Sleep disorders might now be treated with AI

Artificial intelligence can improve the precision of sleep medicines, resulting in more patient-centered care and better outcomes, suggest a new study.

The position statement of the study was published in the journal - Journal of Clinical Sleep Medicine.

The position statement was developed by the AASM's Artificial Intelligence in Sleep Medicine Committee.

According to the statement, the electrophysiological data collected during polysomnography -- the most comprehensive type of sleep study -- is well-positioned for enhanced analysis through AI and machine-assisted learning.

"When we typically think of AI in sleep medicine, the obvious use case is for the scoring of sleep and associated events," said the lead researcher Dr Cathy Goldstein.

"This would streamline the processes of sleep laboratories and free up sleep technologist time for direct patient care," she added.

Because of the vast amounts of data collected by sleep centres, AI and machine learning could advance sleep care, resulting in more accurate diagnoses, prediction of disease and treatment prognosis, characterization of disease subtypes, precision in sleep scoring, and optimization and personalization of sleep treatments.

Goldstein noted that AI could be used to automate sleep scoring while identifying additional insights from sleep data.

"AI could allow us to derive more meaningful information from sleep studies, given that our current summary metrics, for example, the apnea-hypopnea index, aren't predictive of the health and quality of life outcomes that are important to patients," Dr Cathy Goldstein said.

"Additionally, AI might help us understand mechanisms underlying obstructive sleep apnea, so we can select the right treatment for the right patient at the right time, as opposed to one-size-fits-all or trial and error approaches," she added.

Important considerations for the integration of AI into the sleep medicine practice include transparency and disclosure, testing on novel data, and laboratory integration.

The statement recommends that manufacturers disclose the intended population and goal of any program used in the evaluation of patients; test programs intended for clinical use on independent data; and aid sleep centres in the evaluation of AI-based software performance.

"AI tools hold great promise for medicine in general, but there has also been a great deal of hype, exaggerated claims and misinformation," said Goldstein.

"We want to interface with industry in a way that will foster safe and efficacious use of AI software to benefit our patients. These tools can only benefit patients if used with careful oversight," Goldstein added.

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Experiment shows that fatty tongue loss enhances sleep apnoea

A research study showed that tongue fat maybe one of the main reasons for Obstructive Sleep Apnoea (OSA).

A sleep specialist said, the question then was if you reduce the fat in your tongue, does that improve your sleep apnoea? And the answer from our paper is  yes, he said.

Obesity poses a risk for the onset of this medical condition that may lead to snoring and breathing difficulties for its patients during the night.

Researchers said that it was found that the study subjects who were obese and suffered from OSA had tongues with higher fat percentages as compared to obese people who didn't suffer from this condition.

A sleep specialist , not associated with the study said, that reducing excess fat in general, can reduce tongue size.

In this study, the researchers measured the effect of a 10% reduction in weight on the upper airways of 67 obese OSA patients. These tests were carried out using MRI scanning.

The scans showed that sleep apnoea scores improved by 31% as a result of tongue fat reduction.
The Dr. explained, in fact, the more tongue fat you lost, the more your apnoea improved.

OSA can have a wide range of damaging effects on its sufferers which include brain white matter damage, hypertension, increased chances of heart disease, diabetes, stroke and it may even contribute to depression.

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Postmenopausal women may suffer from poor sleep quality, sleep disorders and shorter sleep duration

 Sleep is extremely important. It is a break from the long day at work, the end of the day, and gives us a new day to look forward to when we wake up. Biologically, it is restorative and helps the body recover from diseases, disorders, tiredness, fatigue, etc. A good night's sleep is especially important when you have had a long day, are extremely tired, are not keeping well, or are going through transition phases physically.

One such transition phase is that of menopause. Menopause is when the production of hormones responsible for reproduction comes to a halt in a woman's body. The body experiences various changes through the phase of menopause. A recent study has found that sleep complications are also common during the menopausal phase.

The study was published online in Menopause – the journal of The North American Menopause Society. The study compared sleep quality, duration and disorders between postmenopausal and premenopausal women, and found that sleep problems increase postmenopause.

Statistically, also, sleep disorders are more common during menopause and affect 40 to 60 per cent women.

Poor sleep quality, disorders, and short duration sleep can have adverse health effects. They lead to poor quality of life, high risk of cardiovascular diseases, diabetes, depression, and anxiety. Since certain sleep disorders like sleep apnea are also age-related and are more common in people of older age, women of postmenopausal age are at an elevated risk of such disorders as well.

The study found that postmenopausal women required more time to fall asleep, an excess of thirty minutes when compared with premenopausal women. They were also found to be more likely to suffer from insomnia and obstructive sleep apnoea.

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Sleep-disordered breathing linked to age acceleration

Increase in the severity of sleep-disordered breathing and sleep disruption are associated with epigenetic age acceleration, recent findings suggest.

The study shows that each standard deviation increase in the apnea-hypopnea index, a measure of sleep-disordered breathing severity, was associated with the equivalent of 215 days of biological age acceleration. Similarly, each standard deviation increase in the arousal index, a measure of sleep disruption, was associated with the equivalent of 321 days of age acceleration.

“People’s biological age might not be the same as their chronological age. Individuals, whose biological age is higher than their chronological age, exhibit age acceleration or fast ageing. In our study, we found that more severe sleep-disordered breathing is associated with epigenetic age acceleration. Our data provide biological evidence supporting adverse physiological and health effects of untreated sleep-disordered breathing,” said the lead author. 

Sleep-disordered breathing, such as obstructive sleep apnea, is characterized by abnormalities of respiration during sleep. Episodes often result in reductions in blood oxygen saturation and are usually terminated by brief arousals from sleep. Nearly 30 million adults in the US have obstructive sleep apnea. Common warning signs include snoring and excessive daytime sleepiness.

According to the authors, epigenetic age acceleration is a DNA methylation-based marker of fast biological ageing, and it is associated with modifiable lifestyle factors. Although sleep-disordered breathing is associated with multiple age-related health disorders, its relationship with epigenetic ageing has not been well studied.

Another surprising finding was that the associations were stronger in women than in men, suggesting that women may be particularly vulnerable to the adverse effects of sleep-disordered breathing.

“While women are often considered to be at lower risk for health outcomes related to sleep-disordered breathing, our findings suggest increased biological susceptibility,” said the author.  

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Snoring isn’t just annoying, it could be a sign of serious health problems

When 33-year-old Shekar’s wife Anjana (names changed) first began to complain about his snoring, he brushed her concerns aside. “Just roll me over to the side, and go back to sleep,” he told her with a laugh. But as the months passed, Anjana began to notice more disturbing patterns in Shekar’s sleep. 

Now, he was not only snoring, but frequently waking up for a few seconds with a gasp, as if he couldn’t breathe. Finally, to settle her worrying, Shekar went to an ENT specialist, who recommended a sleep study. The results came as a revelation to Shekar: his sleep was broken at least 30-40 times an hour, as his oxygen-deprived body struggled to get more air into his lungs.

For most of us, snoring is just a minor irritation, more a laughing matter than a genuine concern. After all, we think, it’s just a sign of very deep sleep. But, as Shekar found out, snoring could be an indicator of a much deeper health problem called obstructive sleep apnoea (OSA). If not treated, his doctor explained to him, his OSA could lead to hypertension or high blood pressure, heart problems, diabetes, or even a stroke or a myocardial infarction (commonly called a heart attack).

What is obstructive sleep apnoea?
Obstructive sleep apnoea occurs when the windpipe gets blocked by the tonsils, tongue and so on. Most commonly, the flexible soft palate and the tongue collapse, blocking the passage through which air passes from the nose and mouth to the lungs. As a result, the lungs do not receive enough air, and the whole body is deprived of the oxygen required.

“Our normal oxygen saturation level is at least 95-96%. But we see cases where people’s oxygen levels drop to even 60% when they are sleeping. That means their heart and brain is getting very less oxygen. This is not a trivial issue at all,” says a Senior ENT Specialist.

While there is insufficient research focused on OSA, available statistics indicate that roughly 2-5% of Indian men and 1-2% of Indian women suffer from this condition. This implies that about 34 million people suffer from sleep apnoea. Importantly, over 80% of these cases go undiagnosed.

Signs, symptoms and risk factors
There are several signs and symptoms that you should look for to know if you might have sleep apnoea. While snoring is one of the prominent indicators, there could be people who have OSA without snoring as well. The other common signs and symptoms include episodes of not breathing during sleep, gasping for air during sleep, waking up with a dry mouth, morning headaches, difficulty staying asleep, daytime sleepiness, difficulty paying attention during waking hours and irritability.
There are several factors that could make you more prone to developing OSA. These include excess weight or obesity, thicker neck circumference, narrowed airway, being male, older age, family history of snoring, use of alcohol or sedatives and smoking.

Lack of awareness
The Dr. says that one of the biggest difficulties faced in relation to sleep apnoea is the lack of sufficient awareness of this problem. “In Western countries, you can even be denied a driver’s license if you have OSA, because you might doze off at the wheel. But here we are not that strict. So many people come to us complaining about daytime sleepiness. Some say they regularly doze off during the day. But they don’t realise it’s a symptom of OSA.”

Even among the medical fraternity, he adds, there is not enough attention given to sleep apnoea and the harmful consequences that can result.

How OSA is diagnosed
Dr. says that the techniques for diagnosing and treating sleep apnoea have significantly improved in the last few years. The most common diagnosis technique is a sleep study, where instruments monitor a person while they sleep, to check the Apnoea-Hypapnoea index, number of stops in breathing or incidents of shallow breathing in an hour. Besides this, doctors also look at the Respiratory Distress Index (changes in sleep due to effort to breathe) and snoring index.

One of the more recent innovations in the area of diagnosis, says the  Dr., is called DISE, drug-induced sleep endoscopy. In this technique, patients are placed in a drug-induced sleep, and an endoscopy is performed on them while they sleep to discover which parts of the respiratory passages are getting blocked and why. This technique, however, is still not prevalent enough, he adds.

Treatment

For treatment, doctors most commonly advise a CPAP (continuous positive airway pressure) machine, which is a breathing mask that pushes a steady and continuous flow of air into the patient’s airways. However, says the Dr., the problem for most patients is that CPAP requires constant and continuous use. “One of the problems is that it has to be used on all 365 days, throughout the entire hours of sleep. But people buy it, use it for one or two years and then stop because they get fed up. Some people also complain about discomfort because of wearing the mask at all points.

However, adds the Dr., several lifestyle modifications as well as surgeries can help patients significantly. Lifestyle modifications could include weight-loss programmes, including bariatric surgery for severe obesity; quitting smoking; healthier diet, including reduction of alcohol consumption; and developing better sleep habits.

Surgeries to remove blockages such as a septal deviation or to widen the respiratory passages are also highly useful. In this area, says the Dr. , the biggest innovation in recent years is coblation, which uses radio frequency to remove tissue, causing minimal damage to surrounding tissue, reducing the amount of blood loss and pain to the patient. “We now have a much better understanding of snoring, better investigative patterns and treatment procedures. Now what is necessary is for people to take the problem as seriously as it deserves,” he adds.

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Causes of Nighttime Urination

When you body goes into rest mode every night, your bladder switches gears and produces less, but more concentrated urine to let you sleep without interruption. This balance can be cut short by a variety of factors, including disease. And while the majority of people need a nighttime detour to the bathroom because of the glass of wine they had in the evening and have nothing to worry about, frequent and multiple nighttime urination is a red flag.
Even so, nocturia (the scientific term for frequent nighttime urination) may be caused by a disease, there are some benign causes, among which are the following:

    Diuretic medications
    Caffeine
    Alcohol
    Excessive fluids before bedtime.

As a symptom, nocturia can point to a variety of diseases, from urinary infections to neurological diseases and everything in-between. Scroll down to read about each cause.

1. Obstructive Sleep Apnea
Nighttime urination is so prevalent in sleep apnea that it became a tell-tale sign of the disease, as significant as snoring, but many people don’t suspect that sleep apnea may be the cause of frequent nighttime urination. The American Sleep Apnea Association mentions that over 84% of patients suffering from sleep apnea reported nocturia.

Many patients with untreated sleep apnea report 6 or more nighttime bathroom trips. The underlying mechanism of nocturia in sleep apnea is unclear, but it is known that patients who start a treatment targeting sleep apnea find that it resolves the nightly bathroom breaks almost completely.

2. Bladder Prolapse
A bladder prolapse can happen when a woman’s bladder is poorly supported by pelvic muscles and ligaments, as a result, it descends to the vaginal wall. Patients with even a minor prolapse complain about nocturia, and bladder prolapse is one of the leading causes of nocturia in women.

In this condition, nighttime urination likely occurs because the tension of the vagina can aggravate the bladder when in a horizontal position, and one gets the urge to urinate, even when the bladder isn’t full.

3. Enlarged Prostate
 An enlarged prostate is called benign prostatic hyperplasia (BPH) in medical terms. In patients suffering from BPH, the urinary tract changes its shape and functionality together with the enlargement of the prostate.

BPH is one of the major causes of nocturia in males, which is brought about by increased bladder sensation and the narrowing of the urethra, which can make you feel an urgency to urinate, even when your bladder is nearly empty. In these cases, nocturia is not the only symptom and an increased need to urinate and incontinence are also observed.

4. Anxiety and Depression
Mental problems, such as anxiety and depression may manifest themselves in the form of nocturia, too. Although the exact link between these 2 conditions is unknown, nocturia is believed to be a side effect of sleep disturbances that come with anxiety and depression.

In these cases, it’s not the need to empty the bladder that wakes a person up, but they take a trip to the bathroom when they’re already up. To stop both the nocturia and the sleep disturbances, it is recommended to try to relax before sleep, either by doing breathing exercises, aromatherapy, or meditation.

It is also a good idea to avoid evening naps, nighttime meals and caffeinated drinks in the evenings.

5. UTIs
One of the most common causes of nocturia are a urinary tract infections (UTIs), cystitis, as well as bladder or kidney infections. These infections of the urinary system usually cause frequent burning sensations before, during and after urination, as well as the urgency to urinate during the day and night.

Other symptoms of these infections include changes in urine, fever, pain in the lover back and lower pelvis.

6. Swelling of the Legs (Edema)
There are many causes of edema, ranging from liver failure to heart disease, but all of these conditions cause excess water buildup in the tissues of the extremities.

This extra fluid has to go somewhere, so the body transports this fluid to the kidneys to excrete it from the body, which usually happens at night. This way, patients suffering from leg swelling may have to take a few night trips to the bathroom.

7. Multiple Sclerosis
People who suffer from multiple sclerosis, too, can experience nocturia, with an estimated 80 percent having some sort of bladder dysfunction during the progression of the disease, with some patients having to wake up 5-8 time during the night, feeling the urge to urinate.

This symptom occurs because MS patients have suffered damage to the nervous system, which may result in the disruption of nerve signals connected to the functioning of the bladder.

8. Parkinson’s Disease
Parkinson's disease (PD) is the 2nd most common neurodegenerative disease. In the course of the disease, patient most commonly experience motor control difficulties, but as much as 60% of PD patients also have bladder symptoms.

Although the causes of nocturia in PD are poorly understood, it was suggested that it may be due to higher quantities of urine production or a lower capacity of the bladder.

9. Overactive Bladder
An overactive bladder is a diagnosis encompassing a variety of conditions that all have the same symptom: a sudden unstoppable urge to urinate. Nocturia is one of the symptoms of an overactive bladder, and it is more common in people over the age of 60, but it has also been reported that one in three adults over the age of 30 needs 2 or more nighttime bathroom trips as well.

Other symptoms of an overactive bladder include a sudden uncontrollable urge to urinate, frequent incontinence, and more than 8 bathroom breaks in a 24-hour period. The reasons of this conditions are unknown, and therapy includes a variety of exercise, dietary restrictions, botox injections and even electro stimulation.

10. Tumors In the Pelvic Area
Both malignant and benign tumors of the organs of the lower abdomen, such as kidneys, reproductive organs and the digestive system may cause nighttime urination, as the tumor may press against the bladder, making it smaller and capable of holding less urine.

This will usually cause not only nocturia, but also incontinence and frequent urination during the day time.

11. Diabetes
Having high blood glucose levels can make the body get rid of excess glucose through urine. The more sugar the urine contains, the more it stimulates urine production.

This will make you urinate more often throughout the day and night, and it will also bring about the sensation of thirst. There is also a form of diabetes called diabetes insipidus that causes excess urination, with some patients urinating 20 litres (5.28 gallons) more than a normal person every day.

Please keep in mind that the information contained in this article is presented for informative purposes only. If you experience nocturia or any other suspicious symptoms, make sure to get a diagnosis by a specialist.
 

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                    PS- THOSE INTERESTED IN RECIPES ARE FREE TO  VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/                                                                                                                                                         FOR INFO ABOUT KNEE REPLACEMENT, YOU CAN VIEW MY BLOG-                                                  https:// kneereplacement-stickclub.blogspot.com/           

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