台灣睡眠醫學學會 111年度會員大會暨20th學術研討會

Welcome Chiu,

President of Taiwan Society of Sleep Medicine

Director of Sleep Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation

Assistant Professor, College of Medicine, Tzu Chi University

Time / Room Room 1001

Room 1002 Room 1003

12:00-14:00 Registration

13:50 14:00 [Opening Ceremony]

President of TSSM (TSSM 邱國樑理事長致詞) (Room 1001)

14:00-14:50

14:50 15:15

[Keynote Lecture 1]

A Biopsychosocial Approach to Sleep Offers Pathways Beyond Sleep

Prof Fiona H. Barwick PhD (Stanford, USA)

Moderator: 楊建銘教授 (Room 1001)

Coffee Break and Poster Viewing 審查委員：李學禹醫師、楊建銘教授、毛衛中醫師

15:15 17:30 [Symposium 1]

Cardiology and Sleep Medicine

Organizer: 林育聖醫師

Moderators: 陳濘宏醫師 / 杭良文醫師 (Sponsored by ResMed)

(1) 15:15 15:40

15:15 15:35

Heart and Sleep from Clinic to Study: A Cardiologist View 林育聖醫師

[Symposium 2] Gastroenterology and Sleep Medicine

Organizer: 劉文德醫師

Moderator: 李學禹醫師

15:15 15:40

Sleep Apnea and Gastroesophageal Reflux Disease: Literature Review, Clinical Experience and Community Survey 李信謙醫師

[Symposium 3] Circadian Clock and Sleep

Organizer / Moderator: 張芳嘉教授

15:15 15:35

Circadian Transcription Factor BMAL1 and RNABinding Protein MEX3A Co Regulate Lgr5+ Stem Cells and Stress Response in the Intestine 黃雯華研究員

(2) 15:40 16:05

15:35 15:55

Central Sleep Apnea in Patients with Heart Failure 莊立邦醫師

15:40 16:05

The Role of Neurogenic Inflammation in Obstructive Sleep Apnea 劉文德醫師

15:35 15:55

Family Members Additively Repress the Ectopic Expression of BASIC PENTACYSTEINE3 to Prevent Disorders in Arabidopsis Vegetative Development 蔡皇龍教授

(3) 16:05 16:30 15:55 16:15

Atherosclerosis and Circadian Rhythm 王朝永醫師

16:05 16:30

Sleep Endoscopy 陳美娟醫師

15:55 16:15

Using Two Photon and Endoscope to Observe Light Responsive Cells in the Suprachiasmatic Nucleus in Mouse

陳示國教授

Time / Room Room 1001 Room 1002 Room 1003

(4) 16:30 16:55

16:15 16:35

Clinical Cardiovascular Disease Applications of Longterm Physiological Data Recorded by Wearables 林澂教授

(5) 16:55-17:10

16:35 17:00

Streamline the Diagnosis and Integrated Care for CVD Patients with OSA –Singapore Experiences

Prof. LEE Chi Hang, Ronald

17:00 17:20

Q and A

16:30 16:55

Current Theory and Literature Review of Gastroesophageal Reflux and Dysphagia in Sleep Disorders 盧柏文醫師

16:15 16:35

Deciphering UbiquitinMediated Regulation in Plant Circadian Clock 李金美教授

16:55 17:10 Q and A 16:35 16:55

Transcriptional Repression by Cryptochrome in the Absence of Period 邱奕穎教授

16:55 17:15

Coordinated Timing among Multiple Circadian Clocks 明智煥教授

Time / Room Room 1001 Room 1002 Room 1003

08:00-09:00

Registration (Poster Viewing) 審查委員：李學禹醫師、楊建銘教授、毛衛中醫師

09:00 10:00 [Keynote Lecture 2]

Management of Cardiovascular Disease in Patients with Sleep Apnea: A Case Based Review of Personalized Treatment

Prof. Michael D. Faulx (CCLCM, USA)

Moderator: 陳濘宏醫師 (Room 1001)

10:00 10:20

10:20 12:10 [Symposium 4]

Maxillomandibular Advancement (MMA) for Obstructive Sleep Apnea (OSA)

Organizer / Moderator: 林政輝醫師

Coffee Break and Poster Viewing

[Symposium 5] Sleep-Heart Interaction: Phenotyping and Personalized Treatment in OSA Patients with Cardiovascular Diseases

Organize: 李佩玲醫師

Moderators: 侯嘉殷理事長 (TSOC) / 王鶴健理事長 (TSPCCM)

[Technologist Training] 技師教育訓練

Organizer：劉勝義理事

Moderator：林嘉謨醫師

(1) 10:20 10:45 10:20 10:55

Maxillomandibular Advancement for OSA: Felonies and Misdemeanors

Kasey Li, DDS, MD

(2) 10:45 11:10 10:55 11:30

10:20 10:40 Obstructive Sleep Apnea Phenotype and Cardiovascular Disease: Example of Atrial Fibrillation 李佩玲醫師 (TSSM)

Surgical-Orthodontic Treatment of Obstructive Sleep Apnea Using Surgery-First Approach 廖郁芳醫師 10:40 11:00

(3) 11:10 11 35 11:30 12 05

10:20 10:45

The AASM Troubleshooting Guidelines 劉勝義技師

The Prevalence, Screen, Diagnosis and Treatment of Obstructive Sleep Apnea in Hypertension Population 黃群耀醫師 (TSOC) 10:45 11:10 睡眠圖譜呼吸事件判讀 林文貴技師

MMA for OSA: An Orthodontic-First Approach 11:00 11 20 Sleep-Heart Interaction: Heart Failure 吳彥雯醫師 (TSOC)

11:10 11 35 高山睡眠

Time / Room Room 1001 Room 1002 Room 1003

(4)

11:35 12:00

12:05 12:10 Q and A

11:20 11:40

Obstructive Sleep Apnea and Pulmonary Hypertension

劉景隆醫師 (TSPCCM)

(5) 12:00 12:10

11:40 12:10 Panel Discussion

12:10 12:30 會員大會 (Room 1001)

12:35 13:35 [Keynote Lecture 3]

ECG and Heart Rate Use in the Diagnosis of Sleep and Sleep Disorders

Prof. Thomas Penzel (Charite University Hospital, Germany) Moderator：邱國樑理事長 (Room 1001)

13:40 15:20 [Symposium 6]

Neurology and Sleep

Organizer / Moderator: 徐崇堯醫師

(1) 13:40 14:05

Restless Legs Syndrome: An Update 李穎昇醫師

(2) 14:05 14:30 Epilepsy and Sleep 葉威志醫師

(3) 14:30 14:55

Obstructive Sleep Apnea and Stroke 林煥然醫師

[Symposium 7] Microbiota and Sleep Organizer: 李立昂醫師 Moderators: 郭博昭教授 / 康焜泰醫師

New Era in Microbiota Technology 周士軒博士

Gut Microbiota and Sleep Disorder 李立昂醫師

Tonsil Microbiome among Obstructive Sleep Apnea

Children across Intermittent Hypoxemia and Body Weight Status 莊海華醫師

11:35 12:00

Manual PAP Titration in Sleep Lab: Focus on the Aspect of BIPAP and ASV Titration 林煜傑技師

12:00 12:10 Q and A

[Lunch Symposium]

Lemborexant, Novel DORA for Insomnia Treatment and RealWorld Experience Sharing 陳田育醫師

Moderator: 李信謙醫師 (Sponsored by Eisai)

(4) 14:55 15:20

REM Sleep Behavior Disorder (RBD) 詹博棋醫師

Probiotics and Insomnia 楊靜修教授

15:20-15:35 Coffee Break

Time / Room Room 1001 Room 1002 Room 1003

15:35 17:00 [Oral Presentation A]

Moderator: 周昆達醫師

[Oral Presentation B]

Moderator: 楊鈞百醫師

(1) 15:35 15:50

Respiratory Arousal in Patients with Very Severe Obstructive Sleep Apnea and How It Changes after a NonFramework Surgery

The Impact of Unexpected Sleep Disordered Breathing on Patients with Newly Diagnosis Generalized Anxiety Disorder: A CaseControl Study in Taiwan

(2) 15:50 16:05

Diagnosis of Obstructive Sleep Apnea in Dysphonia Patients: Role of Laryngopharyngeal Reflux

(3) 16:05 16:20

The Impact of Continuous Positive Airway Pressure on Blood Pressure in Patients with Ischemic Stroke and Obstructive Sleep Apnea

Possible Treatment to Epiglottic Collapse in OSA Patients: What Did Drug Induced Sleep Endoscopy Tell Us? 16:40 17:00

(4) 16:20 16:35

Award and Closing Ceremony

Speaker Abstract

Position Professor Affiliation Department of Psychology, Chengchi

Research Interests Clinical Psychology, Health Psychology, Behavioral Sleep Medicine, Insomnia, CBT I

October 1 (Sat.)

Keynote Lecture 1

SPEAKER

Fiona Barwick, PhD, DBMS

Position

Clinical Associate Professor

Associate Division Chief Behavioral Sleep Medicine

Director Sleep and Circadian Health Postdoctoral Fellowship Program

Affiliation

Department of Psychiatry and Behavioral Sciences Sleep Division Stanford School of Medicine

Research Interests

Cultural adaptation of cognitive behavioral therapy for insomnia (CBT I) and integration of the biopsychosocial model as a framework for CBT I when treating sleep problems that co occur with psychiatric conditions (major depression, bipolar disorder, OCD, PTSD) and medical conditions (POTS, chronic pain or fatigue, TBI, Multiple Sclerosis, Parkinson’s).

“A Biopsychosocial Approach to Sleep Offers Pathways Beyond Sleep”

Abstract

The biopsychosocial model offers a rich framework from which to address the many factors that can affect sleep, especially when sleep problems occur in the context of psychiatric or medical disorders. Using this framework to guide case conceptualization and treatment decisions can open up new perspectives for both patient and clinician, and can expand successful outcomes beyond the treatment of the sleep disturbance itself. This presentation will explain how behavioral sleep medicine incorporates a biopsychosocial model when treating disorders like insomnia, delayed sleep phase, and sleep apnea. It will provide research studies and case examples to illustrate how this approach to treating sleep problems can lead to unexpected outcomes, including benefits to mental, emotional and physical health, and will suggest mechanistic pathways that might contribute to these outcomes.

Cardiology and Sleep Medicine (Ning-Hung Chen)

Position Professor

Affiliation Chang Gung Memorial Hospital

Research Interests Sleep Medicine

Cardiology and Sleep Medicine

杭良文 (Liang-Wen Hang)

Position

1. Professor

2. Chief of Sleep Medicine Center

Affiliation

1. School of Nursing & Graduate Institute of Nursing China Medical University

2. China Medical University Hospital

Research Interests

1. Sleep Medicine

2. Airway disease , Respiratory Care、Respiratory Therapy

Abstract

The day and night cycle is based on the rotation of the Earth on its axis. The circadian rhythm, driven by molecular clocks and external cues, connects the environmental changes to endogenous physiological function, behavior activities, and organ homeostasis, including the cardiovascular system. Disrupting the circadian rhythm due to shift work, long distance traveling, or genetic variations can lead to obesity, aging, and atherosclerosis.

Experimental evidence and clinical trials both suggest that circadian rhythm disruption results in disruption of cardiovascular physiology and malalignment of multiple cellular functions. Genetic deletion of several circadian genes or shift works all result in increased cardiovascular disease incidences, worsening outcomes, and higher mortality. The interactions of circadian rhythm and the cardiovascular system are comprehensive, including atherosclerosis, endothelial function, heart failure, arrhythmia, and blood pressure control. In this talk, we will examine the detailed links between circadian rhythm and cardiovascular diseases.

Abstract

There is growing attention on the interactions between sleep disorders and cardiovascular diseases. Considerable progress has been made regarding the associated risk of adverse events in patients with cardiovascular diseases comorbid with obstructive sleep apnea (OSA) and how OSA treatment can improve the prognosis of cardiovascular diseases. Although the underlying mechanisms or links have not been fully understood, portable home sleep apnea testing devices or wearables made long term or follow up monitoring of the severity of OSA or treatment possible, and important physiological mechanisms linked between cardiovascular diseases and OSA can be explored. This talk will introduce commonly used portable/wearable devices and how to derive meaningful physiological biomarkers in patients with cardiovascular diseases by long term or continuous recorded data. In addition, potential applications of those biomarkers in those patients comorbid with OSA will be discussed.

October 1 (Sat.)

Cardiology and Sleep Medicine

SPEAKER

Position

Professor of Medicine, National University of Singapore, Singapore Senior Consultant Cardiologist, National University Heart Centre, Singapore

Affiliation

MBBS, MD, MRCP (UK), FRCP (Edin), FHKCP, FHKAM (Medicine), FAMS, FACC, FSCAI

Research Interests

Sleep

“Streamline the diagnosis and integrated care for CVD patients with OSA – Singapore Experiences”

Prof. LEE Chi-Hang, Ronald

Abstract

Obstructive sleep apnea (OSA) is strongly associated with cardiovascular disease (CVD), including hypertension, stroke, heart failure, coronary artery disease, and atrial fibrillation (AF). Studies have shown a worse prognosis for CVD patients with OSA.

During a sleep apnea event, the tongue and the airway's muscles relax and collapse, resulting in obstructed airflow to the lungs. Lapses in breathing typically last between 10 to 20 seconds but can last for 30 seconds or even longer and repeatedly occur during the night. When breathing stops, oxygen levels in the blood drop. Our bodies respond by releasing the stress hormone epinephrine, more commonly known as adrenaline. This "fight or flight" response elevates the heart rate and can lead to high blood pressure. Overall, heart function decreases because it becomes less efficient at pumping blood, and the heart itself is affected because of the pressure changes taking place in the chest.

Not only the clinical consequences but also the economic costs of untreated OSA, the CVD patients with OSA are predominantly middle aged and overweight males, which represents the economically productive middle aged segment.

In this lecture, Prof Ronald will be discussing the clinical approach in Singapore including advocating for more effective screening, evaluation, and management of suspected OSA in patients with CVD.

Gastroenterology and Sleep Medicine (Hsueh-Yu Li)

Position Professor Affiliation Departments of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital

Research Interests Sleep surgery, Obstructive Sleep Apnea

SPEAKER

Gastroenterology and Sleep Medicine Apnea and Gastroesophageal Reflux Disease: Literature Review, Clinical Experience and Survey”

Position

Visiting Staff & Chair

Affiliation

Department of Psychiatry & Sleep Center, Taipei Medical University Hospital

Research Interests

Psychiatry, Sleep Medicine, Public Health

Abstract

Lines of evidence indicate a significant association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD). This talk will briefly introduce current understandings about the relationship between OSA and GERD. Data from a clinical database and community survey will also be presented. 1

October 1 (Sat.)

Gastroenterology and Sleep Medicine

SPEAKER

Position

1. Director, Sleep Center of Shuang Ho Hospital, Taipei Medical University

2. Associate Professor, School of Respiratory Therapy, College of Medicine, Taipei Medical University

3. Director, Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University

4. Attending Physician, Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University

Affiliation

1. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 11052, Taiwan

2. Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan

Research Interests

Sleep medicine, Obstructive sleep apnea, Artificial intelligence in medicine, pulmonary medicine

“The Role of Neurogenic Inflammation in Obstructive Sleep Apnea”

Abstract

As we know, craniofacial abnormality and obesity, the kind of anatomical factors, are essential to cause obstructive sleep apnea (OSA). However, studies have also found that chronic rhinitis, sinusitis, and gastroesophageal reflux, are also prone to inflammation of the upper airway leading to congestion and swelling to deteriorate the severity of OSA. In recent years, research on gastroesophageal reflux disease (GERD) and non allergic rhinitis found associations between some cellular receptors and these disorders. Activating one of the cellular receptors, transient receptor potential cation channel, subfamily V, member 1 (TRPV1) will cause an inflammatory response of the upper airway and esophagus, which is a phenomenon of neurogenic inflammation. The patients will develop symptoms such as runny nose, cough, and acid regurgitation that also cause the deterioration of OSA. Some evidence suggests that patients with erosive esophagitis had increased mRNA performance of TRPV1 on their esophageal mucosa. Besides, the severity of related respiratory inflammation and gastroesophageal reflux will improve if treated with an antagonist against TRPV1. Therefore, these clinical features of GERD, rhinitis and the associated upper airway inflammation are neurogenic inflammation, which is an essential factor leading to OSA. We need further research to approach the role of neurogenic inflammation in the upper airway to figure out the pathogenesis and other treatment strategies.

SPEAKER

Abstract

Sleep-related breathing disorders are complex problems. OSA is one of the major sleep problems not only in elderly but also in the younger patients. It is associated with marked comorbidity and mortality. Till now, mainstay of treatment for OSA is CPAP which is noted for poor compliance in most of the patients. Sleep endoscopy is one of the studies to know the obstruction site in the OSA patients. With precise site, the treatment of the OSA can be individualized and personalized.

Position

Attending Physician of Gastroenterology Department of Shuanghe Hospital

Affiliation

1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan. No.291, Zhongzheng Rd., Zhonghe, Taipei 23561, Taiwan, ROC

2. Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei 11052, Taiwan, ROC

Research Interests

1. Gastrointestinal motility and functional diseases.

2. Development of endoscopic hemostatic devices and materials.

3. Research on the diagnosis and treatment of pylori.

Gastroenterology and Sleep Medicine Theory and Literature Review of Gastroesophageal Reflux and in Sleep Disorders”

Abstract

Gastroesophageal reflux (GERD) is associated with ENT disorders and symptoms and is another risk factor for obstructive sleep apnea syndrome (OSAS). Gastric emptying during sleep was delayed, esophageal clearance was significantly delayed, and upper esophageal sphincter pressure was significantly reduced. Studies have linked OSAS with a high frequency of GERD, resulting from increased intrathoracic pressure, further contributing to acid reflux episodes. Severe progression of OSAS also promotes acid reflux, leading to inflammation and even obstruction of the upper airways. In numerous studies over the past decade, continuous positive airway pressure (CPAP) therapy has been found to improve sleep quality in patients with OSAHS and has been shown to improve reflux. And a recent meta analysis evaluating the evidence for the relationship between hydrogen ion pump inhibitor (PPI) therapy (GERD) and improvement in obstructive sleep apnea (OSA) found that this approach may improve nighttime sleep quality. In addition, more studies are using polysomnography to record apnea index and 24 hour pH monitoring to record the frequency of acid reflux and GERD in OSAS patients; additionally, GERD symptoms are also associated with worsening sleep quality.

MODERATOR

Circadian Clock and Sleep Chang)

Position Dean / Professor

Affiliation School of Veterinary Medicine, National Taiwan University

Research Interests Sleep Physiology, Sleep Medicine, Neurophysiology, Neuropharmacology

SPEAKER

Research Interests

Wendy Hwang Verslues is using cell based and mouse models to investigate the interplay between cancer and circadian rhythms/core clock genes. She aims to understand how disruption of circadian rhythm or dysregulation of core clock genes influences cancer initiation and progression. She wants to mechanistically link circadian regulation to cancer development to provide new strategies or targets for disease prevention and treatment.

Abstract

Rapidly dividing intestinal stem cells (ISCs) are sensitive to chemotherapeutic agents, such as 5 fluorouracil (5 FU). Drug delivery at different times of day can change 5 FU toxicity; however, the underlying mechanism is unclear. We found that fast proliferating LGR5+ crypt base columnar (CBC) cells required for intestinal homeostasis are controlled by the circadian clock transcription factor BMAL1 and the BMAL1 regulated RNA binding protein MEX3A. BMAL1 directly activates Lgr5 transcription and MEX3A post transcriptionally controls Lgr5 mRNA stability. Timing of 5 FU delivery when crypt cells had high BMAL1 and low Lgr5 protected ISCs from apoptosis. BMAL1 is critical for intestinal homeostasis and stress response as Bmal1 knockout in LGR5+ CBCs reduced MEX3A expression, decreased CBC numbers, and made ISCs more sensitive to 5 FU induced apoptosis. Together, these findings demonstrate the central role of BMAL1 in ISC homeostasis and provide a biological explanation for chronotherapeutic chemoprotection.

SPEAKER

Position Assistant of Molecular and Cellular Biology, National Taiwan University

Research Interests

Most of organisms on the earth evolve circadian clocks to control the oscillations of multiple physiological pathways in sync with the ~24-h period, upon the day-night cycles resulted from the earth rotation, such oscillations are called “circadian rhythms. Besides the predictable day night and seasonal cycles, plants are sessile in circumstances with numerous unpredictable transient changes during their growth and development. The rhythmicity of the “circadian clock” profoundly keeps plants on the track without over reacting to the random cues, therefore sustains propagating on an optimal season time. The circadian clock comprises genes tightly interlocked in regulatory feedback loops, in other words, clock related genes are directly or indirectly regulated by their downstream genes. Such regulatory feedback loops make genes peak at a specific time of the day and oscillate according to the external cues like light and temperature

“BASIC PENTACYSTIENEs, PlantSpecific GAGA-Binding Factors, Constitute a Regulatory Gene Network for Tuning Plant Circadian Clock” (Huang-Lung Tsai)

through the day-night cycles. In the model plant, Arabidopsis, LIGHT-REGULATED WD1 (LWD1) plays a role in the morning activation of circadian clock. The five WD repeats of LWD1 form a propeller structure and serve as a protein protein interaction platform. In our previous study, we have revealed that LWDs form co activator protein complexes with specific TCP members to directly activate the expression of morning gene CCA1, thus, secure the normal operation of the circadian clock at dawn. However, expressions of several clock genes in the lwd1 lwd2 double mutant don't obey the interlocking gene circuits, e.g. genes and their repressors are down regulated simultaneously when lacking LWDs. This indicates that our knowledge of the circadian clock is not thorough. To investigate the regulatory mechanism of circadian clock, we will use LWD1 as bait to identify transcription factors with similar transcription trends through a plenty of transcriptomes. We will reveal the molecular mechanism of the circadian clock operation via the study of the LWD1 co-expressed transcription factors. Our study would unravel multifaceted connections between circadian clock and plant developmental processes.

Abstract

BASIC PENTACYSTEINE (BPC) family members are plant specific GAGA motif binding factors (GAFs) controlling multiple developmental processes of growth and propagation. BPCs recruit histone remodeling factors of repressive complexes involving in the transcriptional repression of downstream targets. Under day night cycles, we found multiple BPC members are transcriptionally co expressed with LIGHT REGULATED WD1 (LWD1), which encodes a co activator for the activation of central clock gene, CIRCADIAN CLOCK ASSOCIATED1 (CCA1). The co expression between BPCs and LWDs prompted us to investigate the role of BPCs in the circadian regulation. We revealed that BPC3, a member antagonized by the functional overlap of other BPCs in vegetative tissues aboveground, is ectopically expressed in the quadruple mutant of bpc1 1 bpc2 bpc4 bpc6. The ectopic BPC3 suppresses multiple clock genes including CCA1 in the mutant and the clock oscillation is therefore phase delayed. Consequently, the expression peak of CONSTANS (CO) is delayed and the day time CO level is insufficient to activate the expression of FLOWERING LOCUS T (FT). Intriguingly, even FT expression is obliterated, the mutant is still early flowered due to that the ectopic BPC3 simultaneously suppresses the main floral repressor FLOWERING LOCUS C (FLC) of the autonomous pathway through direct binding to the FLC promoter. Taken together, our study reveals plant-specific GAFs tune the photoperiodic and autonomous floral promotion pathways concurrently to control the vegetative to reproductive transition.

Abstract

For circadian clock, one of the major criteria is that this clock can be entrained by external cycle. In mammal, the strongest external environmental cue to entrain the central clock at the suprachiasmatic nucleus (SCN) is light dark cycle. To convey light information for photoentrainment, a specific group of intrinsically photosensitive retinal ganglion cells (ipRGCs) which express photopigment melanopsin, is essential. After light exposure, ipRGC could release glutamate and PACAP directly through their axonal terminal in the SCN to advance or delay the clock depends on the circadian time of the animal. Since the SCN is located at the bottom of the hypothalamus, how does light input trigger the neuronal response in individual SCN neuron remain unclear. Here, using two photon microscope with GRIN lens, we could record activity of SCN neurons using GCaMP reporter. By analyze the calcium response of SCN neurons, we found that SCN neurons have distinct light response. In addition, the activity correlation analysis suggests that the connection circuit is different at distinct ZT time point. Together, our results suggest that the SCN is composed of a dynamic functional circuit. SCN neurons may not form a strong and stable connection throughout the day. Therefore, a flexible populational coding may be utilized for circadian time keeping.

Abstract

The circadian clock regulates approximately 24 hour rhythmicity of biological pathways to optimize organisms’ responses to the environment and thus increase their fitness. In plants, the clock governs growth, development, and stress resilience, and therefore biomass and quality of crops. The central theme driving the rhythms of the circadian clock across all kingdoms is transcription translation feedback regulation accompanied by post translational modifications. Protein ubiquitination mediated by E3 ubiquitin ligase (E3) and degradation by 26S proteasome has emerged as a conserved regulatory pathway in clock progression. However, due to the instabilities of the complex of E3 and its substrates, it remains largely unrevealed.

We have developed an E3 ubiquitin ligase decoy strategy to stabilize the E3 substrate complex and overcome the challenge. This strategy was applied to co immunoprecipitation to uncover the interactors and molecular mechanism of ZEITLUPE E3 ubiquitin ligases in regulating light inputs into the central circadian clock. We also utilized the E3 decoy strategy to establish an Arabidopsis E3 decoy library, which consists of around 25% of E3 in the Arabidopsis genome. We further set up a high throughput yeast two hybrid yeast screen platform to study the E3 clock regulators’ interacting network to gain a systematical view of the circadian clock and clock regulated pathways in plants

“Transcriptional Repression by Cryptochrome in the Absence of Period” (Yi-Ying Chiou)

Abstract

Circadian rhythm is a physiological mechanism with daily periodicity to adapt to the daily environmental changes. Regulation of circadian rhythm affect behavior (sleep wake cycle) and other physiological functions. The molecular mechanism of circadian regulation is through the transcription translation feedback loop. Cryptochrome protein (CRY) and Period protein (PER) play a negative feedback function in the mammalian system. CRY and PER could interact with each other. Thus, they were considered to regulate circadian rhythm as a heterodimer. However, the ratio of CRY and PER proteins are different at different times of the day, suggesting the existence of their independent functions. This talk will focus on introducing the mammalian transcription translation feedback loop and discuss the independent function of CRY in transcriptional repression based on the research results from in celluo biochemical system in the lab.

October 1 (Sat.)

SPEAKER

Position Assistant Professor Affiliation Graduate Institute of Mind, Brain and Consciousness (GIMBC), Taipei Medical University

Research Interests Circadian biology

Abstract

A spontaneous organization of clock network emerges via communication among cellular circadian oscillators. The organization of clock phases is comparable to network memory in the sense that the pattern is retained and is plastic subject to the photoperiodic light condition and the developmental stage. This pattern of coordinated timing, which we call the phase organization, can be understood as encoded memory of a daylength. Both the mechanism and function of the phase organization remain unknown, but a simple and elegant mathematical description of its formation can be achieved if we allow “negative” coupling among phase oscillators.

“Coordinated Timing among Multiple Circadian Clocks” Myung)

Keynote Lecture 2

陳濘宏 (Ning-Hung Chen)

Position

Director, Department Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital Director, Sleep Center, Chang Gung Memorial Hospital

Affiliation Chang Gung Memorial Hospital

Email ninghung@yahoo.com.tw

Research Interests

Sleep Medicine

Pulmonary Medicine Tuberculosis: diagnosis, immunology and vaccination

“Management in Patients with Apnea: A Case-Based Review of

Abstract

Since the time of my cardiology fellowship I have had an interest in the interaction between sleep apnea and cardiovascular disease. I believe that all cardiologists need to have a better awareness of the impact of unrecognized sleep apnea on the patients they see because sleep apnea is endemic in all areas of cardiovascular medicine. Although a clear consensus regarding the best way to integrate the diagnosis and treatment of sleep apnea into cardiovascular practice is lacking, I believe that current data support routine screening for sleep apnea in patients with cardiovascular disease and provide the basis for practical treatment and management recommendations. I am optimistic that future well designed prospective trials of sleep apnea management and diagnosis in cardiovascular disease are just around the corner and should provide a stronger evidence base to base treatment recommendations on. My presentation covers my approach to the diagnosis and management of sleep apnea in patients with different cardiovascular conditions.

Maxillomandibular Advancement (MMA) for Sleep Apnea (OSA)

Maxillomandibular advancement has become a widely performed operation for the treatment of OSA. The indication, rationale, technical considerations and outcomes are well described in the literature. However, severe complications and failures are encountered too frequently. This lecture will discuss the speaker’s 25 year MMA experience as well as considerations to minimize complications and improve outcomes.

“Maxillomandibular

Research Interests of cephalometric anchorage orthognathic CBCT

Abstract

In recent years, it has become more and more common for patients to seek medical attention due to snoring or sleep apnea. The most significant impact is not only on sleep but also on health related symptoms such as headache, daytime sleepiness, inability to concentrate, etc. The negative impact is beyond imagination. In dental clinics, the treatment of sleep apnea can be divided into invasive and non invasive. If the arch width is insufficient, it is recommended to expand the maxillary width to obtain a functional and esthetically stable bite. Growing children need to perform maxillary expansion; adult patients can use surgical assisted or miniscrew assisted maxillary expansion or even maxillomandibular advancement surgery (MMA) to improve airway problems and clinically related symptoms. This report will share the treatment experience of the Orthodontic department, Kaohsiung Medical University Hospital. When facing different skeletal relations with OSA, how to carry out preoperative orthodontic treatment planning so that sleep surgeons can get the maximum amount of MMA to improve the respiratory symptoms.

Position M.D.,

Affiliation MacKay Memorial Hospital

Research Interests Arrhythmia, Cardiac Electrophysiology, Cardiac Implantable Electronic Devices (CIED)

Research Interests

Her research focuses on clinical phenotyping, molecular mechanism, and therapeutic Intervention of obstructive sleep apnea. She is particularly interested in technology and big data in sleep medicine. Her other works include sleep disordered breathing in pediatrics and pregnancy

“Obstructive Apnea Phenotype Disease: Fibrillation”

Abstract

Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction that results in cessation of airflow during sleep. Untreated OSA may increase the probability of developing cardiovascular diseases, metabolic disorders, and neurocognitive dysfunctions. Evidences support that OSA is independently associated with atrial fibrillation (AF) and severity of OSA may have a dose relationship with AF incident. The prevalence of OSA in general population is 9 38% which increases to 21 47% in patients with AF. Vice versa, the prevalence of AF in general population is 1% which increases to 4% in patients with OSA. Evidences supporting screening of OSA in patients with AF undergoing catheter ablation are strongly while evidences are weak for other patients with AF. Vice versa, the evidences supporting screening of AF in patients with OSA are weak and no evidence suggests the modality for OSA screening. Though CPAP treatment is the standard treatment for OSA, its impact on AF burden is not clear.

1. Director, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan

2. Director, Division of Cardiology, Taipei Medical University Hospital, Taiwan

1. Division of Cardiology, Department of Internal Medicine, Taipei Medical University hospital, Taiwan

2. Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan

3. Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Research Interests Biology, Lipidology, Cardiac Pharmacology, Big data, Wearable device

Abstract

With the progress of the civilized world, the prevalence of hypertension is increasing day by day, and hypertension in Taiwan is also listed as one of the top ten causes of death of the year. Sleep breathing arrest syndrome is a common disease in the civilized world, but also because of the lack of medical advocacy, knowledge promotion, and simple detection methods, although sleep breathing is a very important disease, it is the most easily ignored risk factor for hypertension. The disease can only be screened out through the patient's disease awareness and the vigilance of the clinician, with appropriate measurement tables and screening tools. At present, the tools for the treatment of respiratory arrest syndrome have gradually matured and have certain clinical efficacy, so it is time to face up to and promote the treatment of sleep apnea syndrome in the hypertensive population.

Abstract

Sleep disordered breathing (SDB), including obstructive sleep apnea, central sleep apnea (CSA), and Cheyne Stokes respiration, is common in patients with heart failure (HF) and associated with lower left ventricular ejection fraction (LVEF), increased arrhythmia burden, and increased mortality. All HF patients should be screened for SDB. Effective treatment of OSA with continuous positive airway pressure (CPAP) therapy improves short term and long term outcomes in HF patients. Although adaptive servoventilation (ASV) appears to not reduce CV and all cause death for HF patients with extremely low LVEF, those with profound CSA associated hypoxemia or less severe HF still benefit from ASV therapy. In this talk, we outline the current understanding of the bidirectional relationship between these disorders and HF. Although limited evidence, some studies have shown that sleep quality and insomnia are associated with cognitive function, and patients with HF that are at high risk for cognitive decline. In this talk, we also explore emerging data on the cost effectiveness and outcome of intervention and recent advances in therapeutics, including ongoing trials.

Abstract

Sleep related breathing disorders (SBD), including obstructive sleep apnea (OSA), central sleep apnea, and sleep related hypoventilation, are an under recognized but highly prevalent group of diseases. These nocturnal respiratory events result in intermittent hypoxia, with the potential to increase pulmonary arterial pressure, have a great impact on cardiovascular health. However, the association between OSA and pulmonary hypertension (PH) is not well understood. This relationship appears to be bi directional, but our understanding of the mechanisms that drive the process remains very limited. Consequences of OSA combined with PH have been shown to increase mortality in clinical observational studies. Additionally, limited data suggest that treatment with positive airway pressure (PAP), which improves pulmonary hemodynamics and reduces pulmonary atrial pressure, may be clinically beneficial. Finally, through clinical cases, we will demonstrate and discuss the impact of SDB on pulmonary arterial pressure, as well as the changes in pulmonary arterial pressure following PAP therapy.

Technologist Training

林嘉謨 (Chia-Mo Lin)

Position

Director of Chest Department

Affiliation

Medical College, FU JEN Catholic University, Taipei, Taiwan, ROC.

Research Interests

Sleep medicine, Biochemistry, Pulmonary medicine

Abstract

Artifacts are extraneous signals, appearing within any of the recorded parameters of the polysomnogram. These signals may originate from the patient’s body, from recording instruments and devices used on the patient, or from the surrounding environment.

Most of artifacts are undesirable and can severely impede the scoring and interpretation. These may include 60Hz powerline frequency, slow frequency artifact, electrode popping artifact, excessive ECG potentials recorded in the EEG and EOG channels and various mixed frequencies unrelated to patient physiology, recorded within any of the channels.

The AASM Troubleshooting Guidelines provides a systematic approach to identify and correct artifacts that could interfere with the collection and interpretation of the data. It suggests this word LACES to identify a variety of different artifacts and to correct the cause or source of the artifacts. Each letter stands for a step in the systematic approach. L=Location, A=Application, C=Connection, E=Equipment, S=Settings. By using the LACES method we can fix any problems and produce clean, high quality recordings.

To obtain an accurate polysomnogram, the AASM Troubleshooting Guidelines must be very helpful to individuals who are training to become registered sleep technologists and those interested in improving their knowledge and skills in the field of clinical polysomnographic technology.

“Manual PAP Titration in Sleep Lab: Focus on the Aspect of BIPAP and ASV Titration” (Yu-Chieh

Abstract

Sleep disordered breathing encompasses a series of sleep related breathing disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA) and hypoventilation syndrome. Positive airway pressure (PAP) therapy is an effective and common treatment for patients with sleep disordered breathing. Before the patient start PAP therapy, PAP titration should be executed to determine the optimal setting of PAP. PAP titration can be classified into CPAP, BIPAP and Adaptive servo ventilation (ASV) titration. CPAP titration is the most common titration in sleep lab for patient with OSA. However, in the patients with congestive heart failure, obesity hypoventilation and neuromuscular diseases. CPAP may not afford to relieve the respiratory events among these patients. Advanced mode of PAP including BIPAP and ASV may be applied to these patients. Due to home based automated CPAP titration may be applied to patient with OSA universally in the future. The proportion of patients with comorbidities will increase in laboratory titration in the future. In response to this situation, titration techniques of advanced PAP modes are essential for PSG technologists. In this talk, we will demonstrate the experience of BIPAP and ASV titration to increase the efficacy of advanced PAP titration.

MODERATOR

Keynote Lecture 3 (Kuo-Liang Chiu)

Position

1. Director of Sleep Center

2. Assistant Professor Affiliation

1. Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.

2. College of Medicine, Tzu Chi University

Research Interests

Sleep breathing disorders in cardiovascular diseases

Keynote Lecture 3

SPEAKER

Position

Scientific Chair of Sleep Medicine Center at Charite University Hospital, Berlin, Germany. President of German Sleep Society.

Affiliation

Interdisciplinary Sleep Medicine Center, Charite University Hospital Berlin, Germany

Research Interests

Sleep apnea pathophysiology, cardiovascular consequences of Sleep apnea, Biosignal processing in sleep

“ECG and Heart Rate Use in the Diagnosis of Sleep and Sleep Disorders”

Prof. Thomas Penze

Abstract

An important parameter of polysomnography is recorded with the ECG and additional heart rate recordings. Often the evaluation is minimal in the summarizing reports. As this parameter adds much information to the sleep signals, such as EEG, EOG, and EMG, the cardiac signals give additional diagnostic information for autonomic nervous activity during sleep. In this overview we present methodological developments in sleep research focusing on heart rate, ECG and cardio respiratory couplings. I will report on physiological and pathophysiological insights related to sleep medicine obtained by ECG, heart rate and new technical developments.

Recorded nocturnal ECG facilitates conventional heart rate variability analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in different ways during wakefulness, slow wave sleep, and REM sleep. Analysis of beat to beat heart rate variations with statistical methods allows us to estimate sleep stages based on the differences in autonomic nervous system regulation. Up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration modulated changes in ECG morphology. Examples for this detection method are presented.

MODERATOR

Lunch Symposium (Hsin-Chien Lee)

Position

Visiting Staff & Chair

Affiliation

Department of Psychiatry & Sleep Center, Taipei Medical University Hospital Research Interests Psychiatry, Sleep Medicine, Public Health

MODERATOR

Neurology and Sleep (Chung-Yao Hsu)

Position

Professor, Department of Neurology, Kaohsiung Medical University Chief, Department of Neurology, Kaohsiung Medical University Chief, Department of Neurology, Kaohsiung Medical University Hospital Chief, Sleep Disorders Center, Kaohsiung Medical University Hospital

Affiliation

Kaohsiung Medical University and Hospital

Research Interests

Neurology (Sleep Disorders and Epilepsy)

Restless legs syndrome is a circadian rhythm related and sensorimotor disorder. The diagnostic criteria has been established by IRLSSG as follows: an urge to move, unpleasant sensation when rest, improving sensory symptoms after movement, and deterioration in the evening or night. The current pathogenesis of RLS is presumed as dopaminergic theory, and brain iron deficiency. We will discuss the latest concept of the syndrome especially the pathogenesis, comorbidities and associated diseases burden. Additionally, the relationship of RLS and epilepsy will be emphasized separately.

Neurology and Sleep

SPEAKER

Position Attending Physician

Affiliation

Neurology department, E DA hospital College of medicine, I Shou University

Research Interests

Sleep medicine, epilepsy, clinical neurophysiology

Abstract

Obstructive sleep apnea(OSA) is an important but frequently ignored risk factor of ischemic stroke. The devastating disability after stroke result in socioeconomical burden and warrant better preventing strategy. The talk will focus on the epidemiology of OSA and ischemic stroke and discuss about the bidirectional mechanisms of OSA and stroke. We will also provide current evidence of treatment of OSA benefits ischemic stroke prevention. Besides, we will point out the future direction of clinical studies of OSA in stroke patients. In the end, we will share our experience of treating OSA in stroke through a clinical case.

“Obstructive Sleep Apnea and Stroke”

Abstract

REM sleep behavior disorder (RBD) is a REM sleep parasomnia manifesting as repeated episodes of sleep related vocalization and/or complex motor behaviors. RBD is categorized as either idiopathic or secondary to other neurologic disorders and medications. A clinical history of dream enactment or complex motor behavior together with the presence of muscle atonia during REM sleep confirmed by video polysomnography are mandatory for RBD diagnosis. Most older adults with idiopathic RBD will eventually develop an overt neurodegenerative disorder (α synucleinopathies). The primary goal of treatment is to reduce injury to the patient and their bed partner. In the future, studies will likely evaluate neuroprotective therapies in patients with idiopathic RBD to prevent or delay α synucleinopathy related motor and cognitive decline.

Microbiota and Sleep (Terry B.J. Kuo)

Position Professor of Institute of Brain Science

Affiliation National Yang Ming Chiao Tung University

Research Interests

Autonomic Neuroscience, Sleep Physiology, Neuroscience, Pharmacology, Cloud Computing Science, Signal Analysis

SPEAKER

Research Interests molecular biology microbiology

The mainstream method to identify and analyze bacterial is the 16S rRNA gene sequencing. The nearly 1500 bp 16S rRNA gene includes nine variable regions as known the highly conserved 16S sequence. BIOTOOLS CO., LTD. provides better taxonomic resolution using full length 16S gene sequencing compared conventional V3 V4 sequencing. Nevertheless, our bioinformatic pipeline demonstrates taxonomic resolution at species and strain level. BIOTOOLS CO., LTD. also provides untargeted metabolomics for annotating metabolites that correlate with microbes and further accentuates the potential role of gut microbiota and metabolites as biomarkers to predict outcomes of several disease models. 2 (Sun.)

1. Department of Otorhinolaryngology Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan

2. Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan

3. School of Medicine, National Tsing Hua University, Hsinchu, Taiwan

Research

Abstract

Disruptions of normal sleep may disturb the balance of psycho physical health; therefore, sleep disorders may interfere with the homeostasis of hormone levels, mood, and body weight. Current evidence supported a close relationship between gut microbiota and sleep disorders. The gut microbiota affects its host in many ways; in contrast, sleep disorders can alter microbiota composition and cause dysbiosis. These directional relationships between gut microbiota and sleep disorders may result in metabolic disorders, mood disorders, and other complications. In this talk, we will explore what is present in the literature on the link between gut microbiota and sleep disorders in humans.

Position

1. Associate Professor Department Director PhD. Candidate

1. Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

2. College of Medicine, Chang Gung University, Taoyuan, Taiwan

3. School of Medicine, National Tsing Hua University, Hsinchu, Taiwan

4. Health Promotion Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

5. Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan

Research Interests

Epidemiology, health impact, and prevention of obesity, suboptimal body composition, and declined physical fitness

“Tonsil Microbiome among Obstructive Sleep Apnea Children across Intermittent Hypoxemia and Weight Status”

Abstract

The tonsil microbiome is associated with chronic tonsillitis and obstructive sleep apnea (OSA) in children, and the gut microbiome is associated with host weight status. In this study, we hypothesized that weight status may be associated with clinical profiles and the tonsil microbiome in children with OSA. We prospectively enrolled 33 non healthy weight (cases) and 33 healthy weight (controls) pediatric OSA patients matched by the proportion of chronic tonsillitis. Differences in the tonsil microbiome between the non healthy weight and healthy weight subgroups and relation ships between the tonsil microbiome and clinical variables were investigated. Non-healthy weight was associated with significant intermittent hypoxemia (oxygen desaturation index, mean blood saturation (SpO2), and minimal SpO2) and higher systolic blood pressure percentile, but was not related to the tonsil microbiome. However, chronic tonsillitis was related to Acidobacteria in the non healthy weight subgroup, and oxygen desaturation index was associated with Bacteroidetes in the healthy-weight subgroup. In post hoc analysis, the children with mean SpO2 ≤ 97% had reduced α and β diversities and a higher abundance of Bacteroidetes than those with mean SpO2 > 97%. These preliminary findings are novel and provide insights into future research to understand the pathogenesis of the disease and develop personalized treatments for pediatric OSA.

Oral Presentation A

MODERATOR

周昆達 (Kun-Ta Chou, MD & Ph.D)

Position

Head, Division of clinical respiratory physiology, Department of chest medicine1

Chief Executive Officer, Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan2 Associate Professor, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan3

Affiliation

Taipei Veterans General Hospital, Taipei, Taiwan1,2 National Yang Ming Chiao Tung University, Taiwan3

Research Interests

Sleep Medicine, Chest Medicine, Epidemiology, Intermittent hypoxemia, animal model (Sun.)

Oral Presentation A

ABSTRACT

Respiratory Arousal in Patients with Very Severe Obstructive Sleep Apnea and How It Changes after a Non-Framework Surgery 黃怡舜

Objective: Respiratory arousal in patients with obstructive sleep apnea (OSA) has a helpful role to activate upper airway muscles and the resumption of airflow and an opposing role to exacerbate OSA. Patients with very severe OSA (apnea hypopnea index (AHI) ≥ 60 events/hour) may have specific chemical and mechanical stimuli to initiate a respiratory arousal. Little was reported about how respiratory arousal presents in this distinct subgroup and how a non framework surgery may change it.

Methods: Retrospective cohort study at level 1 sleep laboratory of the authors’ tertiary referral hospital.

Results: Scatter plot with correlation and changes after the surgery were reported in 27 patients with very severe OSA.

Conclusion: Respiratory arousal index was correlated with each of AHI, mean oxyhemoglobin saturation of pulse oximetry (SpO2), mean desaturation, and desaturation index. Its mean was higher than other reports with less severe OSAs. It can be reduced about half after the surgery.

Keywords: palatoplasty; one stage; retropharynx; polysomnography (PSG); Continuous Positive Airway Pressure (CPAP) (Sun.)

ABSTRACT

Introduction

Dysphonia is the symptoms of altered voice quality, which can be described as hoarse, breathy, strained or weak. In our voice center, we found the etiology for dysphonia other than the structural or functional causes of vocal folds, is intractable laryngopharyngeal reflux. Since obstructive sleep apnea (OSA) is believed to be correlated with laryngopharyngeal reflux (LPR), this study aimed to evaluate the prevalence of OSA in patients with LPR complained with dysphonia.

Method

Fifty dysphonia patients were enrolled in the study retrospectively. For each patient, flexible fiberscope was examined, patients with vocal fold lesions were excluded. Patients with the diagnosis of LPR was enrolled and assessed with reflux finding score (RFS). For the patients with intractable LPR after 3 months of medication, further personal history was obtained and PSG was performed.

Result

The main complaints of dysphonia patient is hoarseness, accompanied with lump sensation. Mean duration of dysphonia period is 3 months or more, but not correlate to reflux finding score (RFS). The mean BMI of the OSA group significantly was higher than the non OSA group (p < 0.05), and the mean reflux finding score (RFS) in OSA patients was higher than non OSA patients. Most of the patients in the OSA group showed moderate-severe OSA, but not correlate to BMI.

Conclusion

Dysphonia should be examined with associated risk factors and underlying conditions other than vocal fold lesions alone. A high number of patients with dysphonia suffered from intractable LPR, which could be correlated to OSA. The severity of RFS is related to the possibility of OSA.

ABSTRACT

Background: Continuous positive airway pressure (CPAP) therapy may reduce blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, the benefits of CPAP therapy for the reduction in BP in patients with OSA and ischemic stroke have not previously been proved.

Objective: The BP lowering effects of treatment with CPAP in subacute ischemic stroke patients with OSA.

Methods: This was a prospective and non randomized observational study in which ischemic stroke patients with OSA being treated in a rehabilitation ward were enrolled from 2015 to 2018. The participants who tolerated CPAP were classified as the CPAP group, while those who refused or could not tolerate CPAP were classified as the control group. A comparison was made between the measurements of BP in three consecutive days before and after two weeks of CPAP therapy with the control group by MannWhitney U test.

Results: A total of 44 participants were enrolled and completed the study (control group: 19; CPAP group: 25; mean age= 59.8 years old; mean apnea hypopnea index= 42.9). The average AHI of the CPAP group was decreased from 43.0 ± 17.3 /hr to 6.5 ± 4.9/hr after CPAP therapy. The average time of CPAP usage was 7.3±1.0 hours per night, and all of participants used it for more than 70% of the days during the study period. Morning and evening blood pressure comparison showed no obvious diurnal change. In the CPAP treatment and control groups, statistical significance was achieved for the differences in systolic/diastolic BP in the morning ( 4.9 ± 14.8/ 2.9±8.9 mmHg, respectively) and differences in systolic/diastolic BP at the night time ( 11 ± 8.5/ 4 ± 8.6, respectively).

Conclusion: CPAP treatment is associated with the BP lowering effects among the ischemic stroke patients with OSA.

ABSTRACT

Objective: In obstructive sleep apnea (OSA) patients, epiglottic collapse (EC) remains one of the important factor to continuous positive airway pressure (CPAP) failure. This study aims to explore treatments that can improve EC under drug induced sleep endoscopy with target controlled infusion (TCI DISE) in OSA patients.

Methods: This retrospective study reviewed 274 patients with polysomnography (PSG) or home sleep test (HST) confirmed OSA, who were intolerable to CPAP treatment and therefore underwent TCI DISE from 2016 to 2021 at a tertiary referral hospital. 36 patients with anteroposterior EC were included to this study. Upper airway obstruction was observed by TCI DISE and scored using velum, oropharynx, tongue base and epiglottis (VOTE) classification. EC severity was assessed multiple times with the patients under supine position with or without lateral head rotation and forcefully closed mouth, application of oral appliance (OA), intermittent negative airway pressure (iNAP) respectively.

Results: After applying these procedures to patients, EC severity decreased significantly from total obstruction to partial or no obstruction in 68.8% patients by head rotation, 75.0% patients by forcefully closed mouth, 60.0% patients under OA. EC severity didn’t decrease significantly in supine iNAP use in TCI DISE with only 21% improvement. After simultaneously applying head rotation, EC severity decreased more significantly from total obstruction to partial or no obstruction in 95.0% patients by forcefully closed mouth, 86.2% patients under OA, 89.5% patients under iNAP.

Conclusion: In TCI DISE, we found that EC severity can be reduced most significantly by head rotation with forcefully closed mouth. Supine iNAP use was not effective in decreasing EC severity in TCI DISE.

MODERATOR

Oral Presentation B 楊鈞百 (Chun-Pai Yang)

Position

Director, Sleep Medicine Center

Affiliation

Kuang Tien General Hospital

Research Interests Sleep Medicine, Headache Medicine

ABSTRACT

Objective: Generalized anxiety disorder (GAD) and sleep disordered breathing (SDB) share similar symptoms, such as poor sleep quality, irritability, and poor concentration during daily activities. Some evidence has reported a bidirectional relationship between anxiety disorders and SDB. The aim of this study is to examine the impact of unexpected SDB in patients with newly diagnosed GAD.

Methods: This prospective case control study included patients newly diagnosed with GAD from a psychiatric clinic and healthy controls from the local community. All participants completed questionnaires for sleep and mood symptoms and a resting 5 min heart rate variability (HRV) examination during enrollment. They also used a validated home sleep test device to detect unexpected SDB. An oxygen desaturation index (ODI) ≥5 was considered indicative of SDB.

Results: Total 56 controls and 47 newly diagnosed GAD participants (mean age 55.1±12.04 years) were included. There was no significant difference in the proportion of unexpected SDB in the control and GAD groups (46.43% vs 51.06%). Patients with comorbid GAD and SDB had higher Beck Anxiety Index (BAI) scores (23.83±11.54) than those without SDB (16.52±10.61). Patients with GAD had worse Pittsburgh Sleep Quality Index (PSQI) scores than controls, regardless of SDB comorbidity. Both the control and GAD groups with SDB had lower global autonomic function than the control group without SDB, as evidenced by the HRV results. Backward stepwise regression analysis indicated that age and body mass index (BMI) were the two major risk factors for ODI.

Conclusion: The study revealed that nearly 50% of participants with average age 55 in both the GAD and control groups had unexpected SDB. Among patients with GAD, those with unexpected SDB had more severe anxiety symptoms than those without. Furthermore, age and BMI were considered risk factors for unexpected SDB.

Objective

Traumatic daytime experience may lead to sleep disturbances at night. Sometimes these traumatic experiences replay after falling asleep and subsequently disrupt sleep. In the present study, we hypothesize the activation of neurons that encode fear memory in the hippocampus causes sleep disturbance in animals.

Methods

To observe the brain activity, we performed in vivo calcium imaging in the ventral CA1 of the hippocampus (vCA1) and recorded the electrical field for both vCA1 and basal amygdala (BA) in mice during sleep. Then, we compared the neuronal activity before/after the subjects were fear conditioned. In addition, optogenetic, chemogenetic, and activity dependent neural tagging techniques were used to tag and manipulate neurons that had activated during fear conditioning.

Results

The results demonstrated that neurons in vCA1 were robustly activated during sleep when we applied conditioned stimuli. The electrical field was mainly transferred from vCA1 to BA when the subject heard the conditioned stimuli. Moreover, inhibition of the vCA1 BA pathway reduced the sleep disruption following fear conditioning. In addition, stimulation of the neurons that had activated during fear conditioning caused sleep disturbance

Conclusion

Our results suggest the reactivation of neurons that keep fear memory in vCA1 contributes to sleep disturbance. The vCA1 to BA is one of the main pathways leading to this type of sleep disturbance.

ABSTRACT

Objective: Various automatic algorithms have been developed in recent years to accelerate sleep scoring and to reduce human efforts in rodent models. Nonetheless, even for those showing excellent performance, no algorithm has been validated on different strains of rodent. The applicability of such system in genetic modified animal models was therefore unclear. The aim of this study is to develop an automatic sleep analysis scoring algorithm using supervised and unsupervised approaches to discriminate between normotensive Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR).

Methods: Polysomnographic analysis was performed on freely moving WKY and SHR under full day monitoring. Continuous power spectral analysis was applied to the electroencephalogram (EEG) and electromyogram (EMG) signals, from which the mean power frequency (MPF) of the EEG and the power magnitude of the EMG (EMG power) were quantified. Automatic scoring algorithm was developed using rule based, clustering method and the support vector machine (SVM). Rats consciousness states were discriminated into active waking (AW), paradoxical sleep (PS), and quiet sleep (QS). Hypnograms constructed by each method were compared with manual scoring outcome to assess accuracy. Moreover, SHR are reported to have more fragmented sleep architecture pattern in comparison with WKY. Inter phasal transitions were quantified upon the two strains to assess the applicability on strain discrimination.

Results: MPF and EMG power thresholds for rule based scoring algorithm determined using different frequency bands of encephalogram and one dimensional clustering method showed decent performance on the accuracy among the WKY rats and the SHR rats (85% 87%). Two dimensional clustering (K means) implemented as unsupervised machine learning method presented 85% accuracy for the WKY rats and 70% accuracy for the SHR rats. Notably, Two dimensional clustering method showed the best sensitivity for paradoxical sleep on both strain (70% 75%). Support vector machine exhibited the best performance with 94% accuracy for the WKY rats and 93% accuracy for the SHR rats. Sleep phase alternation counts quantified by all the above methods showed significant difference among WKY rats and SHR rats (p<0.05).

Conclusion: Unsupervised machine learning algorithm using SVM resulted in the best performance among all other approaches. The sleep architectural pattern of the SHR rats revealed to be fragmented and can be easily identified compared to the WKY rats using automatic scoring algorithms.