Juvenile idiopathic arthritis may be associated with an increased risk of obstructive sleep apnea
1. In this retrospective, cohort, control-matched study, a diagnosis of juvenile idiopathic diabetes was associated with an increased risk of developing obstructive sleep apnea.
2. Additionally, the association between sleep apnea and juvenile idiopathic arthritis was strongest in those aged 18-30 and in males.
Evidence Rating Level: 2 (Good)
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that affects the temporomandibular joint. JIA can lead to deformities in the joint that can cause upper airway collapse and difficulty breathing, increasing the risk of obstructive sleep apnoea (OSA). However, no studies have investigated the association between JIA and OSA.
This retrospective cohort study conducted in Taiwan investigated the risk of developing OSA following a JIA diagnosis using a longitudinal research database. Patients were followed retrospectively until OSA was resolved or withdrawal from the national insurance system which would have precluded them from treatment information in the The primary outcome assessed was presence of OSA in the context of a JIA diagnosis.
Overall, this study showed an increased risk of OSA amongst patients with JIA, compared to the non-JIA control group, after controlling for confounding comorbidities. The incidence of OSA in the JIA group was highest among individuals between the ages of 18-30. Furthermore, males were at greater risk of developing OSA compared with females in the entire study population. Finally, amongst patients with JIA, onset of OSA was most common either within 36 months, or after 60 months of first presentation with JIA-related sequelae. However, this study was limited because JIA is typically a delayed diagnosis and thus the association between JIA and OSA may be underestimated due to the exclusion of OSA first individuals with a delayed JIA diagnosis. Nonetheless, this study was significant in suggesting that there may be an association between JIA and OSA.
Sulthiame may be a safe and effective medication for severe obstructive sleep apnea
1. In this randomized controlled trial, sulthiame was shown to be a safe oral medication that can improve sleep apnea symptoms.
2. However, the medication sulthiame was associated with more adverse events, such as paresthesia and headaches, compared to placebo.
Evidence Rating Level: 2 (Good)
Obstructive sleep apnea (OSA) is a condition that’s associated with a range of cardiometabolic diseases, including hypertension, arrhythmia, stroke, and diabetes. The main treatment for OSA is continuous positive airway pressure therapy (CPAP), but this is not always effective due to patient adherence. The drug sulthiame, (STM) has been shown to inhibit the enzyme carbonic anhydrase, which has been implicated in one of the main pathological mechanisms of OSA. However, the safety and efficacy of this drug has not been tested in patients with OSA.
This randomized, placebo-controlled, double-blind dose-guiding study was designed to evaluate safety and tolerability of STM in patients with moderate and severe OSA who cannot comply with CPAP therapy. The study involved five consecutive dose escalation cohorts over 4 weeks of treatment, with 68 patients randomized to receive either STM or placebo. Patients were included if they were between 18 and 75 years, had a body mass index between 20 and 35, an Epworth Sleepiness Scale score of at least 6, and had an apnea-hypopnea index greater than 15, corresponding to moderate to severe OSA. Sleep was assessed using polysomnography and patient-reported outcomes were also collected.
Results demonstrated that STM was safe and well tolerated amongst patients with moderate and severe OSA, with no severe adverse events (AEs) attributed to the medication, in keeping with the known safety profile of STM. Specifically, a 200 mg dose had a more favorable tolerability profile compared to 400 mg. The number of AEs were higher in the STM treatment group than placebo; however, commonly reported AE’s including paresthesia’s and headaches were generally short lasting and mild. Compared to the placebo, the apnea-hypoxia was significantly reduced in the STM group. Sleep efficacy and latency were also improved with STM administration. However, this study was limited by its short study period of 4 weeks and the exploration of only 2 doses. Nonetheless, this study provides evidence that the safety profile is acceptable and can improve OSA symptoms.
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Environmental noises are associated with poor self-reported sleep quality
1. In this update to the World Health Organization (WHO) systematic review and meta-analysis, evening transport noises have a negative effect on sleep quality.
2. Additionally, pre-existing WHO recommendations on sound thresholds at night, including 45 dB for road traffic, 44 dBÂ for rail traffic, and 40 dB for air traffic, remain adequate targets to prevent sleep disturbances.
Evidence Rating Level: 1 (Excellent)
Sleep is an important component to physical and mental health and well-being. Environmental noises have been linked to a significant burden of disease with regards to sleep. The World Health Organization (WHO) has published guidelines for protecting human health from exposure to environmental noise, including recommendations for target nighttime noise levels to mitigate the effects of traffic noise on sleep. However, these guidelines were based off a 2015 systematic review and meta-analysis and have not been updated since.
This systematic review and meta-analysis aimed to update the data and evidence behind these recommendations by including studies published up to 2021. Eligible studies include assessment of self-reported sleep disturbances. This study added 11 additional studies to the pre-existing 25 studies from the original systematic review. The study included only primary investigations in humans exposed to environmental noise from aircraft, road, and rail traffic at home, with sound pressure levels measured or predicted at the participant’s home. The study excluded those with subjective evaluations of noise levels and those that did not specify noise levels at the participant’s home address. The systematic review was prepared using the PRISMA guidelines. Primary outcomes assessed included sleep disturbance, awakenings, and falling asleep.
The study found that there was a significant probability of being highly sleep disturbed by nocturnal noise from aircraft, road, and railway. Additionally, the exposure-response relationships studied in this systematic review and meta-analysis closely agreed with the previous study at low sound levels across all traffic types, though greater disparity was noted at higher levels with aircraft noise. The quality of evidence for these outcomes and assessment of risk of bias was moderate. However, this study was limited by potential exposure misclassification in modeling noise levels at the most exposed side of a home rather than at the bedroom. Additionally, the meta-analysis did not adjust for age, sex, socioeconomic status, and pre-existing sleep disorders. Nonetheless, this study provides confirmation that the WHO guidelines are beneficial in avoiding sleep disturbances.
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