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Secondly, the concept is being redefined as links between a plurality of domains are recognized (human health, animal health, the environment, and food), following the emergence of international health and food crises and as their multi-level consequences are being addressed by various stakeholders, including public authorities, political leaders, and economic actors.

In multiple system atrophy (MSA), sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent. We present a case of 59-year old female with cerebellar-type MSA, who showed transient paradoxical breathing effort during non-REM sleep on diagnostic polysomnography. Since this thoraco-abdominal paradox was atypical for and did not coincide with upper airway obstruction it most likely indicated central dysregulation of the diaphragm. Continuous positive airway pressure therapy with low pressure (5 cmH₂O) was sufficient to completely resolve this type of respiratory dysregulation. This case extends the clinical spectrum of sleep-disordered breathing in MSA.

In multiple system atrophy (MSA), sleep-disordered breathing has a broad spectrum of phenotypes, among them inspiratory stridor and obstructive sleep apnea being most frequent. We present a case of 59-year old female with cerebellar-type MSA, who showed transient paradoxical breathing effort during non-REM sleep on diagnostic polysomnography. Since this thoraco-abdominal paradox was atypical for and did not coincide with upper airway obstruction it most likely indicated central dysregulation of the diaphragm. Continuous positive airway pressure therapy with low pressure (5 cmH₂O) was sufficient to completely resolve this type of respiratory dysregulation. Selleckchem RBN013209 This case extends the clinical spectrum of sleep-disordered breathing in MSA.

Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine diagnostic accuracy, feasibility and patient preference of Home Sleep Apnea Testing (HSAT) compared with PSG for detection of SDB in NMD.

Participants with NMD at risk for SDB, aged ≥13 years, underwent HSAT followed by overnight PSG with concomitant Laboratory Sleep Apnea Testing (same device as HSAT). Sensitivity and specificity were calculated for standard Apnea-Hypopnea Index (AHI) cut-offs for mild (≥5/h), moderate (≥15/h) and severe SDB (≥30/h), and for Oxygen Desaturation Index (ODI) ≥5/h. Receiver operating characteristic (ROC) curves were built. A questionnaire assessed patient preference.

Of 38 participants, 73% had moderate-severe SDB and 79% had technically acceptable HSAT. For AHI ≥15/h, HSAT sensitivity and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD.

Sleep quality in patients studied with laboratory-based polysomnography (PSG) may differ from sleep quality in patients studied at home, but remains clinically relevant and important to describe. We assessed objective sleep quality and explored factors associated with poor sleep in patients undergoing laboratory-based PSG.

We reviewed diagnostic PSG studies from a 10-year period at a single sleep center. Total sleep time (TST) and sleep efficiency (SE) were assessed as markers of sleep quality. Poor sleep was defined as TST≤4 hours or SE≤50%. Multivariable analysis was performed to determine associations between objective sleep quality as an outcome and multiple candidate predictors including age, sex, race, body mass index, comorbidities, severity of obstructive sleep apnea (OSA), and central nervous system medications.

Among 4,957 patients (age 53 ± 15 years), average TST and median SE were 5.8 hours and 79% respectively. There were 556 (11%) and 406 (8%) patients who had poor sleep based on TST and SE respectively. In multivariable analysis, those who were older (per 10 year 1.48 [1.34, 1.63], male (1.38 [1.14,1.68]) and had severe OSA (1.76 [1.28, 2.43]) were more likely to have short sleep. Antidepressant use was associated with lower odds of short sleep (0.77 [0.59,1.00]). Older age (per 10 year 1.48 [1.34, 1.62]), male sex (1.34 [1.07,1.68]) and severe OSA (2.16 [1.47, 3.21]) were associated with higher odds of poor SE.

We describe TST and SE from a single sleep center cohort. Multiple demographic characteristics were associated with poor objective sleep in patients during laboratory-based PSG.

We describe TST and SE from a single sleep center cohort. Multiple demographic characteristics were associated with poor objective sleep in patients during laboratory-based PSG.

To evaluate whether obstructive sleep apnea (OSA) and its severity are related to dyslipidemia and alanine transaminase (ALT) elevation as a marker of nonalcoholic fatty liver disease (NAFLD) in children.

The data collected from polysomnography, laboratory measurements (lipid profile and liver enzyme), and body mass index (BMI) in children aged 0-18 years who visited the pediatric department between 2012 and 2018 were retrospectively analyzed.

There were a total of 273 participants in the study (age 0-6 years, 7-12 years, and 13-18 years 61.9%, 26.4%, and 11.7%, respectively). In the 7-12- and 13-18-year-old groups, obesity was strongly associated with OSA severity (Cramer's V = 0.498, P < 0.001). High-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the OSA group than in the non-OSA group, irrespective of the presence of obesity. In addition, HDL-C levels were significantly different between the OSA severity groups after adjusting for BMI (P = 0.000). In the obese group, moderate and severe OSA were associated with ALT elevation (P = 0.023 and P = 0.045, respectively).

This study suggests that OSA might be an independent risk factor for dyslipidemia, and that OSA and obesity have a synergistic effect on ALT elevation. Early diagnosis and treatment of OSA from childhood, especially in obese children, will reduce metabolic complications.

This study suggests that OSA might be an independent risk factor for dyslipidemia, and that OSA and obesity have a synergistic effect on ALT elevation. Early diagnosis and treatment of OSA from childhood, especially in obese children, will reduce metabolic complications.