Obese miniature pigs could offer insight into sleep apnoea in humans - New neural network enables easy screening of sleep apnoea patients with cerebrovascular disease - Michael Oko speaks to Look North - A review of sleep research in 2020 - Snore Centre now offers online video consultations - Is sleep apnoea a COVID risk? - Try the Snore Centre Mobile App
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Snore Centre eNewsletter February 2021

Obese miniature pigs could offer insight into sleep apnoea in humans

Miniature pigs could provide clues to help experts tackle sleep apnoea in humans, a new study published in Heliyon claims.

With a small snout, a short curly tail, and a big round stomach, Yucatan mini pigs are the epitome of cute. But they also have airways that are similar in size and tissue type to those of humans, meaning they sometimes snore 'like a dinosaur', according to US researchers.

Using magnetic resonance imaging (MRI) scans taken while they were sleeping, the experts found an increase in airflow velocity in narrow regions of the pigs' throats. Higher airflow velocity – and narrowing in the throat – may be reasons why air stops flowing, causing sleep apnoea. The problem was more pronounced in obese pigs. Previous research has already found a link between obesity and the occurrence of sleep apnoea in humans.  

Zi-Jun Liu, a research professor and principal investigator in the Department of Orthodontics at the University of Washington, and his colleagues sought to better understand the mechanism behind the condition. They looked at Yucatan mini pigs partly because they're comparable in both airway structure and size to humans. Although being described as mini, they're still 100 pounds at normal weight and anywhere between 150 and 200 pounds when obese. Two of the pigs used in the experiments were classified as obese and three were of normal weight.

'These are very fat pigs,' said Liu at the Department of Orthodontics at the University of Washington, which is in Seattle, the US.  'To give some context, normal human body mass index (BMI) range is around 25-28, with obesity reached at over 30-35. After sedating the subjects, the team observed multiple episodes of sleep apnoea per hour in both obese pigs, while only one of the pigs of normal weight displayed sleep apnoea episodes.

While the researchers did not witness any episodes of snoring in the normal weight mini pigs, the obese pigs emitted a low, dinosaur-like snoring in both sedated and natural sleep. Researchers also studied all five mini pigs in an MRI machine while they were in sedated sleep. Sleep apnoea is known to be caused by anatomical restrictions of the nose and throat that cause stoppages of airflow.

So far, the dynamics of how air flows through these passages and the mechanisms that cause the airflow to stop are not well understood. To learn more, the research team then used the MRI scans to construct a 3D replica of the pigs' airways.

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New neural network enables easy screening of sleep apnoea patients with cerebrovascular disease

A new neural network developed by researchers at the University of Eastern Finland and Kuopio University Hospital enables an easy and accurate assessment of sleep apnoea severity in patients with cerebrovascular disease. The assessment is automated and based on a simple nocturnal pulse oximetry, making it possible to easily screen for sleep apnoea in stroke units.

Up to 90% of patients experiencing a stroke have sleep apnoea, according to earlier studies conducted at Kuopio University Hospital. If left untreated, sleep apnoea can reduce the quality of life and rehabilitation of patients with stroke and increase the risk for recurrent cerebrovascular events.

“Although screening of sleep apnoea is recommended for patients with cerebrovascular disease, it is rarely done in stroke units due to complicated measurement devices, time-consuming manual analysis, and high costs,” Researcher Akseli Leino from the University of Eastern Finland says.

In the new study, researchers developed a neural network to assess the severity of sleep apnoea in patients with acute stroke and transient ischaemic attack (TIA) by using a simple nocturnal oxygen saturation signal. The apnoea-hypopnea index, which represents the number of apnoea and hypopnea events per hour, is commonly used in the diagnostics of sleep apnoea. When the researchers compared the results of manual scoring and those obtained using the new neural network, the median difference was only 1.45 events per hour. The neural network was also 78% accurate in classifying patients into four different categories on the basis of sleep apnoea severity (no sleep apnoea, mild, moderate, severe). The neural network was able to identify moderate and severe sleep apnoea, both of which require treatment, in patients with acute stroke or TIA with a 96% specificity and a 92% sensitivity.

“The neural network developed in the study enables an easy and cost-effective screening of sleep apnoea in patients with cerebrovascular disease in hospital wards and stroke units. The nocturnal oxygen saturation signal can be recorded with a simple finger pulse oximetry measurement, with no time-consuming manual analysis required,” Medical Physicist Katja Myllymaa from Kuopio University Hospital points out.

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Michael Oko speaks to Look North about how to stay healthy in case of COVID-19 infection

A review of sleep research in 2020

The Lancet has published a useful summary of the major research into sleep published in 2020:

2020 has been an unprecedented year because a modified coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread rapidly from China to all continents, leading to the COVID-19 pandemic. The first studies of COVID-19-associated sleep disorders were reported in China. 

Huang and Zhao collected information from a survey of 7236 volunteers (mean age 35·3 years [SD 5·6]). About a third of them were health-care workers. About 35% of these participants reported symptoms of general anxiety, 20% of depression, and 18% of poor sleep quality. The participants who were most worried about the pandemic also reported the most symptoms. Health-care workers were clearly under great pressure, which was reflected in the high prevalence of mental-health symptoms that they reported.

The increased prevalence of sleep disorders in 2020 has also been highlighted in several other publications from different countries. These studies examined the effect on sleep of SARS-CoV-2 infection and confounders related to isolation, quarantine, anxiety, stress, or financial losses. According to a European task force, symptoms of insomnia could be related to psychosocial factors and to the confinements.

In Italy, anxiety related to COVID-19 was highly associated with disturbed sleep. In a survey of 2291 Italians, 57·1% reported poor sleep quality, 32·1% high anxiety, 41·8% high distress, and 7·6% reported post-traumatic symptoms of stress.

In the International COVID-19 Sleep Study, different factors are being investigated using a harmonised set of questions. Insomnia, nightmares, sleep apnoea, fatigue, exhaustion, and REM sleep behaviour disorder are being investigated by this collaboration. The hypothesis is that fatigue, sleepiness, and REM sleep behaviour disorder might be related to SARS-CoV-2 infection per se, whereas insomnia might be related mainly to confinement, anxiety, and other psychosocial factors.

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Snore Centre now offers online video consultations via Doctify

Given the current crisis with many people's movements severely restricted The Snore Centre has set up an online consultation service in partnership with Doctify

Patients can now access our first class sleep service from their own homes without having to risk travel or attending a clinic in person.

Doctify is revolutionising the global healthcare market, enabling patients to search, book and review clinics and hospitals online. They strongly believe in the benefit of patient reviews and how they strengthen the patient-specialist relationship: empowering people to make informed decisions, as well as recognising the exceptional dedication of clinics and hospitals.


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