ORCID Profile
0000-0002-4304-0112
Current Organisation
Charité Universitätsmedizin Berlin
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Biomedical Engineering not elsewhere classified | Other Technology | Signal Processing | Technology not elsewhere classified | Medical Physiology not elsewhere classified | Medical Devices | Biomedical Engineering
ANZSRC Socio-Economic Objective (SEO)
Expanding Knowledge in Technology | Diagnostic Methods | Expanding Knowledge in Engineering | Road Safety | Health not elsewhere classified |
Related Links
Publications
How many sleep stages do we need for an efficient automatic insomnia diagnosis?
Publisher: IEEE
Date: 08-2016
Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.SLEEP.2007.05.008
Abstract: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region. We obtained data from Transport Authorities in 25 countries (Austria, AT Belgium, BE Czech Republic, CZ Denmark, DK Estonia, EE Finland, FI France, FR Germany, DE Greece, GR Hungary, HU Ireland, IE Italy, IT Lithuania, LT Luxembourg, LU Malta, MT Netherlands, NL Norway, EC Poland, PL Portugal, PT Slovakia, SK Slovenia, SI Spain, ES Sweden, SE Switzerland, CH United Kingdom, UK). Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome. Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.
Sleep-Wake Classification using Statistical Features Extracted from Photoplethysmographic Signals
Publisher: IEEE
Date: 07-2019
Position paper on the management of patients with obstructive sleep apnea and hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis
Publisher: Oxford University Press (OUP)
Date: 05-01-2018
DOI: 10.1093/SLEEP/ZSX214
The diagnostic method has a strong influence on classification of obstructive sleep apnea
Publisher: Wiley
Date: 14-08-2015
DOI: 10.1111/JSR.12318
Abstract: Polygraphy (PG) and polysomnography (PSG) are used in clinical settings in Europe for diagnosing obstructive sleep apnea (OSA), but their equivalence in unselected clinical cohorts is unknown. We hypothesized that the method would affect both diagnostic outcomes and disease severity stratification. Data from 11 049 patients in the multi-centre European Sleep Apnea Cohort (ESADA) with suspected OSA (male and female, aged 18-80 years) were used in two groups of patients to compare PG (n = 5745) and PSG (n = 5304). Respiratory events were scored using the 2007 American Association of Sleep Medicine (AASM) criteria. In subjects who underwent PSG, mean apnea-hypopnea index (AHI) using sleep time (AHIPSG 31.0 ± 26.1 h(-1) ) and total analysed time (TAT) (AHITAT 24.7 ± 22.0 h(-1) ) were higher than in subjects who underwent PG (AHIPG 22.0 ± 23.5 h(-1) ) (P < 0.0001). The oxygen desaturation index (ODI) was lower in subjects investigated with PG (ODIPG 18.4 ± 21.7 h(-1) ) compared to subjects investigated with PSG (ODIPSG 23.0 ± 25.3 h(-1) ) but not different when the PSG was indexed by TAT (ODITAT 18.6 ± 21.4 h(-1) , P < 0.65). The proportion of patients with an AHI ≥ 15 was 64% in the subjects who underwent PSG and 47% in the subjects who underwent PG (P < 0.001). Overall, patients investigated using PG are likely to have a 30% lower AHI on average, compared to patients investigated by PSG. This study suggests that PG interpreted using standard guidelines results in underdiagnosis and misclassification of OSA. We advocate the development of PG-specific guidelines for the management of OSA patients.
A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-04-2019
DOI: 10.5664/JCSM.7730
Sex Hormones and Sleep in Men and Women From the General Population: A Cross-Sectional Observational Study
Publisher: The Endocrine Society
Date: 11-2016
DOI: 10.1210/JC.2016-1832
Abstract: Associations between sex hormones and sleep habits originate mainly from small and selected patient-based s les. We examined data from a population-based s le with various sleep characteristics and the major part of sex hormones measured by mass spectrometry. We used data from 204 men and 213 women of the cross-sectional Study of Health in Pomerania-TREND. Associations of total T (TT) and free T, androstenedione (ASD), estrone, estradiol (E2), dehydroepiandrosterone-sulphate, SHBG, and E2 to TT ratio with sleep measures (including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index [AHI], Insomnia Severity Index, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index) were assessed by sex-specific multivariable regression models. In men, age-adjusted associations of TT (odds ratio 0.62 95% confidence interval (CI) 0.46-0.83), free T, and SHBG with AHI were rendered nonsignificant after multivariable adjustment. In multivariable analyses, ASD was associated with Epworth Sleepiness Scale (β-coefficient per SD increase in ASD: -0.71 95% CI: -1.18 to -0.25). In women, multivariable analyses showed positive associations of dehydroepiandrosterone-sulphate with wake after sleep onset (β-coefficient: .16 95% CI 0.03-0.28) and of E2 and E2 to TT ratio with Epworth Sleepiness Scale. Additionally, free T and SHBG were associated with AHI in multivariable models among premenopausal women. The present cross-sectional, population-based study observed sex-specific associations of androgens, E2, and SHBG with sleep apnea and daytime sleepiness. However, multivariable-adjusted analyses confirmed the impact of body composition and health-related lifestyle on the association between sex hormones and sleep.
Obstructive sleep apnoea independently predicts lipid levels: Data from the European Sleep Apnea Database
Publisher: Wiley
Date: 21-08-2018
DOI: 10.1111/RESP.13372
Abstract: Obstructive sleep apnoea (OSA) and dyslipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and plasma lipid concentrations in patients enrolled in the European Sleep Apnea Database (ESADA) cohort. The cross-sectional analysis included 8592 patients without physician-diagnosed hyperlipidaemia or reported intake of a lipid-lowering drug (age 50.1 ± 12.7 years, 69.1% male, BMI: 30.8 ± 6.6 kg/m There was a dose response relationship between TC and ODI (mean ± SE (mg/dL): 180.33 ± 2.46, 184.59 ± 2.42, 185.44 ± 2.42 and 185.73 ± 2.44 P < 0.001 across ODI quartiles I-IV). TG and LDL concentrations were better predicted by AHI than by ODI. HDL-C was significantly reduced in the highest AHI quartile (mean ± SE (mg/dL): 48.8 ± 1.49 vs 46.50 ± 1.48 P = 0.002, AHI quartile I vs IV). Morbid obesity was associated with lower TC and higher HDL-C values. Lipid status was influenced by geographical location with the highest TC concentration recorded in Northern Europe. OSA severity was independently associated with cholesterol and TG concentrations.
Photoplethysmographic-based automated sleep–wake classification using a support vector machine
Publisher: IOP Publishing
Date: 11-08-2020
Sleep apnoea severity independently predicts glycaemic health in nondiabetic subjects: the ESADA study
Publisher: European Respiratory Society (ERS)
Date: 02-04-2014
DOI: 10.1183/09031936.00162713
Abstract: Obstructive sleep apnoea (OSA) is associated with increased risk of dysglycaemia but the intimate link of these conditions with obesity makes discerning an independent relationship between them challenging. Glycosylated haemoglobin (HbA1c) levels predict adverse cardiovascular outcomes in nondiabetics but there is a lack of population-level data exploring the relationship of HbA1c with OSA. A cross-sectional analysis of 5294 participants in the multinational European Sleep Apnoea Cohort (European Sleep Apnoea Database) study was performed, assessing the relationship of OSA severity with HbA1c levels in nondiabetic subjects, with adjustment for confounding factors. HbA1c levels correlated significantly with OSA severity in univariate analysis. Following adjustment for confounding factors, apnoea-hypopnoea index (AHI) (standardised β 0.158 p<0.001), along with nocturnal hypoxaemia, predicted HbA1c. Adjusted mean HbA1c levels were lower in the lowest AHI quartile (5.24%, 95% CI 5.21-5.27%) than in the second (5.37%, 95% CI 5.34-5.40%), third (5.44%, 95% CI 5.41-5.47%) or highest (5.50%, 95% CI 5.46-5.53%) quartiles. Subjects in the higher quartiles had significantly greater adjusted odds ratios of HbA1c level ≥6.0% than those in the first quartile. In stratified analyses, OSA severity predicted glycaemic health irrespective of sleep study modality, sex, obesity or daytime sleepiness. OSA severity independently predicts glycaemic health in nondiabetic subjects. Further studies should assess the impact of OSA treatment on glycaemic health and elucidate underlying mechanisms.
Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis
Publisher: Elsevier BV
Date: 08-2019
Pulse transit time and heart rate variability in sleep staging
Publisher: IEEE
Date: 08-2016
Sleep – the yet underappreciated player in cardiovascular diseases: A clinical review from the German Cardiac Society Working Group on Sleep Disordered Breathing
Publisher: Oxford University Press (OUP)
Date: 29-10-2019
Abstract: Patients with a wide variety of cardiovascular diseases, including arterial and pulmonary hypertension, arrhythmia, coronary artery disease and heart failure, are more likely to report impaired sleep with reduced sleep duration and quality, and also, sometimes, sleep interruptions because of paroxysmal nocturnal dyspnoea or arrhythmias. Overall, objective short sleep and bad sleep quality (non-restorative sleep) and subjective long sleep duration are clearly associated with major cardiovascular diseases and fatal cardiovascular outcomes. Sleep apnoea, either obstructive or central in origin, represents the most prevalent, but only one, of many sleep-related disorders in cardiovascular patients. However, observations suggest a bidirectional relationship between sleep and cardiovascular diseases that may go beyond what can be explained based on concomitant sleep-related disorders as confounding factors. This makes sleep itself a modifiable treatment target. Therefore, this article reviews the available literature on the association of sleep with cardiovascular diseases, and discusses potential pathophysiological mechanisms. In addition, important limitations of the current assessment, quantification and interpretation of sleep in patients with cardiovascular disease, along with a discussion of suitable study designs to address future research questions and clinical implications are highlighted. There are only a few randomised controlled interventional outcome trials in this field, and some of the largest studies have failed to demonstrate improved survival with treatment (with worse outcomes in some cases). In contrast, some recent pilot studies have shown a benefit of treatment in selected patients with underlying cardiovascular diseases.
Deep Learning and Insomnia: Assisting Clinicians with Their Diagnosis
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 11-2017
Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Is snoring during pregnancy a predictor of later life obstructive sleep apnoea? A case–control study
Publisher: Elsevier BV
Date: 03-2021
Brief overview of technology and applications in railway operator safety
Publisher: IEEE
Date: 11-2011
Management of obstructive sleep apnea in Europe
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.SLEEP.2010.10.003
Abstract: In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services. Two questionnaires were sent to 39 physicians in 22 countries in Europe. In order to standardize the responses, the questionnaire was accompanied by an ex le. Sleep centers from 21 countries (38 physicians) participated. A broad consistency among countries with respect to the following was found: pathways included referral to sleep physicians/sleep laboratories, necessity for objective diagnosis (primarily by polysomnography), use of polygraphic methods, analysis of polysomnography (PSG), indications for positive airway pressure (PAP) therapy, application of standard continuous PAP (CPAP) therapy (100% with an CPAP/APAP ratio of 2.24:1), and the need (90.5%) and management of follow-up. Differences were apparent in reimbursement of the diagnostic procedures and follow-up, in the procedures for PAP titration from home APAP titration with portable sleep apnea monitoring (38.1%) up to hospital monitoring with PSG and APAP (85.7%), and in the qualification requirements of sleep physicians. Management of OSA in different European countries is similar except for reimbursement rules, qualification of sleep specialists and procedures for titration of the CPAP treatment. A European network (such as the one accomplished by the European Cooperation in Science and Technology [COST] B26 Action) could be helpful for implementing these findings into health-service research in order to standardize management in a cost effective perspective.
Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity
Publisher: Oxford University Press (OUP)
Date: 28-01-2021
Abstract: Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical s le. 1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates. Patients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to in iduals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based on SDNN (adjusted mean: 37.4 vs. 46.2 ms p & 0.0001), RMSSD (21.5 vs. 27.9 ms p & 0.0001), ShanEn (1.83 vs. 2.01 p & 0.0001), and Forbword (36.7 vs. 33.0 p = 0.0001). While no differences were found in frequency-domain measures overall, among obese patients there was a shift to sympathetic dominance in severe OSA, with a higher LF/HF ratio compared to obese non-OSA patients (4.2 vs. 2.7 p = 0.009). Time-domain and nonlinear HRV measures during wakefulness are associated with OSA severity, with severe patients having remarkably reduced and less complex HRV. Frequency-domain measures show a shift to sympathetic dominance only in obese OSA patients. Thus, HRV during wakefulness could provide additional information about cardiovascular physiology in OSA patients. A Prospective Observational Cohort to Study the Genetics of Obstructive Sleep Apnea and Associated Co-Morbidities (German Clinical Trials Register - DKRS, DRKS00003966) www.drks.de/drks_web/navigate.do?navigationId=trial.HTML& TRIAL_ID=DRKS00003966
Positionspapier „Schlafmedizin in der Kardiologie“, Update 2021
Publisher: Springer Science and Business Media LLC
Date: 09-2021
Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: longitudinal data from the ESADA cohort
Publisher: Wiley
Date: 24-05-2018
DOI: 10.1111/JSR.12705
Abstract: The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m
Poster presentations 1
Publisher: Springer Science and Business Media LLC
Date: 10-2011
Classification of healthy and insomnia subjects based on wake-to-sleep transition
Publisher: IEEE
Date: 12-2016
Continuing professional development: introducing the ERS International Certificate in Respiratory Sleep Medicine.
Publisher: European Respiratory Society (ERS)
Date: 03-2017
Chronic kidney disease in European patients with obstructive sleep apnea: the ESADA cohort study
Publisher: Wiley
Date: 18-05-2016
DOI: 10.1111/JSR.12426
Abstract: The cross-sectional relationship of obstructive sleep apnea with moderate to severe chronic kidney disease, defined as an estimated glomerular filtration rate <60 mL min
Searching arousals: A fuzzy logic approach
Publisher: IEEE
Date: 08-2015
EEG time and frequency domain analyses of primary insomnia
Publisher: IEEE
Date: 08-2015
Genetic aspects of hypertension and metabolic disease in the obstructive sleep apnoea-hypopnoea syndrome
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.SMRV.2007.08.004
Abstract: Though it has long been recognised that there is a hereditary component to the obstructive sleep apnoea/hypopnoea syndrome (OSAHS), identifying its genetic basis remains elusive. Hypertension and metabolic syndrome, like OSAHS, are polygenic disorders, physiologically complex and the product of highly organised, hierarchical systems within the body. Elucidating their genetic basis is difficult when they are considered in isolation but even more difficult if their interrelationships with each other are brought into play. Not least of the problems is the lack of adequate and consistent phenotyping, which has h ered genetic dissection of these diseases in addition, sleep-disordered breathing has not been factored into most studies dealing with essential hypertension or metabolic syndrome. Genome-wide scans have yielded inconsistent results in all three disorders under discussion and candidate gene studies of possible regulatory molecules require more rigorous replication. One approach would be to use 'intermediate' phenotypes and dense mapping of candidate genes for identifying genotype-phenotype correlations. This review focuses on genetic factors, which may be responsible for the expression of cardiovascular disease and metabolic syndrome in the context of OSAHS.
Democracy and Pedagogy Count
Publisher: Springer Netherlands
Date: 14-09-2012
Evaluation of excessive daytime sleepiness in obstructive sleep apnea across international sleep centers
Publisher: Oxford University Press (OUP)
Date: 16-11-2022
Estimating relative respiratory effort from features of photo-plethysmography signal
Publisher: IEEE
Date: 07-2013
Driving habits and risk factors for traffic accidents among sleep apnea patients – a E uropean multi‐centre cohort study
Publisher: Wiley
Date: 07-07-2014
DOI: 10.1111/JSR.12171
Abstract: Obstructive sleep apnea is associated with increased motor vehicle accident risk, and improved detection of patients at risk is of importance. The present study addresses potential risk factors in the European Sleep Apnea Database and includes patients with suspected obstructive sleep apnea [n = 8476, age 51.5 (12.5) years, body mass index 31.0 (6.6) kg m(-2) , 82.4% driver's licence holders]. Driving distance (km year(-1) ), driver's licence type, sleep apnea severity, sleepiness and comorbidities were assessed. Previously validated risk factors for accident history: Epworth Sleepiness Scale ≥16 habitual sleep time ≤5 h use of hypnotics and driving ≥15 000 km year(-1) were analysed across European regions. At least one risk factor was identified in male and female drivers, 68.75 and 51.3%, respectively. The occurrence of the risk factors was similar across Europe, with only a lower rate in the eastern region (P = 0.001). The mean number of risk factors increased across classes of sleep apnea severity. Frequent driving was prevalent [14.0 (interquartile range 8.0-20.0) × 10(3) km year(-1) ] and 32.7% of drivers had severe obstructive sleep apnea [apnea-hypopnea index 50.3 (38.8-66.0) n h(-1) ]. Obesity, shorter sleep time and younger age were associated with increased traffic exposure (P ≤ 0.03). In conclusion, the risk factors associated with accident history were common among European patients with suspected obstructive sleep apnea, but varied between geographical regions. There was a weak covariation between occurrence of risk factors and clinically determined apnea severity but frequent driving, a strong risk factor for accidents, was over-represented. Systematic evaluation of accident-related risk factors is important to detect sleep apnea patients at risk for motor vehicle accidents.
Insomnia Characterization: From Hypnogram to Graph Spectral Theory
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 10-2016
Estimating sleep disordered breathing based on heart rate analysis
Publisher: IEEE
Date: 07-2013
Performance of a Convolutional Neural Network Derived from PPG Signal in Classifying Sleep Stages
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 06-2022
A novel insomnia identification method based on Hjorth parameters
Publisher: IEEE
Date: 12-2015
The European Sleep Apnoea Database (ESADA): report from 22 European sleep laboratories
Publisher: European Respiratory Society (ERS)
Date: 26-05-2011
DOI: 10.1183/09031936.00046710
Abstract: The European Sleep Apnoea Database (ESADA) reflects a network of 22 sleep disorder centres in Europe enabled by a COST action B26 programme. This ongoing project aims to describe differences in standard clinical care of patients with obstructive sleep apnoea (OSA) and to establish a resource for genetic research in this disorder. Patients with suspected OSA are consecutively included and followed up according to local clinical standards. Anthropometrics, medical history, medication, daytime symptoms and sleep data (polysomnography or cardiorespiratory polygraphy) are recorded in a structured web-based report form. 5,103 patients (1,426 females, mean±sd age 51.8±12.6 yrs, 79.4% with apnoea/hypopnoea index (AHI) ≥5 events·h(-1)) were included from March 15, 2007 to August 1, 2009. Morbid obesity (body mass index ≥35 kg·m(-2)) was present in 21.1% of males and 28.6% of females. Cardiovascular, metabolic and pulmonary comorbidities were frequent (49.1%, 32.9% and 14.2%, respectively). Patients investigated with a polygraphic method had a lower AHI than those undergoing polysomnography (23.2±23.5 versus 29.1±26.3 events·h(-1), p<0.0001). The ESADA is a rapidly growing multicentre patient cohort that enables unique outcome research opportunities and genotyping. The first cross-sectional analysis reveals a high prevalence of cardiovascular and metabolic morbidity in patients investigated for OSA.
CPAP Treatment and Cardiovascular Prevention
Publisher: Elsevier BV
Date: 04-2020
Blood pressure and cardiovascular parameters during sleep arousals
Publisher: IEEE
Date: 07-2017
Insomnia symptoms combined with nocturnal hypoxia associate with cardiovascular comorbidity in the European sleep apnea cohort (ESADA)
Publisher: Springer Science and Business Media LLC
Date: 22-11-2018
Characterising insomnia: A graph spectral theory approach
Publisher: IEEE
Date: 08-2015
Periodic leg movement (PLM) monitoring using a distributed body sensor network
Publisher: IEEE
Date: 08-2015
Classification of Healthy Subjects and Insomniac Patients Based on Automated Sleep Onset Detection
Publisher: Springer Singapore
Date: 18-12-2015
Electrophysiological Brain-Cardiac Coupling in Train Drivers during Monotonous Driving
Publisher: MDPI AG
Date: 02-04-2021
Abstract: Electrophysiological research has previously investigated monotony and the cardiac health of drivers independently however, few studies have explored the association between the two. As such the present study aimed to examine the impact of monotonous train driving (indicated by electroencephalogram (EEG) activity) on an in idual’s cardiac health as measured by heart rate variability (HRV). Sixty-three train drivers participated in the present study, and were required to complete a monotonous train driver simulator task. During this task, a 32 lead EEG and a three-lead electrocardiogram were recorded from each participant. In the present analysis, the low (LF) and high frequency (HF) HRV parameters were associated with delta (p 0.05), beta (p = 0.03) and gamma (p 0.001) frequency EEG variables. Further, total HRV was associated with gamma activity, while sympathovagal balance (i.e., LF:HF ratio) was best associated fronto-temporal delta activity (p = 0.02). HRV and EEG parameters appear to be coupled, with the parameters of the delta and gamma EEG frequency bands potentially being the most important to this coupling. These relationships provide insight into the impact of a monotonous task on the cardiac health of train drivers, and may also be indicative of strategies employed to combat fatigue or engage with the driving task.
Investigating relative respiratory effort signals during mixed sleep apnea using photoplethysmogram
Publisher: Springer Science and Business Media LLC
Date: 22-05-2013
Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients
Publisher: Public Library of Science (PLoS)
Date: 04-10-2016
Severity of individual obstruction events increases with age in patients with obstructive sleep apnea
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.SLEEP.2017.06.004
Abstract: Age is a risk factor of obstructive sleep apnea (OSA). It has been shown that OSA progresses over time, although conflicting results have been reported. However, the effect of age on the severity of OSA and in idual obstruction events has not been investigated within different OSA severity categories by taking the most prominent confounding factors (i.e., body mass index, gender, smoking, daytime sleepiness, snoring, hypertension, heart failure, and proportion of supine sleep) into account. Polygraphic data of 1090 patients with apnea-hypopnea index (AHI) ≥5 were retrospectively reanalyzed. The effect of age on the severity of OSA and obstruction events was investigated in general, within different OSA severity categories, and in different age groups (age <40, 40≤ age <50, 50≤ age <60, and age ≥60 years). In the whole population, AHI and durations of apneas, hypopneas, and desaturations increased with increasing age (B ≥ 0.108, p ≤ 0.010). In more detailed analysis, AHI increased with age only in the moderate OSA category (B = 0.075, p = 0.022), although durations of apneas increased in mild and severe OSA categories (B ≥ 0.076, p ≤ 0.038). Furthermore, durations of hypopneas increased with age in mild and moderate OSA categories (B ≥ 0.105, p ≤ 0.038), and durations of desaturations (B ≥ 0.120, p ≤ 0.013) in all OSA severity categories. AHI was not statistically significantly different between the age groups, although durations of obstruction events tended to increase towards older age groups. As obstruction event severity was more strongly dependent on the age than it was dependent on AHI, considering the severity of obstruction events could be beneficial while estimating the long-term effects of the treatments and prognosticating the disease progression.
Electroencephalography as a predictor of self-report fatigue/sleepiness during monotonous driving in train drivers
Publisher: IOP Publishing
Date: 30-10-2018
Abstract: In this study, electroencephalography activity recorded during monotonous driving was investigated to examine the predictive capability of monopolar EEG analysis for fatigue/sleepiness in a cohort of train drivers. Sixty-three train drivers participated in the study, where 32- lead monopolar EEG data was recorded during a monotonous driving task. Participant sleepiness was assessed using the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the Karolinksa sleepiness scale (KSS) and the checklist of in idual strength 20 (CIS20). Self-reported fatigue/sleepiness scores of the train driver cohort were primarily associated with EEG delta, theta, and alpha variables however, some beta and gamma associations were also implicated. Furthermore, general linear models informed by these EEG variables were able to predict self-reported scores with varying degrees of success, representing between 48% and 54% of variance in fatigue scores. Self-reported fatigue/sleepiness scores of train drivers were predicted with varying degrees of success (dependent upon the self-reported fatigue/sleepiness measure) by alterations to monopolar delta, theta, and alpha band activity variables, indicating EEG as a potential indicator for fatigue/sleepiness in train drivers.
Sleep onset detection based on Time-Varying Autoregressive models with particle filter estimation
Publisher: IEEE
Date: 12-2014
Use of the Clinical Global Impression scale in sleep apnea patients – Results from the ESADA database
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.SLEEP.2018.10.028
Abstract: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement). CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, 'normal, not ill' 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = -0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and -0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up. CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.
Cohort Profile: The Study of Health in Pomerania
Publisher: Oxford University Press (OUP)
Date: 18-02-2010
DOI: 10.1093/IJE/DYP394
Detection of Respiratory Arousals Using Photoplethysmography (PPG) Signal in Sleep Apnea Patients
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 05-2014
A Two Stage Approach for the Automatic Detection of Insomnia
Publisher: IEEE
Date: 06-0007
Accurate automatic identification of slow wave sleep using a single electro-oculogram channel
Publisher: IEEE
Date: 02-2014
Fixed But Not Autoadjusting Positive Airway Pressure Attenuates the Time-dependent Decline in Glomerular Filtration Rate in Patients With OSA
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.CHEST.2018.04.020
Abstract: The impact of treating OSA on renal function decline is controversial. Previous studies usually included small s les and did not consider specific effects of different CPAP modalities. The aim of this study was to evaluate the respective influence of fixed and autoadjusting CPAP modes on estimated glomerular filtration rate (eGFR) in a large s le of patients derived from the prospective European Sleep Apnea Database cohort. In patients of the European Sleep Apnea Database, eGFR prior to and after follow-up was calculated by using the Chronic Kidney Disease-Epidemiology Collaboration equation. Three study groups were investigated: untreated patients (n = 144), patients receiving fixed CPAP (fCPAP) (n = 1,178), and patients on autoadjusting CPAP (APAP) (n = 485). In the whole s le, eGFR decreased over time. The rate of eGFR decline was significantly higher in the subgroup with eGFR above median (91.42 mL/min/1.73 m fCPAP but not APAP may prevent eGFR decline in OSA.
Psychophysiology of Monotonous Driving, Fatigue and Sleepiness in Train and Non-Professional Drivers: Driver Safety Implications
Publisher: MDPI AG
Date: 22-09-2023
DOI: 10.3390/BS13100788
Agreement in the scoring of respiratory events and sleep among international sleep centers
Publisher: Oxford University Press (OUP)
Date: 04-2013
DOI: 10.5665/SLEEP.2552
Prevalence of OSA Globally, in Asia and Oceania: Estimates using currently available data
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/JSR.49_12912
Diabetes Mellitus Prevalence and Control in Sleep-Disordered Breathing
Publisher: Elsevier BV
Date: 10-2014
Abstract: OSA is associated with an increased risk of cardiovascular morbidity. A driver of this is metabolic dysfunction and in particular type 2 diabetes mellitus (T2DM). Prior studies identifying a link between OSA and T2DM have excluded subjects with undiagnosed T2DM, and there is a lack of population-level data on the interaction between OSA and glycemic control among patients with diabetes. We assessed the relationship between OSA severity and T2DM prevalence and control in a large multinational population. We performed a cross-sectional analysis of 6,616 participants in the European Sleep Apnea Cohort (ESADA) study, using multivariate regression analysis to assess T2DM prevalence according to OSA severity, as measured by the oxyhemoglobin desaturation index. Patients with diabetes were identified by previous history and medication prescription, and by screening for undiagnosed diabetes with glycosylated hemoglobin (HbA1c) measurement. The relationship of OSA severity with glycemic control was assessed in diabetic subjects. T2DM prevalence increased with OSA severity, from 6.6% in subjects without OSA to 28.9% in those with severe OSA. Despite adjustment for obesity and other confounding factors, in comparison with subjects free of OSA, patients with mild, moderate, or severe disease had an OR (95% CI) of 1.33 (1.04-1.72), 1.73 (1.33-2.25), and 1.87 (1.45-2.42) (P < .001), respectively, for prevalent T2DM. Diabetic subjects with more severe OSA had worse glycemic control, with adjusted mean HbA1c levels 0.72% higher in patients with severe OSA than in those without sleep-disordered breathing (analysis of covariance, P < .001). Increasing OSA severity is associated with increased likelihood of concomitant T2DM and worse diabetic control in patients with T2DM.
Recommendations for the management of patients with obstructive sleep apnoea and hypertension
Publisher: European Respiratory Society (ERS)
Date: 08-02-2013
DOI: 10.1183/09031936.00226711
Abstract: This article is aimed at addressing the current state-of-the-art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnoea (OSA) in cardiovascular (in particular hypertensive) patients, as well as for the management of cardiovascular diseases (in particular arterial hypertension) in OSA patients. The present document is the result of work performed by a panel of experts participating in the European Union COST (Cooperation in Scientific and Technological research) Action B26 on OSA, with the endorsement of the European Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.
Comparing two insomnia detection models of clinical diagnosis techniques
Publisher: IEEE
Date: 07-2017
European Respiratory Society statement on sleep apnoea, sleepiness and driving risk
Publisher: European Respiratory Society (ERS)
Date: 02-10-2020
DOI: 10.1183/13993003.01272-2020
Abstract: Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA the mechanisms involved in this association the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance the impact of treatment on MVA risk in affected drivers and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
Defining Extreme Phenotypes of OSA Across International Sleep Centers
Publisher: Elsevier BV
Date: 09-2020
Photoplethysmography derivatives and pulse transit time in overnight blood pressure monitoring
Publisher: IEEE
Date: 08-2606
Clinical presentation of patients with suspected obstructive sleep apnea and self‐reported physician‐diagnosed asthma in the ESADA cohort
Publisher: Wiley
Date: 11-07-0004
DOI: 10.1111/JSR.12729
Abstract: Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the s le). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.
Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study
Publisher: American Physiological Society
Date: 03-2019
DOI: 10.1152/AJPHEART.00649.2018
Abstract: The objective of the present study was to quantify repolarization lability and its association with sex, sleep stage, and cardiovascular mortality. We analyzed polysomnographic recordings of 2,263 participants enrolled in the Sleep Heart Health Study (SHHS-2). Beat-to-beat QT interval variability (QTV) was quantified for consecutive epochs of 5 min according to the dominant sleep stage [wakefulness, nonrapid eye movement stage 2 (NREM2), nonrapid eye movement stage 3 (NREM3), and rapid eye movement (REM)]. To explore the effect of sleep stage and apnea-hypopnea index (AHI) on QT interval parameters, we used a general linear mixed model and mixed ANOVA. The Cox proportional hazards model was used for cardiovascular disease (CVD) death prediction. Sex-related differences in T wave litude ( P 0.001) resulted in artificial QTV differences. Hence, we corrected QTV parameters by T wave litude for further analysis. Sleep stages showed a significant effect ( P 0.001) on QTV. QTV was decreased in deep sleep compared with wakefulness, was higher in REM than in NREM, and showed a distinct relation to AHI in all sleep stages. The T wave litude-corrected QTV index (cQTVi) in REM sleep was predictive of CVD death (hazard ratio: 2.067, 95% confidence interval: 1.105–3.867, P 0.05) in a proportional hazards model. We demonstrated a significant impact of sleep stages on ventricular repolarization variability. Sex differences in QTV are due to differences in T wave litude, which should be corrected for. Independent characteristics of QTV measures to sleep stages and AHI showed different behaviors of heart rate variability and QTV expressed as cQTVi. cQTVi during REM sleep predicts CVD death. NEW & NOTEWORTHY We demonstrate here, for the first time, a significant impact of sleep stages on ventricular repolarization variability, quantified as QT interval variability (QTV). We showed that QTV is increased in rapid eye movement sleep, reflective of high sympathetic drive, and predicts death from cardiovascular disease. Sex-related differences in QTV are shown to be owing to differences in T wave litude, which should be corrected for.
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