Background The gold standard for sleep monitoring is in-lab polysomnography (PSG), which is expensive, time-consuming and requires specialized equipment. Onera Health has developed the first wireless patch-based PSG system, the Onera STS, which consists of four body-worn patches that record full PSG outside of a hospital setting. The objective of this study was to validate the Apnea-Hypopnea-Index (AHI) from the Onera STS against in-lab PSG.

Background: Polysomnography (PSG) is the gold standard for diagnosing and monitoring sleep disorders, however, it is time-consuming and costly, as the application of the equipment can only be done by trained sleep technicians and the test must be conducted within a sleep laboratory. Objectives: In this study we assessed the performance of the first wireless patch-based PSG system, the Onera Sleep Test System (STS), which can be applied by the patient and performed outside of the sleep laboratory in settings such as the home. To achieve this, sleep stage and physiological data from the Onera STS were compared to gold standard in-lab PSG. Materials and methods: The recordings were unsupervised to simulate a home-use environment. Epoch-by-epoch agreement was assessed by calculating sensitivity, specificity, accuracy, and Cohens kappa coefficient. Pearsons correlation coefficients were calculated for multiple sleep parameters to measure the level of entire night agreement. Results: Substantial agreement with a Cohens kappa of 0.69 across all sleep stages was determined, which reached 0.81 when Stage N1 was removed from the analysis. A high accuracy, specificity, and sensitivity were found for wake N2, N3 and REM. Although specificity (95.25%) and accuracy (89.62%) were high for N1, sensitivity was low (27.19%). Sleep parameters calculated by sleep stage transitions, apnea hypopnea index and oxygen desaturation index, showed strong correlations. Conclusions: The Onera STS provides comparable clinical information to traditional PSG. Moreover, the application time was reduced by 77% which reduces the overall costs of PSG. These results open the possibility for PSG studies to be performed efficiently outside of the sleep laboratory at a larger scale, thus improving access for patients.

Abstract Introduction Current home sleep test (HST) devices are limited by an absence of EEG, or by being too cumbersome to use. We developed a wireless PSG system (Onera Health, NL) consisting of four disposable patches to record EEG, EOG, EMG, SaO2, ECG, bioimpedance derived respiratory airflow and effort, airflow via nasal cannula, snoring sounds, body position, actigraphy, and leg movements. Signals are stored on reusable electronic modules attached to each patch. Methods We measured PSG hook-up time in 15 healthy laypersons (6 male, 9 female, age 18-to-70 yrs, BMI 29.7±5.2 kg/m2). We also enrolled 6 additional asymptomatic healthy volunteers (2 male, 4 female, age 27-to-33 yrs, BMI 24.3±5.7 kg/m2) with history of occasional snoring, on which we scored the apnea-hypopnea index (AHI) using data from our patch-based PSG system recorded at home. We evaluated scoring using the 2016 AASM rules for hypopneas in comparison to the 2007 AASM rules requiring a greater than 3% fall in SaO2 for obstructive hypopneas. Results Mean hook-up time for applying all four patches and electronic modules was 4:42 ± 1:20 min. Mean home sleep efficiency was 89.5 SE 1.9% with an average REM% of 20 SE 6.7%. When comparing the 2016 vs 2007 AASM rules for scoring hypopneas, the AHI increased more than threefold during NREM (9.0 SE 2.0/h vs 2.7 SE 0.8/h; p<0.03) and minimally during REM (11.7 SE 2.3/h and 7.1/h SE 1.8/h; p<0.01), implying an overall increase in the AHI from 3.7 SE 0.8/h to 9.9 SE 1.9/h; p<0.02. One subject changed AHI category from normal to mild (3.6 to 14.4/h), another from mild to moderate (12.7 to 26.3/h) using the 2016 AASM rules. Conclusion Our wireless patch-based PSG system is an easy solution for sleep studies at home or in the sleep lab, lowering the burden to conduct large scale epidemiologic sleep studies. The presence of standard EEG signals allows to determine NREM and REM statistics, respiratory and non-respiratory arousal indices, AHI and RERA’s by sleep stages. Preliminary study results show that using cortical arousal criteria for hypopneas, the AHI increase is more pronounced in NREM compared to REM sleep. Support (if any):

Apnea-hypopnea index (AHI) is the main polysomnographic measure to diagnose obstructive sleep apnea (OSA). We aimed to evaluate the effect of three standard hypopnea definitions on the prevalence of OSA and its association with cardiometabolic outcomes in the general population. We analyzed data from the HypnoLaus study (Lausanne, Switzerland), in which 2,162 participants (51

This study determined the prevalence of rapid eye movement (REM) related sleep-disordered breathing (REM-SDB) in the general population and investigated the associations of REM-SDB with hypertension, metabolic syndrome, diabetes and depression.Home polysomnography (PSG) recordings (n=2074) from the population-based HypnoLaus Sleep Cohort (48.3% men, 57±11 years old) were analysed. The apnoea-hypopnoea index was measured during REM and non-REM sleep (as REM-AHI and NREM-AHI, respectively). Regression models were used to explore the associations between REM-SDB and hypertension, diabetes, metabolic syndrome and depression in the entire cohort and in subgroups with NREM-AHI <10 events·h-1 and total AHI <10 events·h-1The prevalence of REM-AHI ≥20 events·h-1 was 40.8% in the entire cohort. An association between increasing REM-AHI and metabolic syndrome was found in the entire cohort and in both the NREM-AHI and AHI subgroups (p-trend=0.014, <0.0001 and 0.015, respectively). An association was also found between REM-AHI ≥20 events·h-1 and diabetes in both the NREM-AHI <10 events·h-1 (odds ratio (OR) 3.12 (95% CI 1.35-7.20)) and AHI <10 events·h-1 (OR 2.92 (95% CI 1.12-7.63)) subgroups. Systolic and diastolic blood pressure were positively associated with REM-AHI ≥20 events·h-1REM-SDB is highly prevalent in our middle-to-older age sample and is independently associated with metabolic syndrome and diabetes. These findings suggest that an increase in REM-AHI could be clinically relevant.

To determine the prevalence and clinical associations of respiratory effort-related arousals (RERA) in a general population sample. A total of 2,162 participants (51.2

OBJECTIVE:Sleep-disordered breathing (SDB) is currently considered as a unique condition, but it has been suggested that the prevalence, clinical presentation, and associated conditions may differ by sex or by menopausal status in women. We aimed to assess the prevalence of SDB and associated comorbidities in pre- and postmenopausal women compared with men.METHODS:Participants of the population-based HypnoLaus Sleep Cohort study underwent polysomnography in their home environment and had extensive phenotyping for diabetes, hypertension, metabolic syndrome, and depression.RESULTS:A total of 2121 subjects (age 40-85 [59 ± 11] years, body mass index 25.6 ± 4.1 kg/m2, 1024 men and 1097 women [769 postmenopausal]) were included. SDB prevalence based on an apnea-hypopnea index of >5/h, >15/h, >20/h, and ≥30/h, respectively, was 83.8%, 49.7%, 37.5%, and 22.0% in men; 35.1%, 8.6%, 3.3%, and 1.3% in premenopausal women; and 71.6%, 29.4%, 20.7%, and 10.1% in postmenopausal women. In multivariable models, SDB severity was significantly associated with hypertension in women (p = 0.007) (mainly in postmenopausal women) but not in men (p = 0.065), with diabetes in men (p = 0.021) but not in women overall (p = 0.853) or in postmenopausal women (p = 0.725), with metabolic syndrome in men (p = 0.002) and women (p < 0.001), and with depression in women (p = 0.007) but not in men (p = 0.853).CONCLUSION:SDB prevalence in this middle-aged to-older population was high, particularly in men and postmenopausal women. SDB was associated with hypertension and depression exclusively in women, whereas an association with diabetes was present only in men. These findings suggest that the SDB definition and management recommendations may need to be adapted to these groups' specificities.

Introduction: Sleep-disordered breathing (SDB) in women is probably under-diagnosed. It is also unclear whether clinical conditions associated with SDB differ by gender or by hormonal status in women. Aims and objectives: To assess the prevalence of SDB and associated comorbidities in pre- and post-menopausal women (pre-M, post-M) compared with men. Methods: The subjects of the population-based HypnoLaus Sleep Cohort underwent polysomnography in their home environment and had extensive phenotyping for diabetes, hypertension, metabolic syndrome and depression. Results: 2121 subjects (age 40–85 [59±11]yo), BMI 25.6±4.1 kg/m2, 51.7% women (70% post-M) were included. SDB prevalence with an AHI of >5/h, >15/h, and ≥30/h, respectively, was: 83.8%, 49.7%, and 22.0% in men, 35.1%, 8.6%, and 1.3% in pre-M women, and 71.6%, 29.4%, and 10.1% in post-M women. In contrast to men and post-M women, SDB in pre-M women was not associated with age, neck circumference and snoring. In multivariable adjusted regression models, SDB severity was significantly associated with: hypertension in women (p=0.007), post-M women (p=0.048) but not in men (p=0.065); with diabetes in men (p=0.021) but not in women (p=0.853) or in post-M women (p=0.725); with metabolic syndrome in men (p=0.002), women (p<0.001) and post-M women (p<0.001); and with depression in women (p=0.007) but not in men (p=0.853) or post-M women (p=0.061). Conclusion: The prevalence of SDB in this population-based cohort was high, particularly in men and post-M women. SDB was associated with hypertension and depression exclusively in women, with diabetes in men only, and with metabolic syndrome in both genders.

OBJECTIVE:Periodic limb movements during sleep (PLMS) are prevalent in the general population, but their impact on sleep and association with cardiometabolic disorders are a matter of debate. METHODS:Data from 2162 participants (51.2% women, mean age 58.4 ± 11.1 years) of the population-based HypnoLaus study (Lausanne, Switzerland) were collected. Subjective sleep complaints and habits were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale (ESS). Participants underwent a full polysomnography (PSG) at home and were evaluated for the presence of hypertension, diabetes, and metabolic syndrome. RESULTS:Participants with a PLMS index (PLMSI) > 15/h (28.6% of the sample) had longer subjective sleep latency (18.6 ± 17.2 vs. 16.1 ± 14.3 min, p = 0.014) and duration (7.1 ± 1.2 vs. 6.9 ± 1.1 h, p < 0.001) than participants with PLMSI ≤ 15/h. At the PSG, they spent more time in stage N2 sleep (49.0 ± 11.2 vs. 45.5 ± 9.8%, p < 0.001), less in stage N3 (17.6 ± 8.2 vs. 20.6 ± 8.4%, p < 0.001) and in REM sleep (20.3 ± 6.4 vs. 22.4 ± 6.0%, p < 0.001), and exhibited longer REM latency (104.2 ± 70.2 vs. 91.7 ± 58.6 min, p < 0.001) and higher arousal index (26.5 ± 12.3 vs. 19.2 ± 9.7 n/h, p < 0.001). Participants with a PLMSI > 15/h had a lower ESS scores and higher prevalence of hypertension, diabetes, and metabolic syndrome. Multivariate analysis adjusting for confounding factors confirmed the independent association of PLMSI > 15/h with subjective sleep latency and duration, and with objective sleep structure disturbances. However, the associations with sleepiness and cardiovascular risk factors disappeared. CONCLUSIONS:In our large middle-age European population-based sample, PLMSI > 15/h was associated with subjective and objective sleep disturbances but not with sleepiness, hypertension, diabetes, or metabolic syndrome.

ObjectivePeriodic limb movements during sleep (PLMS) are sleep phenomena characterized by periodic episodes of repetitive stereotyped limb movements. The aim of this study was to describe the prevalence and determinants of PLMS in a middle to older aged general population.MethodsData from 2,162 subjects (51.2% women, mean age = 58.4 ± 11.1 years) participating in a population‐based study (HypnoLaus, Lausanne, Switzerland) were collected. Assessments included laboratory tests, sociodemographic data, personal and treatment history, and full polysomnography at home. PLMS index (PLMSI) was determined, and PLMSI > 15/h was considered as significant.ResultsPrevalence of PLMSI > 15/h was 28.6% (31.3% in men, 26% in women). Compared to subjects with PLMSI ≤ 15/h, subjects with PLMSI > 15/h were older (p < 0.001), were predominantly males (p = 0.007), had a higher proportion of restless legs syndrome (RLS; p < 0.001), had a higher body mass index (p = 0.001), and had a lower mean glomerular filtration rate (p < 0.001). Subjects with PLMSI > 15/h also had a higher prevalence of diabetes, hypertension, and beta‐blocker or hypnotic treatments. The prevalence of antidepressant use was higher, but not statistically significant (p = 0.07). Single nucleotide polymorphisms (SNPs) within BTBD9 (rs3923809), TOX3 (rs3104788), and MEIS1 (rs2300478) genes were significantly associated with PLSMI > 15/h. Conversely, mean hemoglobin and ferritin levels were similar in both groups. In the multivariate analysis, age, male gender, antidepressant intake, RLS, and rs3923809, rs3104788, and rs2300478 SNPs were independently associated with PLMSI > 15/h.InterpretationPLMS are highly prevalent in our middle‐aged European population. Age, male gender, RLS, antidepressant treatment, and specific BTBD9, TOX3, and MEIS1 SNP distribution are independent predictors of PLMSI > 15/h. ANN NEUROL 2016;79:464–474

OBJECTIVE:To assess the association between sleep structure and cognitive impairment in the general population. METHODS:Data stemmed from 580 participants aged >65 years of the population-based CoLaus/PsyCoLaus study (Lausanne, Switzerland) who underwent complete sleep evaluation (HypnoLaus). Evaluations included demographic characteristics, personal and treatment history, sleep complaints and habits (using validated questionnaires), and a complete polysomnography at home. Cognitive function was evaluated using a comprehensive neuropsychological test battery and a questionnaire on the participant's everyday activities. Participants with cognitive impairment (global Clinical Dementia Rating [CDR] scale score > 0) were compared with participants with no cognitive impairment (global CDR score = 0). RESULTS:The 291 participants with a CDR score > 0 (72.5 ± 4.6 years), compared to the 289 controls with CDR = 0 (72.1 ± 4.6 years), had significantly more light (stage N1) and less deep (stage N3) and REM sleep, as well as lower sleep efficiency, higher intrasleep wake, and higher sleepiness scores (all p < 0.05). Sleep-disordered breathing was more severe in participants with cognitive impairment with an apnea/hypopnea index (AHI) of 18.0 (7.8-35.5)/h (p50 [p25-p75]) (vs 12.9 [7.2-24.5]/h, p < 0.001), and higher oxygen desaturation index (ODI). In the multivariate analysis after adjustments for confounding variables, the AHI and the ODI ≥4% and ≥6% were independently associated with cognitive impairment. CONCLUSIONS:Participants aged >65 years with cognitive impairment have higher sleepiness scores and a more disrupted sleep. This seems to be related to the occurrence of sleep-disordered breathing and the associated intermittent hypoxia.

Explorer l’association entre sommeil et déficits cognitifs dans un échantillon de la population générale. Nous avons analysé les données de 580 sujets participant à l’étude HypnoLaus (Lausanne, Suisse) qui ont eu un enregistrement polysomnographique et une évaluation cognitive (Clinical Dementia Rating Scale, CDR). Les participants avec un score CDR global > 0 ont été considérés comme ayant des troubles cognitifs. Nous avons identifié 291 sujets (72,4 ± 4,6 ans, 43,3 % femmes) avec des troubles cognitifs. Comparés à 289 contrôles (72,1 ± 4,6 ans, 65,7 % femmes), ils présentaient moins de stade 3 (61,0 ± 33,4 vs 67,5 ± 32,5 min, p = 0,017), moins de sommeil paradoxal (73,6 ± 31,7 vs 79,9 ± 30,9 min, p = 0,016), ainsi que des index d’apnées/hypopnées (IAH : 16,0 ± 17,6 vs 10,7 ± 12,8/h, p < 0,001) et de désaturations (IDO3 %, IDO4 %, IDO6 %, p < 0,001 pour tous) plus élevés. Après ajustement pour l’âge, le sexe, l’indice de masse corporelle, la présence d’une hypertension, d’un diabète, d’une dépression, la consommation d’alcool, de tabac, de médicaments et le niveau d’études, l’IAH (OR : 1,013 IC 95 % [1,0004–1,0277], p = 0,043), l’IDO4 % (1,0162 [1,0013–1,0313], p = 0,033) et le IDO6 % (1,0289 [1,0028–1,0557], p = 0,029) restaient indépendamment associés à la présence de troubles cognitifs. Dans le modèle multivarié, l’IAH, l’IDO4 % et l’IDO6 % étaient indépendamment associés à la présence de déficits cognitifs. Les troubles respiratoires au cours du sommeil pourraient jouer un rôle dans leur développement.

Objective. Although sleep is a biomarker for general health and pathological conditions, its changes across age and gender are poorly understood. Methods. Subjective evaluation of sleep was assessed by questionnaires in 5,064 subjects, and 2,966 were considered without sleep disorders. Objective evaluation was performed by polysomnography in 2,160 subjects, and 1,147 were considered without sleep disorders. Only subjects without sleep disorders were included (aged 40–80 years). Results. Aging was strongly associated with morning preference. Older subjects, especially women, complained less about sleepiness, and pathological sleepiness was significantly lower than in younger subjects. Self-reported sleep quality and daytime functioning improved with aging. Sleep latency increased with age in women, while sleep efficiency decreased with age in both genders. Deep slow-wave sleep decreased with age, but men were more affected. Spectral power densities within slow waves (< 5 Hz) and fast spindles (14–14.75 Hz) decreased, while theta-alpha (5-1 Hz) and beta (16.75–25 Hz) power in non-rapid eye movement sleep increased with aging. In REM sleep, aging was associated with a progressive decrease in delta (1.25–4.5 Hz) and increase in higher frequencies. Conclusions. Our findings indicate that sleep complaints should not be viewed as part of normal aging but should prompt the identification of underlying causes.

BACKGROUND Chronic mountain sickness (CMS) is often associated with vascular dysfunction, but the underlying mechanism is unknown. Sleep-disordered breathing (SDB) frequently occurs at high altitude. At low altitude, SDB causes vascular dysfunction. Moreover, in SDB, transient elevations of right-sided cardiac pressure may cause right-to-left shunting in the presence of a patent foramen ovale (PFO) and, in turn, further aggravate hypoxemia and pulmonary hypertension. We speculated that SDB and nocturnal hypoxemia are more pronounced in patients with CMS compared with healthy high-altitude dwellers, and are related to vascular dysfunction. METHODS We performed overnight sleep recordings, and measured systemic and pulmonary artery pressure in 23 patients with CMS (mean ± SD age, 52.8 ± 9.8 y) and 12 healthy control subjects (47.8 ± 7.8 y) at 3,600 m. In a subgroup of 15 subjects with SDB, we assessed the presence of a PFO with transesophageal echocardiography. RESULTS The major new findings were that in patients with CMS, (1) SDB and nocturnal hypoxemia was more severe (P < .01) than in control subjects (apnea-hypopnea index [AHI], 38.9 ± 25.5 vs 14.3 ± 7.8 number of events per hour [nb/h]; arterial oxygen saturation, 80.2% ± 3.6% vs 86.8% ± 1.7%, CMS vs control group), and (2) AHI was directly correlated with systemic blood pressure (r = 0.5216; P = .001) and pulmonary artery pressure (r = 0.4497; P = .024). PFO was associated with more severe SDB (AHI, 48.8 ± 24.7 vs 14.8 ± 7.3 nb/h; P = .013, PFO vs no PFO) and hypoxemia. CONCLUSIONS SDB and nocturnal hypoxemia are more severe in patients with CMS than in control subjects and are associated with systemic and pulmonary vascular dysfunction. The presence of a PFO appeared to further aggravate SDB. Closure of the PFO may improve SDB, hypoxemia, and vascular dysfunction in patients with CMS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov.

Le but de cette étude était de comparer les caractéristiques du sommeil chez les patients migraineux et chez des témoins appariés sur l’âge et le sexe. Les données de 2162 participants à l’étude Hypnolaus/Psycholaus, une cohorte basée sur un échantillon représentatif de la population de Lausanne (Suisse), ont été analysées. Nous avons identifié les sujets migraineux sur la base des critères de l’International Headache Society. Les plaintes et les habitudes du sommeil ont été évaluées à l’aide de l’index de qualité du sommeil de Pittsburgh, l’échelle d’Epworth, les critères diagnostiques du syndrome des jambes sans repos, le questionnaire de Berlin pour les troubles respiratoires et du questionnaire de typologie circadienne de Horne/Ostberg. Tous les sujets ont eu une polysomnographie (PSG) complète à domicile. Cent quinze sujets migraineux (âge moyen : 54,3 ± 10,7 années, 69,5 % de femmes) ont été identifiés. Par rapport à 230 témoins appariés, les migraineux ont rapporté une moins bonne qualité de sommeil (score PSQI : 6,1 ± 3,3 vs 5 ± 2,8, p = 0,006), une latence d’endormissement subjective plus longue (20,2 ± 18,8 vs 16,2 ± 14,5 min, p = 0,009), plus de jambes sans repos (22,6 % vs 13,9 %, p = 0,039) et plus d’apnées constatées par l’entourage (11,3 % vs 5,2 %, p = 0,014). Nous n’avons pas observé de différences majeures entre les deux groupes en ce qui concerne les paramètres PSG, sauf une tendance à un allongement du temps total de sommeil (415,7 ± 58,2 vs 403,1 ± 73 min, p = 0,10) et à une diminution du sommeil lent profond (20,4 ± 7,3 % vs 21,9 ± 8,2 %, p = 0,10). Aucune différence significative n’a été observée concernant la prise de médicaments pouvant influencer le sommeil. Comparés à des sujets témoins, les migraineux rapportent plus de plaintes liées au sommeil, malgré l’absence de différences significatives concernant les variables objectives du sommeil mesurées par PSG.

Investiguer la fréquence des mouvements périodiques des jambes au cours du sommeil (MPJS) et leurs déterminants dans la population générale. Nous avons analysé les données de 2162 sujets issus de la population générale (âge moyen 58 ± 11 ; 51,2 % des femmes) participant à l’étude Hypnolaus, une cohorte communautaire basée sur un échantillon représentatif de la population de la ville de Lausanne (Suisse). Tous les participants ont eu une évaluation clinique, ont rempli une série de questionnaires sur le sommeil et ont eu un enregistrement polysomnographique à domicile. L’index de MPJS (MPJSI) a été déterminé en fonction des critères de l’AASM 2007 avec un seuil pathologique de MPJSI fixé à > 15/h. Pour l’ensemble de la population, le MPJSI était de (médiane [P05–P95]) 14 [1–75]/heure de sommeil et 618 sujets (28,6 %) avaient un MPJSI > 15/h (34 [17–97]). Comparés aux sujets avec un MPJSI ≤ 15/h, ils étaient plus âgés (63,7 ± 10,7 vs 56,4 ± 10,5 ans, p < 0,001), le pourcentage d’hommes était plus élevé (53,4 contre 47 %, p = 0,007), l’indice de distribution des globules rouges (reflet indirect de la concentration de fer sanguin) était plus bas (13,3 ± 0,7 vs 13,4 ± 0,9 fl, p < 0,01) et ils avaient un IMC plus haut (26,1 ± 4,3 vs 25,5 ± 4,2 kg/m2, p < 0,001). Un pourcentage plus élevé d’entre eux avait un syndrome d’impatiences (25,3 vs 15 %, p < 0,001), un diabète (14,2 vs 8,2 %, p < 0,001), une hypertension (54,5 vs 36,3 %, p < 0,001) et consommaient des hypnotiques (10,8 vs 8 %, p < 0,05). Il n’y avait pas de différences concernant la somnolence diurne mesurée par l’échelle d’Epworth. Dans l’analyse multivariée, l’âge, le sexe (masculin) et la présence d’un syndrome d’impatiences étaient indépendamment associés à un PLMSI > 15/h. La présence de MPJS est fréquente dans la population générale adulte. L’âge, le sexe masculin et la présence d’impatiences à l’éveil sont des facteurs prédictifs indépendants d’un MPJSI supérieur à 15/h.

INTRODUCTION:The aim of this study was to evaluate if there is a significant effect of lunar phases on subjective and objective sleep variables in the general population. METHODS:A total of 2125 individuals (51.2% women, age 58.8 ± 11.2 years) participating in a population-based cohort study underwent a complete polysomnography (PSG) at home. Subjective sleep quality was evaluated by a self-rating scale. Sleep electroencephalography (EEG) spectral analysis was performed in 759 participants without significant sleep disorders. Salivary cortisol levels were assessed at awakening, 30 min after awakening, at 11 am, and at 8 pm. Lunar phases were grouped into full moon (FM), waxing/waning moon (WM), and new moon (NM). RESULTS:Overall, there was no significant difference between lunar phases with regard to subjective sleep quality. We found only a nonsignificant (p = 0.08) trend toward a better sleep quality during the NM phase. Objective sleep duration was not different between phases (FM: 398 ± 3 min, WM: 402 ± 3 min, NM: 403 ± 3 min; p = 0.31). No difference was found with regard to other PSG-derived parameters, EEG spectral analysis, or in diurnal cortisol levels. When considering only subjects with apnea/hypopnea index of <15/h and periodic leg movements index of <15/h, we found a trend toward shorter total sleep time during FM (FM: 402 ± 4, WM: 407 ± 4, NM: 415 ± 4 min; p = 0.06) and shorter-stage N2 duration (FM: 178 ± 3, WM: 182 ± 3, NM: 188 ± 3 min; p = 0.05). CONCLUSION:Our large population-based study provides no evidence of a significant effect of lunar phases on human sleep.

Rationale Limited-channel portable monitors (PMs) are increasingly used as an alternative to polysomnography (PSG) for the diagnosis of obstructive sleep apnoea (OSA). However, recommendations for the scoring of PM recordings are still lacking. Pulse-wave amplitude (PWA) drops, considered as surrogates for EEG arousals, may increase the detection sensitivity for respiratory events in PM recordings. Objectives To investigate the performance of four different hypopnoea scoring criteria, using 3% or 4% oxygen desaturation levels, including or not PWA drops as surrogates for EEG arousals, and to determine the impact of measured versus reported sleep time on OSA diagnosis. Methods Subjects drawn from a population-based cohort underwent a complete home PSG. The PSG recordings were scored using the 2012 American Academy of Sleep Medicine criteria to determine the apnoea–hypopnoea index (AHI). Recordings were then rescored using only parameters available on type 3 PM devices according to different hypopnoea criteria and patients-reported sleep duration to determine the ‘portable monitor AHIs’ (PM-AHIs). Main results 312 subjects were included. Overall, PM-AHIs showed a good concordance with the PSG-based AHI although it tended to slightly underestimate it. The PM-AHI using 3% desaturation without PWA drops showed the best diagnostic accuracy for AHI thresholds of ≥5/h and ≥15/h (correctly classifying 94.55% and 93.27% of subjects, respectively, vs 80.13% and 87.50% with PWA drops). There was a significant but modest correlation between PWA drops and EEG arousals (r=0.20, p=0.0004). Conclusion Interpretation of PM recordings using hypopnoea criteria which include 3% desaturation without PWA drops as EEG arousal surrogate showed the best diagnosis accuracy compared with full PSG.

STUDY OBJECTIVES To evaluate the association between objective sleep measures and metabolic syndrome (MS), hypertension, diabetes, and obesity. DESIGN Cross-sectional study. SETTING General population sample. PARTICIPANTS There were 2,162 patients (51.2% women, mean age 58.4 ± 11.1). INTERVENTIONS Patients were evaluated for hypertension, diabetes, overweight/obesity, and MS, and underwent a full polysomnography (PSG). MEASUREMENTS AND RESULTS PSG measured variables included: total sleep time (TST), percentage and time spent in slow wave sleep (SWS) and in rapid eye movement (REM) sleep, sleep efficiency and arousal index (ArI). In univariate analyses, MS was associated with decreased TST, SWS, REM sleep, and sleep efficiency, and increased ArI. After adjustment for age, sex, smoking, alcohol, physical activity, drugs that affect sleep and depression, the ArI remained significantly higher, but the difference disappeared in patients without significant sleep disordered breathing (SDB). Differences in sleep structure were also found according to the presence or absence of hypertension, diabetes, and overweight/obesity in univariate analysis. However, these differences were attenuated after multivariate adjustment and after excluding subjects with significant SDB. CONCLUSIONS In this population-based sample we found significant associations between sleep structure and MS, hypertension, diabetes, and obesity. However, these associations were cancelled after multivariate adjustment. We conclude that normal variations in sleep contribute little if any to MS and associated disorders.