Oh-Young Kwon

Obstructive sleep apnea (OSA) presents an elevated risk to patients with stroke, especially during the acute phase when prolonged bed rest in the supine position is common in stroke unit (SU). Recent studies suggest that rostral fluid shifts may worsen OSA severity. This study aimed to compare OSA severity between patients with acute stroke in a SU and outpatients with OSA using in-laboratory polysomnography (iPSG) to gain further insight into this relationship. This cross-sectional study was conducted at Samsung Changwon Hospital between April 2021 and October 2022. Patients with acute stroke and outpatients who underwent iPSG were included. SU patients were screened for OSA symptoms and selected based on modified Mallampati score ≥ 3. SU patients were assessed using iPSG during their hospital stay after bed rest periods. Propensity score matching (PSM) was used to control for confounding variables. Among 530 SU patients, 30 completed iPSG. SU patients exhibited significantly higher supine apnea–hypopnea index (AHI) than outpatients (60.1 vs 28.4, P = .004). The stroke group showed increased odds of elevated supine AHI (OR = 4.99, 95% CI: 1.90–13.11, P = .001). After PSM adjustment, the association remained significant (OR = 18.47, 95% CI: 1.53–222.20, P = .022). Eighty percent of SU patients had moderate-to-severe OSA (AHI ≥ 15) compared to 60% of outpatients. Patients with acute stroke in a SU demonstrate significantly higher supine AHI compared to outpatients with OSA. These findings suggest that prolonged bed rest and supine positioning during acute stroke management may contribute to OSA severity.

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Yang TW, et al. J Clin Neurol. 2022 Nov;18(6):642-652. https://doi.org/10.3988/jcn.2022.18.6.642

Study Objectives: Rapid eye movement (REM) sleep without atonia (RWA) is essential for diagnosing REM sleep behavior disorder (RBD). Manual and automatic quantifications of RWA that use different criteria have been validated. This study compared the RWA quantification methods for diagnosing RBD. Methods: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systemically searched for studies published from inception to December 2021. The inclusion criteria were cohort, cross-sectional, and case-control studies assessing the sensitivity and specificity of RWA quantification methods. Pooled estimates of the sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were determined. Risk of bias and certainty of evidence was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool and the Grading of Recommendations, Assessment, Development, and Evaluations framework, respectively. Results: Fourteen articles including 402 patients with RBD met the inclusion criteria. Manual methods evaluating any chin and phasic flexor digitorum superficialis (FDS) activity had the highest DOR (138.8, 95% CI = 21.8% to 881.7%) and AUC (0.9686). The automatic REM atonia index (RAI) showed similar or higher sensitivity (89.1%, 95% CI = 84.6% to 92.7%) but a lower specificity (73.5%), DOR (43.1), and AUC (0.9369) than the manual techniques. Conclusions: In this meta-analysis, manual RWA quantification that employed chin or phasic FDS activity had the best RBD diagnostic performance. The automatic RAI method may be useful for screening patients with RBD. The results should be interpreted carefully because of the high risk of bias in patient selection and significant heterogeneity among the studies. PROSPERO Registration number: CRD42021276445.