Showing papers on "Epworth Sleepiness Scale published in 2003"

Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis.

Abstract: Background Although continuous positive airway pressure (CPAP) has become the standard of care in the treatment of obstructive sleep apnea (OSA), 2 systematic reviews have questioned its utility Since the publication of these reviews, several randomized controlled trials have been reported We, therefore, performed a meta-analysis to assess the effect of CPAP on subjective and objective sleepiness Methods We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSA Meta-analyses were performed using a random-effects model Statistical heterogeneity was assessed using the Q statistic Results Twelve trials of CPAP in patients with OSA meeting our inclusion criteria were found The Epworth Sleepiness Scale score was reported in 11 studies (706 patients) A meta-analysis found that CPAP reduced the Epworth Sleepiness Scale score an average of 294 points more than placebo ( P 10 = 577, P P P = 04) more than placebo Conclusions Continuous positive airway pressure therapy significantly improves subjective and objective measures of sleepiness in patients with OSA across a diverse range of populations Patients with more severe apnea and sleepiness seem to benefit the most

Italian version of the Epworth sleepiness scale: external validity.

Abstract: We assessed the validity of an Italian language version of the Epworth sleepiness scale (ESS). The translated ESS was compared to the multiple sleep latency test (MSLT), considered the gold standard for the diagnosis of excessive daytime sleepiness (EDS). Within the context of a multicentric national study on narcolepsy (Gruppo Italiano Narcolessia Studio Epidemiologico Nazionale, GINSEN) involving 17 Italian sleep centres, we compared the two diagnostic tests on 91 prospectively recruited subjects with suspected EDS (34 with narcolepsy, 16 with obstructive sleep apnea syndrome, 19 with idiopathic hypersomnia, and 22 with other sleep, neurologic or psychiatric disorders). ESS scores were inversely correlated with mean sleep latency values, as measured with MSLT (rho = −0.31, p<0.01). ESS cut-off scores with best sensitivity and specificity were 12 and 17. For the 5-min MSLT cut-off, sensitivity was 87% and 47% respectively; specificity 39% and 74%. For the 8-min MSLT cut-off, sensitivity was 84% and 49%; specificity 50% and 88%. The Italian version of the ESS is an easy-to-use form useful for preliminary screening of daytime sleepiness level in specialist settings.

Sleep attacks, daytime sleepiness, and dopamine agonists in Parkinson's disease.

Abstract: To study the putative association of dopamine agonists with sleep attacks in patients with Parkinson's disease (PD) and their relation to daytime sleepiness, we performed a survey of 2,952 PD patients in two German counties. In 177 patients, sudden, unexpected, and irresistible sleep episodes while engaged in some activity were identified in a structured telephone interview. Ninety-one of these patients denied the occurrence of appropriate warning signs. A total of 133 patients (75%) had an Epworth Sleepiness Scale (ESS) score >10; 65 (37%) >15. Thirty-one patients (18%) had an ESS score < or =10 and yet experienced sleep attacks without warning signs. Thus, although a significant proportion of patients at risk for sleep attacks might be identified using the ESS, roughly 1% of the PD patient population seems to be at risk for sleep attacks without appropriate warning signs and without accompanying daytime sleepiness. Sleep attacks occurred with all dopamine agonists marketed in Germany (alpha-dihydroergocryptine, bromocriptine, cabergoline, lisuride, pergolide, pramipexole, ropinirole), and no significant difference between ergot and nonergot drugs was evident. Levodopa (L-dopa) monotherapy carried the lowest risk for sleep attacks (2.9%; 95% confidence interval [CI], 1.7-4.0%) followed by dopamine agonist monotherapy (5.3%; 95% CI, 1.5-9.2%) and combination of L-dopa and a dopamine agonist (7.3%; 95% CI, 6.1-8.5%). Neither selegeline nor amantadine or entacapone appeared to influence the occurrence of sleep attacks. A high ESS score, intake of dopamine agonists, and duration of PD were the main influencing factors for the occurrence of sleep attacks. The odds ratio for dopamine agonist therapy was 2.9 compared to 1.9 with L-dopa therapy and 1.05 for a 1-year-longer disease duration.

Randomized trial of modafinil for treating subjective daytime sleepiness in patients with Parkinson's disease

Abstract: We assessed the safety and efficacy of modafinil for the treatment of excessive daytime sleepiness in patients with Parkinson's disease (PD). This was a single-site, randomized, double-blind, placebo-controlled crossover study of 21 PD patients having an Epworth Sleepiness Scale (ESS) score > or =10. They received either placebo or modafinil 200 mg/day for 3 weeks, followed by a washout week, then the alternate treatment for 3 weeks. The ESS data demonstrated a carryover effect, so the changes from baseline ESS scores were compared between the two treatments for period 1 only. The ESS scores for the placebo group went from 16.0 +/- 4.2 (mean +/- SD) to 17.0 +/- 5.1 and for the modafinil group went from 17.8 +/- 4.2 to 14.4 +/- 5.7 (P = 0.039). There was no significant carryover effect for any other measure. The patient Clinical Global Impression of Change (+3 to -3) improved by 0.75 on modafinil compared with 0.15 for placebo (P = 0.07). A total of 7 of 20 (35%) of the patients reported some improvement on modafinil but not placebo. There was no significant improvement or worsening of the UPDRS subscores I-III, Timed Tap test, or time on. Vital signs, electrocardiograms, and lab tests were unchanged. Modafinil was very well tolerated. Our data demonstrate that, in a small sample size, administration of 200 mg/day of modafinil was associated with few side effects and was modestly effective for the treatment of excessive daytime sleepiness in patients with PD.

Assessment of sleep and sleepiness in Parkinson disease.

Abstract: STUDY OBJECTIVES: To develop a short and practical scale (SCOPA-SLEEP) that evaluates nighttime sleep and daytime sleepiness. The scale is developed for research in Parkinson disease but may be of value for other somatic diseases. DESIGN: Postal survey including 4 instruments, the SCOPA-SLEEP nighttime sleep (5 items) and daytime sleepiness (6 items), the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. SETTING: Movement Disorders Center, Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. PARTICIPANTS: 143 patients with Parkinson disease and 104 controls. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Reliability of the scale was high: internal consistency of the nighttime sleep and daytime sleepiness scales were 0.88 and 0.91, respectively (Cronbach alpha), and test-retest reliabilities were 0.94 and 0.89, respectively (intraclass correlation coefficient). Scale scores differed significantly between patients and controls (P <.001). Construct validity was assessed by correlations with scales that addressed similar constructs. Correlation between the nighttime sleep scale and the Pittsburgh Sleep Quality Index was 0.83 (P <.001), and the correlation between the daytime sleepiness scale and the Epworth Sleepiness Scale was 0.81 (P <.001). Factor analysis revealed 1 factor each for both scales, indicating that the scales measure 1 construct, which justifies the calculation of sumscores. The coefficient of variation of both the nighttime sleep and the daytime sleepiness scale was higher than that of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, indicating a better ability to detect differences between individuals. CONCLUSIONS: The SCOPA-SLEEP is a reliable and valid instrument for assessing nighttime sleep and daytime sleepiness in patients with Parkinson disease

Functional Outcomes of Excessive Daytime Sleepiness in Older Adults

Abstract: OBJECTIVES: To describe the effect of self-reported excessive daytime sleepiness (EDS) on functional outcomes. DESIGN: Case-control study designed to examine differences in functional status between cases (with daytime sleepiness) and controls (no daytime sleepiness) with regard to demographic factors, general health, sleep history, and medications. SETTING: Retirement communities in southeastern Pennsylvania, Delaware, and New Jersey. PARTICIPANTS: Seventy-six nondepressed, nondemented adults, aged 65 and older, were cases (had daytime sleepiness) and 38 were controls (had no daytime sleepiness). MEASUREMENTS: Standardized questionnaires to assess disease-specific functional status (Functional Outcomes of Sleepiness Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS)), depression (Geriatric Depression Scale-Short Form and the Center for Epidemiologic Studies-Depression Scale), dementia (Short Blessed Test), demographic factors, current medical history, and sleep complaints. RESULTS: There was a significant difference in functional status between sleepy cases and nonsleepy controls. Sleepiness had a moderate to large negative effect (effect size range from 0.59 to 0.83, P < .005) on the following functional domains of the FOSQ: social outcome, general productivity, vigilance, activity level, and global assessment of functional status. Correlation between ESS and FOSQ subscales were −0.31 to −0.67, P < .05. Examination of cases with daytime sleepiness revealed increased functional impairment in individuals with more than three medical conditions or those taking more than four medications (P < .001 and P = .03, respectively). CONCLUSION: Daytime sleepiness is associated with functional impairments in a broad range of activities. The decrease in daily functioning noted in the sleepy subjects has implications for deconditioning and related comorbidity. These findings suggest that exploration of daytime sleepiness should be part of the ongoing assessment of the elderly, particularly those with multiple medical conditions.

Adjunct Modafinil for the Short-Term Treatment of Fatigue and Sleepiness in Patients With Major Depressive Disorder: A Preliminary Double-Blind, Placebo-Controlled Study

Abstract: BACKGROUND: Fatigue and sleepiness are primary symptoms of depression that may not resolve with antidepressant therapy. Modafinil is a novel agent that has been shown to improve wakefulness and lessen fatigue in a variety of conditions. In this study, we examined the utility of modafinil as an adjunct therapy to treat fatigue and sleepiness in patients with major depression who are partial responders to antidepressants. METHOD: Patients with partial response to anti-depressant therapy given for at least a 6-week period for a current major depressive episode (DSM-IV criteria) were enrolled in this 6-week, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Patients received once-daily doses (100-400 mg) of modafinil or matching placebo as adjunct treatment to ongoing antidepressant therapy. The effects of modafinil were evaluated using the Hamilton Rating Scale for Depression (HAM-D), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS), the Clinical Global Impression of Change (CGI-C), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Adverse events were monitored throughout the study. RESULTS: One hundred thirty-six patients were randomized to treatment, with 118 patients (87%) completing the study. Most patients (82%) were fatigued, and one half of patients (51%) were sleepy. Modafinil rapidly improved fatigue and daytime wakefulness, with significantly greater mean improvements from baseline than placebo in fatigue (FSS) scores at week 2 (p < .05) and sleepiness (ESS) scores at week 1 (p < .01); the differences between modafinil and placebo at week 6 were not statistically significant. Assessment of the augmentation effects of modafinil (HAM-D, CGI-C, and SF-36) did not significantly distinguish modafinil from placebo. Modafinil was well tolerated in combination with a variety of antidepressants. CONCLUSION: Modafinil may be a useful adjunct therapy for the short-term management of residual fatigue and sleepiness in patients who are partial responders to antidepressant therapy.

Assessment of Sleep and Sleepiness in Parkinson Disease SLEEP IN NEUROLOGIC DISEASE

Abstract: Measurements and Results: Reliability of the scale was high: internal consistency of the nighttime sleep and daytime sleepiness scales were 0.88 and 0.91, respectively (Cronbach α), and test-retest reliabilities were 0.94 and 0.89, respectively (intraclass correlation coefficient). Scale scores differed significantly between patients and controls (P < .001). Construct validity was assessed by correlations with scales that addressed similar constructs. Correlation between the nighttime sleep scale and the Pittsburgh Sleep Quality Index was 0.83 (P < .001), and the correlation between the daytime sleepiness scale and the Epworth Sleepiness Scale was 0.81 (P < .001). Factor analysis revealed 1 factor each for both scales, indicating that the scales measure 1 construct, which justifies the calculation of sumscores. The coefficient of variation of both the nighttime sleep and the daytime sleepiness scale was higher than that of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, indicating a better ability to detect differences between individuals. Conclusions: The SCOPA-SLEEP is a reliable and valid instrument for assessing nighttime sleep and daytime sleepiness in patients with Parkinson disease.

Fatigue and depression are associated with poor quality of life in ALS

Abstract: Twenty-five ALS subjects filled out five questionnaires: the ALS Functional Rating Scale, Multidimensional Fatigue Inventory, multidimensional McGill Quality of Life, Center of Epidemiologic Study--Depression Scale, and the Epworth Sleepiness Scale. Fatigue, depression, and excessive somnolence are more pronounced in ALS subjects than in normal controls. Both fatigue and depression are associated with poorer quality of life in subjects with ALS, and should be treated aggressively.

Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity

Abstract: Background: We have demonstrated that obstructive sleep apnea (OSA) is prevalent in 60% of patients undergoing bariatric surgery. A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA. Methods: All 100 consecutive patients with symptoms of OSA were prospectively evaluated by polysomnography before gastric bypass. Preoperative and postoperative scores of Epworth Sleepiness Scale (ESS), Respiratory Disturbance Index (RDI), and other parameters of sleep quality were compared using t-test. Results: Preoperative RDI was 40±4 (normal 5 events/hour, n=100). 13 patients had no OSA, 29 had mild OSA, while the remaining 58 patients were treated preoperatively for moderate-severe OSA. At a median of 6 months follow-up, BMI and ESS scores improved (38±1 vs 54±1 kg/m2, 6±1 vs 12±0.1, P<0.001, postoperatively vs preoperatively). To date, 11 patients have completed postoperative polysomnography (3-21 months) after losing weight (BMI 40±2 vs 62±3 kg/m2, P<0.001).There was significant improvement in ESS (3±1 vs 14±2), minimum O2 saturation (SpO2 86±2 vs 77±5), sleep efficiency (85±2% vs 65±5%), all P<0.001, postop vs preop; and RDI (56±13 vs 23±7, P=0.041). Regression analysis demonstrated no correlation between preoperative BMI, ESS score and the severity of OSA; and no correlation between % excess body weight loss and postoperative RDI. Conclusion: Weight loss following gastric bypass results in profound improvement in OSA. The severity of apnea cannot be reliably predicted by preoperative BMI and ESS; therefore, patients with symptoms of OSA should undergo polysomnography.

Sleepiness in Parkinson's disease: a controlled study.

Abstract: Sudden-onset sleep episodes while driving have been reported in Parkinson's disease (PD) patients, and termed sleep attacks because they were reported to be irresistible and to occur without warning. We postulate that these episodes are due to excessive daytime sleepiness secondary to the high frequency of sleep disorders in PD patients and the sedative effects of dopaminergic medications. We assessed the frequency and relationship between excess daytime sleepiness and sleep episodes while driving (SE) in patients with PD. We evaluated 101 consecutive PD patients presenting to the Movement Disorder Center at the Mount Sinai School of Medicine using a questionnaire that incorporated a subjective estimate of sleepiness, the Epworth Sleepiness Scale (ESS) and information on disease severity and dopaminergic medications. One hundred age-matched respondents without PD served as a control population. Excess daytime sleepiness was reported in 76% of PD patients compared to 47% of controls (P or =10 were observed in 40.6% of PD patients compared to 19% of controls (P or =15, compared to 5% of controls (P < 0.001). Sleep episodes while driving were experienced by 20.8% of PD drivers compared to 6% of control drivers (P < 0.05). The mean daily levodopa (L-dopa) dose equivalent was 1,142 +/- 858 mg in PD drivers who experienced a SE while driving compared to 626 +/- 667 mg in those who had not (P < 0.05). Similarly, ESS was significantly greater in drivers with a SE than in those without (11.6 +/- 6.4 vs. 8.4 +/- 4.1; P < 0.05). Logistic regression analysis demonstrated that ESS and mean daily L-dopa dose equivalents were predictors of sleep episodes while driving, whereas age, gender, disease severity, and individual dopaminergic agents were not. These findings support the notion that sleep episodes while driving in PD patients are related to excess daytime sleepiness and dopaminergic load. Physicians should advise and treat patients accordingly.

Variation in symptoms of sleep-disordered breathing with race and ethnicity: the Sleep Heart Health Study.

Abstract: Study objectives To examine the relation of sleep-related symptoms to race and ethnicity in a diverse sample of middle-aged and older men and women. Design Cross-sectional questionnaire survey. Setting In the initial phase of the Sleep Heart Health Study, men and women enrolled in participating epidemiologic cohort studies were surveyed. Participants 13,194 men and women 40 years of age and older, including 11,517 non-Hispanic white, 648 black, 643 American Indian, 296 Hispanic, and 90 Asian-Pacific Islander. Interventions Not applicable. Measurements and results After adjustment for BMI and other factors, frequent snoring was more common among Hispanic women (odds ratio (OR) = 2.25, 95% confidence interval (CI) = 1.48, 3.42) and black women (OR = 1.55, 95% Ci = 1.13, 2.13) than among non-Hispanic white women. Hispanic men were significantly more likely to report frequent snoring than non-Hispanic white men (OR = 2.30, 95% CI = 1.43, 3.69). Black, American Indian, and Asian men did not differ significantly from white men in snoring prevalence. American Indian women were significantly more likely to report breathing pauses during sleep than their white, non-Hispanic counterparts (OR = 1.52, 95% CI 1.03, 2.24), although polysomnography data on a subset of the sample suggested that the association between this symptom reported on questionnaire and objective evidence of sleep-disordered breathing may be weaker among American Indians than among other groups. Mean Epworth Sleepiness Scale scores were slightly higher in black men and women than in their white, non-hispanic counterparts. Conclusions Frequent snoring was more common among black and Hispanic women and Hispanic men than among their white non-Hispanic counterparts, even after adjusting for BMI and other factors. Further research including polysomnography and objective measurements of sleepiness is needed to assess the physiologic and clinical significance of these findings.

Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis.

Abstract: Background: Improving quality of life is considered to be a major endpoint and motivation for clinical intervention in patients with perennial allergic rhinitis (PAR). In addition to classical symptoms of congestion, pruritus, and rhinorrhea, patients will often complain of not being able to sleep well at night and of feeling fatigued during the day. Like sleep apnea, PAR has also been shown to cause sleep disturbance and consequently worsen daytime fatigue and somnolence. Hypothesis: It is proposed that by decreasing nasal obstruction due to allergic rhinitis by treating with the topical steroid budesonide, symptoms of daytime fatigue and somnolence can be improved. Methods: Twenty-two subjects were enrolled in a double-blind, placebo-controlled, crossover study using Baalam's design. Patients were treated with either budesonide 128 μg/day or placebo. Subjective data include the Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Rhino-conjunctivitis Quality of Life Questionnaire, and a daily diary recording nasal symptoms, sleep problems, and daytime fatigue. Results: The results illustrated that the topical nasal corticosteroid significantly improved daytime fatigue (P = 0.03), somnolence (P = 0.02), and quality of sleep (P = 0.05) compared to placebo in patients suffering from PAR. Summary: Budesonide is able to improve congestion, sleep, and daytime somnolence.

Sleep quality and clinical correlates in patients on maintenance dialysis.

Abstract: Background: Sleep quality is a subject of increasing interest to clinicians caring for dialysis patients. Self-assessed sleep disturbances have been associated with quality of life outcomes. The goal of this study was to identify clinical and laboratory parameters that are independently associated with overall sleep quality among prevalent dialysis patients. Methods: The Epworth Sleepiness Scale (ESS) and the Sleep Problems Index (SPI), a questionnaire derived from the Medical Outcomes Study, were administered to 71 dialysis patients and 68 subjects without known kidney disease (control group). The ESS and the SPI sleep item responses between the 2 groups were compared. The sleep items from the SPI were also aggregated into a sleep quality score. Multivariate linear regression analyses of sleep quality scores were used to identify clinical factors that were independently associated with poor sleep. Results: The ESS score was not significantly different between the 2 groups. However, the responses to the SPI sleep items demonstrated significantly impaired subjective sleep quality in dialysis patients compared with control subjects. In addition, overall sleep quality, as measured by the aggregated sleep score, was lower in dialysis patients compared with the control group (41 vs. 47, p< 0.001). In multivariate analyses, factors that were independently associated with poor sleep quality in dialysis patients were male gender (p = 0.006), history of coronary artery disease (p = 0.003), and high phosphate level (p = 0.05). Conclusion: This study demonstrates that global sleep quality of dialysis patients is substantially impaired. Poor sleep quality was associated with male gender, coronary artery disease and high serum phosphate level, a modifiable factor. Future studies are needed to examine the relationship of serum phosphate level to sleep quality in dialysis patients.

Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome.

Abstract: OBJECTIVE: In this study, we compare the objective results of uvulopalatopharyngoplasty (UPPP) combined with tongue base radiofrequency reduction (TBRF) with standard UPPP treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS).STUDYDESIGN: We conducted a retrospective study of 277 patients who had stage I, II, or III OSAHS based on the Friedman staging system previously presented.METHODS: One hundred thirty-four patients who had treatment with UPPP only were used as a control group. This included 31 patients with stage I, 29 patients with stage II, and 74 patients with stage III OSAHS. An additional 143 patients with Stage II (n = 52) and III (n = 91) OSAHS were treated with combined UPPP and TBRF, initially and followed by additional TBRF treatments (up to 9000 J) as necessary. Subjective results were collected based on questionnaires and the Epworth Sleepiness Scale score for the experimental group, but these subjective measures were not available for the control group. Objective results were co...

Predictors of objective sleep tendency in the general population.

Abstract: STUDY OBJECTIVES Daytime sleepiness is a pervasive problem that is associated with a significant public-health burden. Although self-reported measures of daytime sleepiness may be useful in identifying at-risk individuals, there is significant controversy because there are no population-based data relating subjective and objective measures of daytime sleep tendency. The aims of this study were to examine the associations between the Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleep tendency, and self-reported information on the Epworth Sleepiness Scale (ESS) and nighttime sleep duration in the general population. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Population-based sample of 261 women and 371 men, mean age of 50.8 years, enrolled in the Wisconsin Sleep Cohort Study. MEASUREMENTS MSLT, ESS, and self-reported sleep duration prior to the MSLT. RESULTS Using survival analysis to model the time to sleep onset during the MSLT, we found that individuals with an intermediate (6-11) and high (> or = 12) ESS score had a 30% and 69% increase in risk for sleep onset during the MSLT, respectively, compared to individuals with a low ESS score (< or = 5). A dose-response relationship between self-reported duration of nighttime sleep and objective sleep tendency was also observed. Compared to individuals reporting more than 7.50 hours of sleep (highest tertile), individuals reporting 6.75 to 7.50 hours and less than 6.75 hours (lowest tertile) had a 27% and 73% increase in risk for sleep onset during the MSLT, respectively. CONCLUSIONS Subjective reports of daytime sleep tendency on the ESS and the duration of nighttime sleep are associated with the results of the MSLT in the general population.

Can patients with obstructive sleep apnea titrate their own continuous positive airway pressure

Abstract: Manual continuous positive airway pressure (CPAP) titration in a tions (9) can improve the efficiency with which CPAP treatsleep laboratory is costly and limits access for diagnostic studies. ment is delivered, as compared with conventional in-laboraMany factors affect CPAP compliance, but education and support, tory overnight CPAP titration. Given the high disease rather than in-laboratory CPAP titration, appear to be pivotal. Self- prevalence and limited healthcare resources, carefully evaluadjustment of CPAP at home will provide equal or superior efficacy ated attempts at greater efficiency in managing patients with in the treatment of obstructive sleep apnea (OSA) as compared OSA are needed. Approximately 15% of patients with OSA with in-laboratory titration. A randomized, single-blind, two-period refuse CPAP treatment at the outset (10, 11), and compliance crossover trial of CPAP treatment at the in-laboratory–determined among those who accept this treatment is frequently suboptioptimal pressure versus at-home self-adjustment of CPAP (starting mal (12, 13). More intensive education and support have pressure based on prediction equation). Eighteen CPAP-naive pa- been documented to improve clinical outcomes in patients tients (16 males, 50 15 years old, apnea hypopnea index 40 with OSA (14), and provision of an abbreviated care regimen 20) with a new diagnosis of OSA were tested. Testing was performed resulted in an inferior clinical outcome (15). It is therefore before and after CPAP treatment in each of two 5-week study limbs. essential to document both compliance with treatment and CPAP, compliance with CPAP treatment, the Sleep Apnea Quality clinical outcomes in association with any intervention aimed of Life Index, the Functional Outcomes of Sleep Questionnaire score, at improving the efficiency with which treatment is delivered the Epworth sleepiness scale score, sleep architecture, sleep apnea to patients with OSA. severity, and maintenance of wakefulness tests were performed. An educational model in which the patient is empowered Both modes of CPAP treatment significantly improved objective with the understanding and ability to make decisions regardand subjective measures of OSA, but they did not differ in efficacy. ing treatment has been demonstrated to be successful in Home self-titration of CPAP is as effective as in-laboratory manual other medical conditions (16). We reasoned that a similar titration in the management of patients with OSA. educational approach might be successful in patients with

Sleep-disordered breathing and cognitive impairment in elderly Japanese-American men.

Abstract: STUDY OBJECTIVE To assess the association between sleep-disordered breathing and cognitive functioning in an elderly cohort of Japanese-American men. DESIGN Cross-sectional study. SETTING The Honolulu-Asia Aging Study of Sleep Apnea, Oahu, Hawaii. PARTICIPANTS 718 men between 79 and 97 years of age examined in 1999 and 2000. MEASUREMENTS Apnea-hypopnea index from in-home overnight polysomnography, performance on the Cognitive Abilities Screening Instrument, body mass index, neck circumference, Epworth Sleepiness Scale, snoring, Center for Epidemiologic Studies Depression 11-item depression scale, physical disability, and history of heart disease, stroke, hypertension, diabetes, and dementia. RESULTS Less than 30% of the men had no sleep-disordered breathing (apnea-hypopnea index or = 30). Severe sleep-disordered breathing was associated with higher body mass index, habitual snoring, and daytime drowsiness. No association was found between sleep-disordered breathing and cognitive functioning, including measures of memory function, concentration, and attention. CONCLUSIONS Sleep-disordered breathing was associated with more drowsiness but not with poor performance on standardized cognitive tests used to screen for Alzheimer disease and other dementias in older persons. Because a healthy-participant effect may have contributed to this finding, more extensive cognitive testing may be necessary to reveal more subtle deficits from sleep-disordered breathing.

Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome.

Abstract: STUDY OBJECTIVE To characterize the function and quality of sleep in patients with irritable bowel syndrome (IBS) DESIGN A prospective study with a historic comparison group SETTING A regional hospital that also serves as a tertiary referral center PATIENTS Eighteen patients with IBS and a comparison group of 20 matched adults with mild benign snoring INTERVENTIONS A polysomnography study and a wrist actigraphy study MEASUREMENTS All subjects underwent sleep studies and completed self-report questionnaires (IBS severity, psychosocial variables, sleep function, and Epworth Sleepiness Scale) Fourteen IBS and 11 comparison patients underwent actigraphy RESULTS The IBS patients had more than 70% less slow-wave stage sleep (45 +/- 73% vs 193 +/- 129%; P = 0006), compensated by increased stage 2 sleep (722 +/- 66% vs 601 +/- 168%; P = 001) The IBS group had significant sleep fragmentation with a significantly higher arousal and awakening index (P < 0001), a longer wake period after sleep onset (P = 002), and more downward shifts to lighter sleep stages (P = 001) The 4-night actigraphy study supported the polysomnography findings The sleep fragmentation index was significantly higher (P = 0008) in the IBS group The IBS patients reported greater daytime sleepiness (90 +/- 48 vs 64 +/- 48, Epworth Sleepiness Scale score, P < 001) and greater impairment in quality of life, which correlated significantly with the sleep fragmentation indexes The difference between the groups was not due to differences in baseline anxiety/depression levels CONCLUSIONS Patients with IBS have impaired sleep quality, reduced slow-wave sleep activity, and significant sleep fragmentation The cause-and-effect relationship of these findings with patients' daytime symptoms should be studied further