Experts and researchers from the field of sleep medicine gathered in June at the 2023 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society in Indianapolis. The conference showcased significant advancements in understanding sleep disorders and their impact on various health conditions. Here are some of the key highlights:
Obstructive Sleep Apnea More Likely Following Vagus Nerve Stimulation
Obstructive sleep apnea (OSA) is a common adverse reaction for patients who have undergone vagus nerve stimulation (VNS) implantation. VNS implantation is a treatment for patients with intractable epilepsy and has been shown to decrease seizure frequency.
To study the rate of OSA development following VNS implantation, researchers conducted a meta-analysis of articles that reported data before and after VNS implantation. The analysis included 306 patients from 7 retrospective studies and 3 prospective studies. The researchers collected data on apnea-hypopnea index, respiratory disturbance index, or OSA rates following VNS implantation.
The researchers identified a pooled OSA rate of 27.3% (95% CI, 15.1%-41.5%;). The subgroup analysis discovered there were no significant differences in OSA rates following VNS implantation between pediatric (22.1%; 95% CI, 8.2%-40.5%) and adult patients (31.9%; 95% CI, 18.9%-47.5%; P =.39). A pooled analysis was performed and found significant heterogeneity (P <.00001; I2, 100%), but with no inter-subgroup heterogeneity (I2, 0%).
Overall, OSA is a common adverse effect following VNS implantation and patients should be monitored post-implantation, the study authors concluded
Saleem M, Santhumayor B, Hasan E, Kolesnik M, Bernbaum M. Obstructive sleep apnea following vagus nerve stimulator implantation: a meta-analysis. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract 0541.
Insomnia Following Trauma Tied to Depression, PTSD in Women Service Members
Insomnia is an independent clinical disorder that can contribute to the development of post-traumatic stress disorder (PTSD) and depression among women service members and veterans, rather than a secondary symptom of mental health disorders, according to research study findings.
Researchers explored the associations between trauma exposure, mental health symptoms, and insomnia among 26,443 women service members and veterans from the Millennium Cohort study.
Participants were analyzed using 2 waves of survey data: time 1 (T1; 2011-2013) and time 2 (T2; 2014-2016). They evaluated recent traumas (ie, combat experience and sexual trauma) in the previous 3 years, probable insomnia at T1, and probable PTSD and depression at T2.
The researchers found that women who experienced recent sexual assault, sexual harassment, or combat had increased risk for probable insomnia in T1, compared with women who had not experienced these events:
- Recent sexual assault (odds ratio [OR], 1.68; 95% CI, 1.24-2.1).
- Sexual harassment (OR, 1.22; 95% CI, 1.05-1.41).
- Combat (OR, 1.34; 95% CI, 1.20-1.49).
Additionally, probable insomnia at T1 was related to probable depression (OR, 2.66; 95% CI, 2.31-3.06) and PTSD (OR, 2.57; 95% CI, 2.27-2.9) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes, the authors noted.
Overall, the diagnosis and treatment of trauma-induced insomnia during military service should be prioritized to prevent development of post-traumatic mental health symptoms. Sleep health in women service members is understudied and should also be prioritized, study authors concluded.
Carlson G, Sharifian N, Jacobson I, LeardMann C, Rull R, Martin J. Contribution of insomnia after trauma to depression and posttraumatic stress disorder in women service members. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract 0349.
Light Exposure Before Sleep May Raise Gestational Diabetes Risk
An increase exposure to light in the evenings may be a “under-recognized, potentially modifiable” risk factor for the development of gestational diabetes, a new study concluded. Research has found an association with mistimed light exposure and impaired glucose regulation in nonpregnant women, but the current research on the effects of light exposure during pregnancy is scarce.
Researchers aimed to assess the relationship between evening light exposure prior to sleep during pregnancy and the incidence of gestational diabetes. They conducted a prospective cohort study with 741 nulliparous women from 8 clinical sites, excluding women with pregestational diabetes. Data was recorded through a sleep diary and a wrist actigraphy monitor for 7 days. The primary outcome measured was the time spent above 10 lux (dim light) during the 3 hours before sleep onset. The time was averaged over days of recording and participants were categorized into 3 groups based on time exposed to light: high, medium, and low.
Women in the high- and medium-light groups had increased risk for gestational diabetes (high group: odds ratio [OR], 5.49; 95% CI, 1.8-23.94; medium group: OR, 4.05; 95% CI, 1.27-17.94), compared with women in the low group(OR 1, reference). Women in the high-light group had more daytime light and were less likely to be defined as late (midpoint >5AM) or fragmented (wake after onset ≥75th percentile) sleepers.
Evening light exposure in pregnancy may be a modifiable risk factor for gestational diabetes and further research on light-targeted interventions as a preventative strategy should be investigated, study authors said.
Kim M, Facco F, Braun R, Wolf M, et al. Light exposure before bedtime in pregnancy is associated with a higher risk of gestational diabetes. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract A137.
Anxiety, Depression as Possible Predisposing Factors for Insomnia in Adults
Predisposing factors for insomnia may include anxiety, depression, and high levels of perceived stress. Other factors may include loss of income and increased pain. Insomnia is one of the most prevalent health conditions negatively affecting the physical and mental health of patients.
Researchers aimed to assess factors that may predispose patients to the onset of insomnia. They enrolled patients from a Canadian epidemiological cohort study that analyzed the development and course of insomnia among adults categorized as “good sleepers” at baseline. Risk and protective factors were measured over a 5-year period through questionnaires that reported on sleep quality, mental health status, perceived stress, and other factors.
Of the 1709 patients, 202 developed insomnia syndrome within 5 years. There may be a significantly increased risk of developing insomnia in patients with:
- Anxiety (hazard ratio [HR], 1.04; P =.018)
- Depression (HR, 1.08; P <.001)
- High levels of perceived stress (HR, 1.07; P <.001)
- Greater occurrence of negative life events (HR, 1.48; P =.02)
- Worse perception of personal health (HR, 2.06; P =.006)
- High levels of perceived pain (HR, 1.48; P =.002)
- Susceptibility to stress (HR, 1.09; P <.001)
- Poor emotional coping skills (HR, 1.04; P <.001)
Some predispositions may also be precipitating factors including high levels of anxiety (HR, 1.07; P <.001), depression (HR, 1.12; P <.001), and high levels of self-perceived stress (HR, 1.08; P <.001). Other precipitating factors include loss of income (HR, 1.35; P =.03), deteriorating perception of personal health (HR, 2.06; P =.006), and increasing pain levels (HR, 1.35; P =.013). Physical activity was not a significant protective factor for insomnia (P=.54).
The researchers note that these results could assist in preventing the onset and chronicity of insomnia by targeting specific precipitating and predisposing factors of insomnia in patients at risk.
Morin C, Vezina-Im L, Ivers H, LeBlanc M, Savard J. Protective and risk factors for insomnia over 5 years in a population-based sample of adults. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract 0324.
OSA Plus Difficulty Initiating, Maintaining Sleep Tied to High Blood Pressure
Elevated blood pressure (BP) is seen in individuals with obstructive sleep apnea (OSA) that have difficulty initiating and/or maintaining sleep (DIMS). DIMS is experienced by approximately 30% and 50% of patients with OSA and sleep disturbances, leading to worsened quality of life and mental health.
Researchers aimed to evaluate the possible association between OSA and sleep disturbances with hypertension. A total of 12,287 patients used an under-mattress sleep analyzer (Withings) to monitor sleep over approximately 6 months in their homes. Researchers recorded the mean apnea-hypopnea index (AHI), sleep onset latency (SOL), and wake after sleep onset (WASO). A home monitor was used to measure patients’ blood pressure (BP).
The study used the following definitions for OSA, DIMS, and hypertension:
- OSA: average AHI of ≥15 events per minute.
- DIMS: average SOL of ≥30 minutes and/or WASO of ≥45 minutes.
- Hypertension: mean systolic BP (SBP) ≥140 mm Hg and/or mean diastolic BP (DPB) ≥90 mm Hg.
Patients were categorized into 4 groups:
- OSA-alone group
- DIMS-alone group
- OAS plus DIMS group
- Control group (patients with neither condition)
Mean participant age was 50±12 years and 88% were men. The prevalence of OSA-alone, DIMS-alone, and OAS plus DIMS was 21%, 10%, and 8%, respectively.
The OSA-alone group was associated with a mean 4.5 mm Hg (95% CI, 4.1-5.0 mm Hg) higher SBP value and a mean 2.6 mm Hg (95% CI, 2.3-2.93 mm Hg) higher DBP value compared with the control group. The OSA plus DIMS group was associated with an increase of 5.9 mm Hg (95% CI, 5.3-6.6 mm Hg) in SBP and 3.7 mm Hg (95% CI, 3.3-4.2 mm Hg) in DBP compared with the control group. This difference was significantly greater than that observed in the OSA-alone group (SBP, +1.4 mm Hg [95% CI, 0.8-2.0 mm Hg]; DBP, +1.12 mm Hg [95% CI, 0.7-1.6 mm Hg]; P <.001).
Researchers also found that OSA-alone and OSA plus DIMS groups were associated with a 37% (95% CI, 22%-54%) and a 60% (95% CI, 36%-88%) increase in prevalence of hypertension, respectively, compared with the control group. Patients in the OSA plus DIMS group had a 17% increase in the prevalence of hypertension vs those in the OSA-alone group (95% CI, –1%-38%).
Overall, hypertension is more prevalent in patients with OSA who have difficulty initiating and maintaining sleep.
Lechat B, Scott H, Sweetman A, Escourrou P, Eckert D. Difficulty initiating and maintaining sleep is associated with increased blood pressure in people with obstructive sleep apnea. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract 0465.
Lemborexant Increases Total Sleep Time in Patients With Insomnia, Mild OSA
In today’s market, there are multiple pharmacologic options for the treatment of insomnia and mild obstructive sleep apnea (OSA), such as benzodiazepines and nonbenzodiazepine hypnotics, which affect γ-aminobutyric acid receptors.
Lemborexant, which was approved by the Food and Drug administration in 2019, is a dual receptor orexin antagonists (DORA) that is associated with significantly increased total sleep time, with rapid eye movement (REM) sleep, according to recent research.
In a phase 3, randomized, double-blind, placebo-controlled, and active-comparator trial, researchers aimed to assess the use of lemborexant to treat adult patients with insomnia and concomitant mild OSA (defined as apnea-hypopnea index >5-≤15 events/hr). The trial consisted of 409 adults aged 55 years and older diagnosed with insomnia and mild OSA. Patients were randomly assigned to receive lemborexant 5 mg (n=114), lemborexant 10 mg (n=105), zolpidem extended-release 6.25 mg (n=112), or placebo (n=78). Researchers compared the least-squares-mean duration of each sleep stage (in minutes) across nights 1/2 vs nights 29/30.
Results indicated that patients who received lemborexant 5 mg or 10 mg experienced significant changes from baseline in total sleep time and REM sleep in both post-randomization assessments (nights 1/2 and nights 29/30), compared with patients who received zolpidem extended-release 6.25 mg or placebo (P <.0001). Neither dosage of lemborexant was superior to zolpidem at nights 1/2 and only lemborexant 5 mg significantly improved non-REM sleep at night 29/30 (P <.05).
Researchers concluded that lemborexant significantly increased total sleep time and REM sleep in patients with insomnia and mild OSA and no severe adverse events were reported.
This study was supported by Clinilabs Drug Development Corporation and Eisai Inc.
Kushida C, Zammit G, Cheng J, Kumar D, Moline M. Effect of lemborexant on sleep architecture in subjects with comorbid insomnia and mild obstructive sleep apnea from a ph 3 trial. Abstract presented at: SLEEP 2023; June 3-7, 2023; Indianapolis, IN. Abstract 0354.
For more SLEEP 2023 meeting coverage visit Neurology Advisor.