode EEG is costly and poorly tolerated by sleeping patients. OBJECTIVES: This is a pilot study to assess the agreement between EEG recordings obtained from a new ear-EEG sensor and those obtained simultaneously from standard scalp electrodes. METHODS: Participants were 4 healthy men, ages 25 to 36 years. During naps, EEG tracings were recorded simultaneously from the ear sensor and standard scalp electrodes. A clinical expert, blinded to the data collection, analyzed 30-second epochs of recordings from both devices using standardized criteria. The agreement between scalp- and ear-recordings was assessed. MEASUREMENTS AND MAIN RESULTS: We scored 360 epochs (scalp-EEG and ear-EEG) of which 254 (70.6%) were scored as non-rapid-eye movement (NREM) sleep using scalp-EEG. The ear-EEG sensor had a sensitivity of 0.88 (95% CI 0.82 to 0.92) and specificity of 0.78 (95% CI 0.70 to 0.84) in detecting N2/N3 sleep. The kappa coefficient, between the scalp- and ear-EEG, was 0.65 (95% CI 0.58 to 0.73). As a sleep monitor (all NREM sleep stages versus wake), the in-ear sensor had a sensitivity of 0.91 (95% CI 0.87 to 0.94) and specificity of 0.66 (95% CI 0.56 to 0.75). The kappa coefficient was 0.60 (95% CI 0.50 to 0.69). CONCLUSIONS: Substantial agreement was observed between recordings derived from a new ear-EEG sensor and conventional scalp electrodes on 4 healthy volunteers during daytime naps.
Emamian F, Khazaie H, Tahmasian M, et al., 2016, The Association Between Obstructive Sleep Apnea and Alzheimer’s Disease: A Meta-Analysis Perspective, Frontiers in Aging Neuroscience, Vol: 8, ISSN: 1663-4365
Morrell MJ, McMillan A, 2016, Does Age Matter? The Relationship between Sleep-disordered Breathing and Incident Atrial Fibrillation in Older Men, American Journal of Respiratory and Critical Care Medicine, Vol: 193, Pages: 712-714, ISSN: 1535-4970
Tahmasian M, Rosenzweig I, Eickhoff SB, et al., 2016, Structural and functional neural adaptations in obstructive sleep apnea: An activation likelihood estimation meta-analysis, Neuroscience and Biobehavioral Reviews, Vol: 65, Pages: 142-156, ISSN: 1873-7528
Obstructive sleep apnea (OSA) is a common multisystem chronic disorder. Functional and structural neuroimaging has been widely applied in patients with OSA, but these studies have often yielded diverse results. The present quantitative meta-analysis aims to identify consistent patterns of abnormal activation and grey matter loss in OSA across studies. We used PubMed to retrieve task/resting-state functional magnetic resonance imaging and voxel-based morphometry studies. Stereotactic data were extracted from fifteen studies, and subsequently tested for convergence using activation likelihood estimation. We found convergent evidence for structural atrophy and functional disturbances in the right basolateral amygdala/hippocampus and the right central insula. Functional characterization of these regions using the BrainMap database suggested associated dysfunction of emotional, sensory, and limbic processes. Assessment of task-based co-activation patterns furthermore indicated that the two regions obtained from the meta-analysis are part of a joint network comprising the anterior insula, posterior-medial frontal cortex and thalamus. Taken together, our findings highlight the role of right amygdala, hippocampus and insula in the abnormal emotional and sensory processing in OSA.
Rosenzweig I, Glasser M, Crum WR, et al., 2016, Changes in Neurocognitive Architecture in Patients with Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure., EBioMedicine, Vol: 7, Pages: 221-229, ISSN: 2352-3964
BACKGROUND: Obstructive sleep apnea (OSA) is a chronic, multisystem disorder that has a bidirectional relationship with several major neurological disorders, including Alzheimer's dementia. Treatment with Continuous Positive Airway Pressure (CPAP) offers some protection from the effects of OSA, although it is still unclear which populations should be targeted, for how long, and what the effects of treatment are on different organ systems. We investigated whether cognitive improvements can be achieved as early as one month into CPAP treatment in patients with OSA. METHODS: 55 patients (mean (SD) age: 47.6 (11.1) years) with newly diagnosed moderate-severe OSA (Oxygen Desaturation Index: 36.6 (25.2) events/hour; Epworth sleepiness score (ESS): 12.8 (4.9)) and 35 matched healthy volunteers were studied. All participants underwent neurocognitive testing, neuroimaging and polysomnography. Patients were randomized into parallel groups: CPAP with best supportive care (BSC), or BSC alone for one month, after which they were re-tested. FINDINGS: One month of CPAP with BSC resulted in a hypertrophic trend in the right thalamus [mean difference (%): 4.04, 95% CI: 1.47 to 6.61], which was absent in the BSC group [-2.29, 95% CI: -4.34 to -0.24]. Significant improvement was also recorded in ESS, in the CPAP plus BSC group, following treatment [mean difference (%): -27.97, 95% CI: -36.75 to -19.19 vs 2.46, 95% CI: -5.23 to 10.15; P=0.012], correlated to neuroplastic changes in brainstem (r=-0.37; P=0.05), and improvements in delayed logical memory scores [57.20, 95% CI: 42.94 to 71.46 vs 23.41, 95% CI: 17.17 to 29.65; P=0.037]. INTERPRETATION: One month of CPAP treatment can lead to adaptive alterations in the neurocognitive architecture that underlies the reduced sleepiness, and improved verbal episodic memory in patients with OSA. We propose that partial neural recovery occurs during short periods of treatment with CPAP.
McMillan A, Morrell MJ, 2016, Sleep disordered breathing at the extremes of age: the elderly, BREATHE, Vol: 12, Pages: 51-60, ISSN: 1810-6838
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- Citations: 44
McMillan A, Bratton DJ, Faria R, et al., 2015, A multicentre randomised controlled trial and economic evaluation of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome in older people: PREDICT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 19, Pages: 1-+, ISSN: 1366-5278
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- Citations: 38
Pearse SS, Sharma R, Wong T, et al., 2015, Accuracy of a pacemaker-derived algorithm for the diagnosis of sleep disordered breathing in heart failure, EUROPEAN JOURNAL OF HEART FAILURE, Vol: 17, Pages: 297-297, ISSN: 1388-9842
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- Citations: 1
Rosenzweig I, Glasser M, Polsek D, et al., 2015, Sleep apnoea and the brain: a complex relationship., Lancet Respiratory Medicine, Vol: 3, Pages: 404-414, ISSN: 2213-2619
Intermittent hypoxia, reoxygenation, and hypercapnia or hypocapnia occur in both adults and children during untreated apnoea and hypopnoea, along with changes in cerebral blood flow and sleep fragmentation. These effects can result in cognitive deficits with functional effects on work and school efficiency. The assessment of how obstructive sleep apnoea affects cognition depends on the specificity and sensitivity of the tests, which are rarely developed specifically for obstructive sleep apnoea. In this Review, we discuss both the neural adaptive and maladaptive processes in response to hypoxaemia. The net result on cognitive and emotional performance depends on the stage of this dynamic process, effects on other body systems, cognitive reserve, and idiosyncratic susceptibility. We also explore the contribution of fragmented sleep, and the disruption of sleep structure, with focus on the effect at different times in the development of disease. This Review will address the gap in the underlying pathophysiology of new clinical and translational findings, and argue their contribution to the inherent complexity of the association between obstructive sleep apnoea and the brain.
Morrell MJ, 2015, One hundred years of pulmonary function testing: a perspective on 'The diffusion of gases through the lungs of man' by Marie Krogh, JOURNAL OF PHYSIOLOGY-LONDON, Vol: 593, Pages: 351-352, ISSN: 0022-3751
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- Citations: 5
Rosenzweig I, Glasser M, Crum WR, et al., 2015, Neuroanatomical Correlates Of Cognitive Dysfunction In Obstructive Sleep Apnoea, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
McMillan A, Bratton DJ, Faria R, et al., 2014, Sleep apnoea in the elderly - authors' reply., Lancet Respir Med, Vol: 2, Pages: e21-e22
Rosenzweig I, Williams SCR, Morrell MJ, 2014, The impact of sleep and hypoxia on the brain: potential mechanisms for the effects of obstructive sleep apnea, CURRENT OPINION IN PULMONARY MEDICINE, Vol: 20, Pages: 565-571, ISSN: 1070-5287
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- Citations: 50
McMillan A, Bratton DJ, Faria R, et al., 2014, Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial, The Lancet Respiratory Medicine, Vol: 2, Pages: 804-812, ISSN: 2213-2600
BackgroundThe therapeutic and economic benefits of continuous positive airway pressure (CPAP) for moderate to severe obstructive sleep apnoea (OSA) syndrome have been established in middle-aged people; however, the benefits in older people are unknown. This trial was designed to address this evidence gap.MethodsThis 12-month, multicentre, randomised trial enrolled patients across 14 National Health Service sleep centres in the UK. Consecutive patients aged 65 years or older with newly diagnosed OSA syndrome were eligible to join the trial. Patients were randomly assigned (1:1) into parallel groups to receive either CPAP with best supportive care (BSC) or BSC alone for 12 months. Randomisation was done by the Medical Research Council Clinical Trials Unit with computer-generated randomisation. The main investigator at each centre was masked to the trial randomisation. Coprimary endpoints were Epworth sleepiness score (ESS) at 3 months and cost-effectiveness over the 12-month trial period. Secondary outcomes were subjective sleepiness at 12 months, plus objective sleepiness, quality of life, mood, functionality, nocturia, mobility, accidents, cognitive function, and cardiovascular risk factors and events at 3 months and 12 months. The analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN90464927.FindingsBetween Feb 24, 2010, and May 30, 2012, 278 patients were randomly assigned to the trial, of whom 231 (83%) completed the trial. 140 patients were allocated to and received CPAP plus BSC and 138 were allocated to and received BSC only. CPAP reduced ESS by 2·1 points (95% CI −3·0 to −1·3; p<0·0001) at 3 months for 124 (89%) of 140 patients compared with 124 (90%) of 138 patients given BSC, and by 2·0 points (−2·8 to −1·2; p<0·0001) at 12 months for 116 patients compared with 122 patients given BSC. The effect
Quinnell TG, Bennett M, Jordan J, et al., 2014, A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO), THORAX, Vol: 69, Pages: 938-945, ISSN: 0040-6376
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- Citations: 59
Quinnell TG, Clutterbuck-James AL, Bennett M, et al., 2014, Randomised controlled trial of mandibular advancement devices for obstructive sleep apnoea (TOMADO): one year follow-up, 22nd Congress of the European-Sleep-Research-Society, Publisher: WILEY-BLACKWELL, Pages: 116-116, ISSN: 0962-1105
Carlisle T, Carthy ER, Glasser M, et al., 2014, Upper airway factors that protect against obstructive sleep apnoea in healthy older males, EUROPEAN RESPIRATORY JOURNAL, Vol: 44, Pages: 685-693, ISSN: 0903-1936
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- Citations: 26
Kelly JL, Jaye J, Pickersgill RE, et al., 2014, Randomized trial of 'intelligent' autotitrating ventilation versus standard pressure support non-invasive ventilation: Impact on adherence and physiological outcomes, RESPIROLOGY, Vol: 19, Pages: 596-603, ISSN: 1323-7799
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- Citations: 53
Shaikh ZF, Kelly JL, Shrikrishna D, et al., 2014, Patent Foramen Ovale Is Not Associated with Hypoxemia in Severe Chronic Obstructive Pulmonary Disease and Does Not Impair Exercise Performance, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 189, Pages: 540-547, ISSN: 1073-449X
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- Citations: 14
McMillan A, Bratton DJ, Faria R, et al., 2014, A 12 Month Multicenter, Parallel, Randomized Trial Of Continuous Positive Airway Pressure In Older People With Obstructive Sleep Apnea Syndrome, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Rosenzweig I, Kempton MJ, Crum WR, et al., 2013, Hippocampal Hypertrophy and Sleep Apnea: A Role for the Ischemic Preconditioning?, PLOS One, Vol: 8, ISSN: 1932-6203
The full impact of multisystem disease such as obstructive sleep apnoea (OSA) on regions of the central nervous system is debated, as the subsequent neurocognitive sequelae are unclear. Several preclinical studies suggest that its purported major culprits, intermittent hypoxia and sleep fragmentation, can differentially affect adult hippocampal neurogenesis. Although the prospective biphasic nature of chronic intermittent hypoxia in animal models of OSA has been acknowledged, so far the evidence for increased ‘compensatory’ neurogenesis in humans is uncertain. In a cross-sectional study of 32 patients with mixed severity OSA and 32 non-apnoeic matched controls inferential analysis showed bilateral enlargement of hippocampi in the OSA group. Conversely, a trend for smaller thalami in the OSA group was noted. Furthermore, aberrant connectivity between the hippocampus and the cerebellum in the OSA group was also suggested by the correlation analysis. The role for the ischemia/hypoxia preconditioning in the neuropathology of OSA is herein indicated, with possible further reaching clinical implications.
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