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Nocturnal sleep architecture in idiopathic hypersomnia: a systematic review and meta-analysis.

ABSTRACT: BACKGROUND:Current sleep medicine nosology places increased importance on nocturnal polysomnographic sleep recordings in the diagnosis of central nervous system disorders of hypersomnolence, particularly idiopathic hypersomnia (IH). OBJECTIVE:Determine what differences in sleep staging and architecture exist between IH and healthy controls using meta-analysis. METHODS:Systematic review identified relevant studies that included nocturnal polysomnography data for IH and healthy control groups. Meta-analysis compared standardized mean differences (Hedge's g) for total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), rapid eye movement (REM) sleep percentage, slow wave sleep (SWS) percentage, and REM latency (REML). Moderator analyses were also conducted for variables with significant heterogeneity among studies. RESULTS:The meta-analysis included 10 studies. Relative to controls, IH demonstrated increased TST (pooled g = 0.92; 95% CI: 0.46 to 1.38, p < 0.0001) and REM percentage (pooled g = 0.36, 95% CI: 0.09 to 0.64, p = 0.01), decreased SOL (pooled g = -0.46; 95% CI: -0.81 to -0.12, p = 0.009) and SWS percentage (pooled g = -0.28, 95% CI: -0.50 to -0.07, p = 0.01), without significant differences in SE (pooled g = 0.03; 95% CI: -0.32 to 0.38, p = 0.86) or REML (pooled g = 0.14, 95% CI: -0.21 to 0.49, p = 0.42). Moderator analysis demonstrated a significant effect of sex on SE, with a higher proportion of women to men significantly predicting lower SE between in IH and controls (p < 0.0001). CONCLUSIONS:IH is associated with several changes in sleep staging and architecture relative to healthy persons, including alterations in REM and SWS not currently delineated in nosological constructs. Further research is indicated to clarify how these findings are related the pathophysiology of IH and related disorders.

SUBMITTER: Plante DT

PROVIDER: S-EPMC5916770 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Nocturnal sleep architecture in idiopathic hypersomnia: a systematic review and meta-analysis.

Plante David T DT

Sleep medicine 20171102

<h4>Background</h4>Current sleep medicine nosology places increased importance on nocturnal polysomnographic sleep recordings in the diagnosis of central nervous system disorders of hypersomnolence, particularly idiopathic hypersomnia (IH).<h4>Objective</h4>Determine what differences in sleep staging and architecture exist between IH and healthy controls using meta-analysis.<h4>Methods</h4>Systematic review identified relevant studies that included nocturnal polysomnography data for IH and healt ...[more]

PMID: 29680423

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Project description:BackgroundHemodialysis patients experience an elevated risk of malnutrition associated with increased morbidity and mortality. Nocturnal hemodialysis (NHD) results in more effective removal of waste products and fluids. Therefore, diet and fluid restrictions are less restricted in NHD patients. However, it is ambiguous whether transition from conventional hemodialysis (CHD) to NHD leads to improved intake and nutritional status. We studied the effect of NHD on protein intake, laboratory indices of nutritional status, and body composition.Study designSystematic review with meta-analysis.PopulationNHD patients.Search strategySystematic literature search from databases, Medline, Cinahl, EMBASE and The Cochrane Library, to identify studies reporting on nutritional status post-transition from CHD to NHD.InterventionTransition from CHD to NHD.OutcomesAlbumin, normalized protein catabolic rate (nPCR), dry body weight (DBW), body mass index (BMI), phase angle, protein intake, and energy intake.ResultsSystematic literature search revealed 13 studies comprising 282 patients that made the transition from CHD to NHD. Meta-analysis included nine studies in 229 patients. In control group controlled studies (n = 4), serum albumin increased significantly from baseline to 4-6 months in NHD patients compared with patients that remained on CHD (mean difference 1.3 g/l, 95% CI 0.02; 2.58, p = 0.05). In baseline controlled studies, from baseline to 4-6 months of NHD treatment, significant increases were ascertained in serum albumin (mean difference (MD) 1.63 g/l, 95% CI 0.73-2.53, p<0.001); nPCR (MD 0.16 g/kg/day; 95% CI 0.04-0.29, p = 0.01); protein intake (MD 18.9 g, 95% CI 9.7-28.2, p<0.001); and energy intake (MD 183.2 kcal, 95% CI 16.8-349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4-6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8-12 months of NHD treatment.LimitationsMost studies had moderate sample sizes; some had incomplete dietary records and relatively brief follow-up period. Studies markedly differed with regard to study design.ConclusionsNHD is associated with significantly higher protein and energy intake as well as increases in serum albumin and nPCR. However, the data on body composition are inconclusive.

Dataset Information

Nocturnal sleep architecture in idiopathic hypersomnia: a systematic review and meta-analysis.

Publications

Nocturnal sleep architecture in idiopathic hypersomnia: a systematic review and meta-analysis.

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