Showing papers on "Epworth Sleepiness Scale published in 2005"
TL;DR: The severity of OSA is independently associated with oxidative stress, and among various sleep-disordered breathing parameters, ODI is most closely related to oxidative stress.
358 citations
TL;DR: At the time ofOSAS diagnosis, women with OSAS are more likely to be treated for depression, to have insomnia, and to have hypothyroidism than are men with the same degree of OSAS.
Abstract: Study objectives Obstructive sleep apnea syndrome (OSAS) results from recurrent episodes of breathing cessation during sleep. Epidemiologic studies have shown that OSAS is more prevalent in men than women (4% vs 2%). Previous studies have explored gender-related differences in upper airway anatomy and function, hormone physiology, and polysomnographic findings. The aim of this study is to assess differences in clinical presentation between women and men with OSAS. Design Retrospective chart review analysis. Setting Tertiary university-based medical center Participants 130 randomly selected women with OSAS matched individually with 130 men with OSAS for age, body mass index, apnea-hypopnea index, and Epworth Sleepiness Scale score. Interventions N/A. Measurements and results Data were obtained from questionnaires and in-laboratory polysomnographic studies. There were no differences between the genders for age (48.0 +/- 1.1 years [mean +/- SEM] for women vs 47.6 +/- 1.0 years for men), body mass index (40.4 +/- 0.7 kg/m2 for women vs 40.0 +/- 0.6 kg/m2 for men), apnea-hypopnea index (36.8 +/- 3.3/hour for women vs 36.0 +/- 3.0/hour for men), or Epworth Sleepiness Scale score (12.45 +/- 0.53 for women vs 12.84 +/- 0.47 for men). Although snoring and sleepiness were similarly common in women and men, women more often described their main presenting symptoms as insomnia (odds ratio: 4.20; 95% confidence interval: 1.54-14.26) and were much more likely to have a history of depression (odds ratio: 4.60; 95% confidence interval: 1.71-15.49) and hypothyroid disease (odds ratio: 5.60; 95% confidence interval: 2.14-18.57). Women presented less often with a primary complaint of witnessed apnea (odds ratio: 0.66; 95% confidence interval: 0.38-1.12), consumed less caffeine per day (3.3 cups in women vs 5.2 cups in men; P = .0001), and admitted to less alcohol consumption (odds ratio: 0.36; 95% confidence interval: 0.18-0.70). Conclusions At the time of OSAS diagnosis, women with OSAS are more likely to be treated for depression, to have insomnia, and to have hypothyroidism than are men with the same degree of OSAS.
309 citations
TL;DR: In this article, the authors evaluated whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE-AD)) could improve sleep in dementia patients living at home with their family caregivers.
Abstract: OBJECTIVES: To evaluate whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer’s Disease (NITE-AD)) could improve sleep in dementia patients living at home with their family caregivers. DESIGN: A randomized, controlled trial. PARTICIPANTS: Thirty-six community-dwelling patients with Alzheimer’s disease (AD) and their family caregivers. INTERVENTION: All participants received written materials describing age- and dementia-related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n 5 17) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills. Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box. Control subjects (n 5 19) received general dementia education and caregiver support. MEASUREMENTS: Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep-wake activity measured at baseline, posttest (2 months), and 6month follow-up using an Actillume wrist-movement recorder. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, and the Revised Memory and Behavior Problem Checklist. Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale. RESULTS: Patients participating in NITE-AD showed significantly greater (Po.05) posttest reductions in number of nighttime awakenings, total time awake at night, and depression, and increases in weekly exercise days than control subjects. At 6-month follow-up, treatment gains were maintained, and additional significant improvements in duration of night awakenings emerged. When cognitive level was controlled, NITE-AD patients had lower longitudinal ratings of daytime sleepiness than controls. There was a trend for control subjects to spend more time in bed at 6 months than NITE-AD patients. CONCLUSION: This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques (specifically, sleep hygiene education, daily walking, and increased light exposure) that are known to improve sleep in nondemented, institutionalized older adults. J Am Geriatr Soc 53:793–802, 2005.
281 citations
TL;DR: Although there seem to be important global variations in the prevalence of insomnia, its symptoms and their management, about one in four individuals do not think they sleep well, and self-reported sleep problems could be underestimated in the general population.
263 citations
TL;DR: Evidence is provided for the use of soothing music as an empirically-based intervention for sleep in older people using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale.
Abstract: Aim. The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan.
Background. Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults.
Method. A randomized controlled trial was used with a two-group repeated measures design.
Sixty people aged 60–83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality.
Results. Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction (P = 0·04–0·001). Sleep improved weekly, indicating a cumulative dose effect.
Conclusion. The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.
237 citations
TL;DR: A statistically significant improvement in actigraphically measured total sleep time on 50 mg melatonin compared to 5 mg or placebo and a significant improvement found in subjective sleep disturbance suggests that these modest effects may be clinically relevant in this patient population.
226 citations
TL;DR: This study aimed to investigate the effects of methylphenidate and sertraline compared with placebo on various neuropsychiatric sequelae associated with traumatic brain injury (TBI).
Abstract: Background
This study aimed to investigate the effects of methylphenidate and sertraline compared with placebo on various neuropsychiatric sequelae associated with traumatic brain injury (TBI).
Methods
This was a 4 week, double-blind, parallel-group trial. Thirty patients with mild to moderate degrees of TBI were randomly allocated to one of three treatment groups (n = 10 in each group) with matching age, gender and education, i.e. methylphenidate (starting at 5 mg/day and increasing to 20 mg/day in a week), sertraline (starting at 25 mg/day and increasing to 100 mg/day in a week) or placebo. At the baseline and at the 4 week endpoint, the following assessments were administered: subjective (Beck Depression Inventory) and objective (Hamilton Depression Rating Scale) measures of depression; Rivermead Postconcussion Symptoms Questionnaire for postconcussional symptoms; SmithKline Beecham Quality of Life Scale for quality of life; seven performance tests (Critical Flicker Fusion, Choice Reaction Time, Continuous Tracking, Mental Arithmetic, Short-Term memory, Digit Symbol Substitution and Mini-Mental State Examination); subjective measures of sleep (Leeds Sleep Evaluation Questionnaire) and daytime sleepiness (Epworth Sleepiness Scale). All adverse events during the study period were recorded and their relationships to the drugs were assessed.
Results
Neuropsychiatric sequelae seemed to take a natural recovery course in patients with traumatic brain injury. Methylphenidate had significant effects on depressive symptoms compared with the placebo, without hindering the natural recovery process of cognitive function. Although sertraline also had significant effects on depressive symptoms compared with the placebo, it did not improve many tests on cognitive performances. Daytime sleepiness was reduced by methylphenidate, while it was not by sertraline.
Conclusions
Methylphenidate and sertraline had similar effects on depressive symptoms. However, methylphenidate seemed to be more beneficial in improving cognitive function and maintaining daytime alertness. Methylphenidate also offered a better tolerability than sertraline. Copyright © 2005 John Wiley & Sons, Ltd.
204 citations
TL;DR: The notion that subjective fatigue and sleepiness can be independent manifestations of sleep disorders is supported, and predominantly fatigued individuals with sleep disorders seem vulnerable to additional negative consequences due to possible interplay between amplified fatigue and psychological distress.
Abstract: The objective of this investigation was to evaluate subjective fatigue versus subjective sleepiness as independent consequences of sleep disorders. Furthermore, we tried to explore how these symptoms relate to alertness, depressive symptoms and illness intrusiveness. In a prospective observational study, 283 sleep-disordered patients referred to a hospital-based sleep laboratory for various indications over a 1-year period were evaluated vis-a-vis fatigue and sleepiness. All patients completed five subjective questionnaires, underwent objective sleep recording and attended a clinical interview with a sleep specialist. The subjective questionnaires included the Epworth Sleepiness Scale, the Fatigue Severity Scale, the Toronto Hospital Alertness Test, the Illness Intrusiveness Rating Scale and the Center for Epidemiologic Studies-Depression Scale. Only 4% of the total sample was referred to the sleep clinic due to a complaint of excessive fatigue compared with 17% for excessive daytime sleepiness. However, during the assessment, 64% of referred patients reported pathological fatigue without overlap of sleepiness and only 4% reported pathological sleepiness without overlap of fatigue. Pearson's correlation analysis indicated a weak association (r=0.18) between subjective fatigue and sleepiness in the total sample. Analysis of variance testing showed strong association between those patients with prominent fatigue and depressive symptoms (P<0.01) and illness intrusiveness (P<0.001). The findings support the notion that subjective fatigue and sleepiness can be independent manifestations of sleep disorders. Furthermore, predominantly fatigued individuals with sleep disorders seem vulnerable to additional negative consequences due to possible interplay between amplified fatigue and psychological distress.
202 citations
TL;DR: Modafinil is a well-tolerated and potentially effective augmenting agent for SSRI partial responders with fatigue and sleepiness despite selective serotonin reuptake inhibitor (SSRI) monotherapy.
Abstract: BACKGROUND Up to one half of depressed patients have partial or no response to antidepressant monotherapy. This multicenter, placebo-controlled study evaluated the efficacy of modafinil augmentation in major depressive disorder (MDD) patients with fatigue and excessive sleepiness despite selective serotonin reuptake inhibitor (SSRI) monotherapy. METHOD Patients (18-65 years) with a DSM-IV diagnosis of MDD and partial response to SSRI monotherapy (> or = 8 weeks) at a stable dose for > or = 4 weeks were eligible. Patients had screening/baseline 31-item Hamilton Rating Scale for Depression (HAM-D) scores of 14 to 26, Epworth Sleepiness Scale (ESS) scores > or = 10, and Fatigue Severity Scale (FSS) scores > or = 4. Patients were randomly assigned to augmentation therapy with modafinil 200 mg/day or placebo for 8 weeks. Assessments included the ESS, Clinical Global Impressions-Improvement scale (CGI-I), 31- and 17-item HAM-D, FSS, Brief Fatigue Inventory (BFI), and Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS Of 311 enrolled patients who received > or = 1 dose of study drug, 158 were randomly assigned to modafinil (70% women) and 153 to placebo (72% women); 85% of each treatment group completed the study. At final visit, modafinil significantly improved patients' overall clinical condition compared with placebo on the basis of CGI-I scores (p = .02), and there were trends toward greater mean reductions in ESS, 31- and 17-item HAM-D, and MADRS scores versus placebo. Modafinil significantly reduced BFI scores for worst fatigue at final visit (p < .05 vs. placebo). There were no significant differences between modafinil and placebo at final visit in FSS or BFI total scores. Adverse events significantly more common during modafinil compared with placebo treatment were nausea (9% vs. 2%; p = .01) and feeling jittery (4% vs. 1%; p = .03). CONCLUSION These findings suggest that modafinil is a well-tolerated and potentially effective augmenting agent for SSRI partial responders with fatigue and sleepiness.
184 citations
TL;DR: It is demonstrated that symptoms of sleep-disordered breathing increase during pregnancy and that more than 10% of subjects may be at risk for developing sleep apnea during pregnancy.
Abstract: Background Although incident snoring is common in pregnant women and has been proposed as a potential risk factor for adverse maternal-fetal outcomes, the development of sleep-disordered breathing during pregnancy has not been prospectively described. Methods Using the Apnea Symptom Score from the Multivariable Apnea Prediction Index and the Epworth Sleepiness Scale, we prospectively assessed symptoms of sleep-disordered breathing and daytime somnolence in 155 women to determine whether symptoms increased during pregnancy and the characteristics associated with increasing symptoms. Results We found that sleep-disordered breathing symptoms (Apnea Symptom Score, 0.44 (SEM 0.58) vs 0.95 (0.09, P 10) was prevalent throughout pregnancy (31.0%-45.5%). Conclusions Our data demonstrate that symptoms of sleep-disordered breathing increase during pregnancy and that more than 10% of our subjects may be at risk for developing sleep apnea during pregnancy. Excessive daytime somnolence was highly prevalent even early in pregnancy and became increasingly common as pregnancy progressed.
183 citations
TL;DR: RLS is common in type 2 diabetic patients and can be a major cause of sleep disruption in these patients, and Logistic regression analysis revealed an association between RLS and peripheral neuropathy.
Abstract: OBJECTIVE —To investigate the presence of restless legs syndrome (RLS) and the quality of sleep in a population of type 2 diabetic patients. RESEARCH DESIGN AND METHODS —The study population was composed of 100 consecutive patients regularly attending a diabetes clinic at the University Hospital of the Federal University of Ceara. The subjects’ quality of sleep was assessed by the Pittsburgh Sleep Quality Index, and excessive daytime sleepiness (EDS) was measured by the Epworth Sleepiness Scale. The RLS was diagnosed using the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Other relevant clinical and laboratory parameters were obtained by interview and chart review. RESULTS —RLS was found in 27% of patients. Poor sleep quality was present in 45% of cases and was associated with age ( P = 0.04), peripheral neuropathy ( P = 0.001), and RLS ( P = 0.000). EDS was found in 26% of patients. Logistic regression analysis revealed an association between RLS and peripheral neuropathy (odds ratio 12.85 [95% CI 2.83–58.40], P = 0.001). CONCLUSIONS —RLS is common in type 2 diabetic patients and can be a major cause of sleep disruption in these patients.
TL;DR: Weight loss provides major improvement or resolution of OSA and CPAP requirements, and also reduces daytime sleepiness, and improves the metabolic syndrome and QOL.
Abstract: While obstructive sleep apnea (OSA) is strongly related to obesity, few studies have examined polysomnographic (PSG) changes with major weight loss. We examined the effect of weight loss following laparoscopic adjustable gastric banding (LAGB) on the PSG changes in patients with severe OSA. In addition, we studied daytime sleepiness, the metabolic syndrome and quality of life (QOL). A prospective study was conducted of 25 severely obese patients (17 men, eight women) with paired diagnostic PSG, biochemical and questionnaire studies, the first prior to LAGB and the second at least 1 y later. Subjects with a baseline apnea–hypopnea index (AHI) >25/h were included. Subject baseline age was 44.7 y, weight 154 kg and body mass index 52.7 kg/m2. The second PSG study was conducted 17.7±10 (range 12–42) months after surgery and mean percentage of excess loss and weight loss were 50.1±15% (range 24–80%) and 44.9±22 kg (range 18–103 kg), respectively. There was a significant fall in AHI from 61.6±34 to 13.4±13, improved sleep architecture with increased REM and stage III and IV sleep, daytime sleepiness, as measured by Epworth Sleepiness Scale, of 13±7.0 to 3.8±3.0, and fewer patients requiring nasal continuous positive airways pressure (CPAP). There were also major improvements in the metabolic syndrome, QOL, body image and fewer symptoms of depression (P<0.05 for all). Weight loss provides major improvement or resolution of OSA and CPAP requirements. It also reduces daytime sleepiness, and improves the metabolic syndrome and QOL. LAGB placement should be considered a broadly effective therapy for sleep apnea in the severely obese patient.
TL;DR: Overall, heartburn during sleep may be associated with sleep complaints and excessive daytime sleepiness, and increased body mass index (BMI), carbonated soft drink consumption, snoring and daytimeSleepiness (Epworth sleepiness scale score), insomnia, hypertension, asthma, and usage of benzodiazepines were strong predictors of heartBurn during sleep.
TL;DR: It is found that an increase in postoperative pain is correlated with a decrease in a patient's quality of recovery in the immediate postoperative period, as assessed by the QoR.
TL;DR: The study revealed SOS and daytime sleepiness as critical factors for traffic safety in addition to motor disabilities of PD patients and suggested that real sleep attacks without any prior sleepiness are rare.
Abstract: Only few studies have addressed driving ability in Parkinson's disease (PD) to date. However, studies investigating accident proneness of PD patients are urgently needed in the light of motor disability in PD and--particularly--the report of "sleep attacks" at the wheel. We sent a questionnaire about sudden onset of sleep (SOS) and driving behavior to 12,000 PD patients. Subsequently, of 6,620 complete data sets, 361 patients were interviewed by phone. A total of 82% of those 6,620 patients held a driving license, and 60% of them still participated in traffic. Of the patients holding a driving license, 15% had been involved in and 11% had caused at least one accident during the past 5 years. The risk of causing accidents was significantly increased for patients who felt moderately impaired by PD, had an increased Epworth Sleepiness Scale (ESS) score, and had experienced SOS while driving. Sleep attacks at the wheel usually occurred in easy driving situations and resulted in typical fatigue-related accidents. Those having retired from driving had a more advanced (subjective) disease severity, higher age, more frequently female gender, an increased ESS score, and a longer disease duration. The study revealed SOS and daytime sleepiness as critical factors for traffic safety in addition to motor disabilities of PD patients. The results suggest that real sleep attacks without any prior sleepiness are rare. However, our data underline the importance of mobility for patients and the need for further studies addressing the ability to drive in PD.
TL;DR: Results confirm previous shorter-term controlled trials, indicating modafinil is a useful adjunct therapy for improving wakefulness in patients with residual excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome who were treated with nCPAP.
Abstract: Study Objectives: Nasal continuous positive airway pressure (nCPAP) usually reduces sleepiness in patients with obstructive sleep apnea/hypopnea syndrome. However, even with regular use of nCPAP, some patients experience residual excessive sleepiness. We evaluated the efficacy and safety of the wake-promoting agent modafinil for treating residual excessive sleepiness in nCPAP-treated patients. Design: 12-week, multicenter, randomized, double-blind, parallel-group, placebo-controlled trial. Patients: Patients aged 18 to 70 years diagnosed with obstructive sleep apnea/hypopnea syndrome and having residual excessive sleepiness during nCPAP therapy were eligible. Interventions: Once-daily modafinil, 200 mg or 400 mg, or placebo. Measurements and Results: Assessments included the Maintenance of Wakefulness Test, Epworth Sleepiness Scale, Clinical Global Impression of Change, and Functional Outcomes of Sleep Questionnaire. Both doses of modafinil significantly improved mean (SD) sleep latency on the Maintenance of Wakefulness Test at weeks 4, 8, and 12 compared with placebo (week 12: modafinil 400 mg, 15.0 [5.3] minutes; 200 mg, 14.8 [5.3] minutes; placebo, 12.6 [5.8] minutes; P <.0001). The Epworth Sleepiness Scale score decreased more in patients taking modafinil compared with those in the placebo group (week 12: modafinil 400 mg, -4.5 [4.3]; 200 mg, -4.5 [4.7]; placebo, -1.8 [3.5]; P <.0001). At week 12, overall clinical condition improved for 61% and 68% of patients treated with modafinil 200 mg and 400 mg, respectively, versus 37% of placebo-treated patients (P <.001). Modafinil was generally well tolerated and did not adversely affect nighttime sleep or nCPAP use. Conclusions: These results confirm previous shorter-term controlled trials, indicating modafinil is a useful adjunct therapy for improving wakefulness in patients with residual excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome who were treated with nCPAP.
TL;DR: The addition of heated humidification when nasal CPAP was instituted did not lead to better compliance, greater improvement in sleepiness, or improved quality of life, but was associated with fewer symptoms attributable to the upper airway.
TL;DR: ED in OSAS is related to nocturnal hypoxemia, and about 75% of OSAS patients with ED treated with nasal CPAP showed remission at one-month follow-up, resulting in significant improvement in quality of life.
TL;DR: Treatment of OSAS reversed the trend of increasing healthcare utilization seen prior to diagnosis, and CPAP results in a long-term health benefit, as measured by the use of healthcare services.
Abstract: STUDY OBJECTIVES Patients with untreated obstructive sleep apnea syndrome (OSAS) have higher healthcare utilization than matched controls. However, the long-term impact of continuous positive airway pressure (CPAP) use on healthcare utilization is unknown. DESIGN Retrospective observational cohort study. SUBJECTS There were 342 eligible men with OSAS and matched controls on whom there were utilization data for 5 years prior to initial OSAS diagnosis and for the 5 years on CPAP treatment of the cases. INTERVENTIONS Patients were treated with CPAP. RESULTS Patients with OSAS were typical cases (mean +/- SD): age, 48.2 +/- 0.6 years; body mass index, 35.6 +/- 0.4 kg/m2; Epworth Sleepiness Scale score, 14.2 +/- 0.3; apnea-hypopnea index, 47.1 +/- 1.8 events per hour. The number of physician visits were higher by 3.46 +/- 0.2 (95% confidence interval [CI]: 2.57 to 4.36) in cases in the year before diagnosis, compared with the fifth year before diagnosis, then decreased over the next 5 years by 1.03 +/- 0.49 (95% CI: -1.99 to -0.07)(P<.0001). Physician fees, in Canadian dollars, were higher by dollars 148.65 +/- dollars 27.27 (95% CI: 95.12 to 202.10) in cases in the year before diagnosis, compared with the fifth year before diagnosis, and then decreased over the next 5 years by dollars 13.92 +/- dollars 27.94(95%CI: -68.68 to 40.83)(P=.0009). Preexisting ischemic heart disease at the time of OSAS diagnosis predicted about a 5-fold increase in healthcare utilization between the second and fifth year of treatment. CONCLUSIONS Treatment of OSAS reversed the trend of increasing healthcare utilization seen prior to diagnosis. Preexisting ischemic heart disease results in a negative impact on healthcare utilization. CPAP results in a long-term health benefit, as measured by the use of healthcare services.
TL;DR: High anxiety score was associated with non-compliance with CPAP therapy and high depression score wasassociated with daytime sleepiness and non- compliance withCPAP therapy.
TL;DR: Oral appliances, especially those that advance the mandible, offer an effective treatment for OSA, and neither study group showed significant difference in mean SF36 scores.
Abstract: The purpose of this study was to investigate the effects of an oral appliance (OA), with and without mandible advance, in the treatment of obstructive sleep apnea syndrome (OSA). Twenty-four patients diagnosed with OSA agreed to participate in this study. The patients were treated for 3 months (with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening). Patients were selected, using a randomized design, to receive an OA model either with (12 patients) or without advance (12 patients). Before treatment, a snoring questionnaire, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Epworth Sleepiness Scale (ESS), and polysomnography were completed. Fifteen subjects completed the protocol (13 men, two women). With respect to basal values, the mandible-advanced OA group presented a decrease in the mean apnea–hypopnea index (AHI) (33.8±4.7 versus 9.6±2.1; p<0.01), number of arousals per hour (33.8±13.9 versus 16.0±1.5; p<0.05), ESS score (14.7±5.1 versus 5.1±1.9; p<0.05), snoring score (15.4±1.9 versus 10.1±3.2; p<0.05), and total FOSQ score (78.1±22.6 versus 99.3±14.4; p<0.05). After treatment, the non-advanced group presented a decrease in the mean AHI (24.0±12.2 versus. 11.7±7.9; p<0.05). However, no significant differences were found in the number of arousals per hour, ESS score, snoring, and total FOSQ score in the non-advanced group. Neither study group showed significant difference in mean SF36 scores. Oral appliances, especially those that advance the mandible, offer an effective treatment for OSA.
TL;DR: MSLT is better than ESS in the measurement of EDS in relation to the severity of OSAS in clinical patients, and it is found that the severe group had significantly shorter mean sleep latency than the moderate and mild groups.
TL;DR: The results show that neither clinical history nor daytime sleepiness differentiate patients with REM SDB from non-REM SDB patients, which may suggest that REM-related SDB is a part of the spectrum of SDB.
TL;DR: Although there was no difference in depression scores between men and women, the relationship between the Somatic factor and apnea severity was significant in men, whereas obesity and the Cognitive factor were significantly associated in women.
TL;DR: The results suggest that SNE with concomitant mandibular advancement to mimic MAS wear, could be a valuable prognostic indicator of successful MAS treatment.
Abstract: This prospective, cohort study evaluated the role of sleep nasendoscopy (SNE) with simultaneous mandibular protrusion in predicting successful mandibular advancement splint (MAS) therapy in subjects with obstructive sleep apnoea (OSA). Nineteen OSA subjects diagnosed by overnight polysomnography were referred for MAS therapy, following SNE investigation. A Herbst MAS was fabricated for each subject. Once this had been adjusted for maximal, subjective, therapeutic effect, follow-up sleep studies were undertaken with the appliance in situ. The SNE was repeated with the appliance in place to allow the effects of the original mandibular protrusion and the actual effect of the MAS to be compared. The MAS was removed and the original and current site(s) of obstruction evaluated. Pre-treatment SNE showed airway obstruction at the following levels: intermittent multi-level (16 subjects), sustained multi-level (two subjects) and tongue base (one subject). In all individuals, gentle advancement of the mandible during SNE improved airway patency and reduced snoring. When the SNE was repeated with the MAS in situ, all subjects showed improvements in snoring and airway patency. Follow-up sleep studies confirmed the efficacy of the MAS, with all patients showing a reduction in the apnoea/hypopnoea index (AHI). Median reductions in AHI (from 28.1 to 6.1, P < 0.001) and Epworth Sleepiness Scale (ESS) scores (from 9 to 6, P < 0.001) were highly statistically significant. The results suggest that SNE with concomitant mandibular advancement to mimic MAS wear, could be a valuable prognostic indicator of successful MAS treatment.
TL;DR: The relationships between an Epworth Sleepiness Scale score >10 and sleep habits and risk factors for obstructive sleep apnea are as expected and being Măori, a man, older, or more socioeconomically deprived could be related to a higher prevalence of sleep disorders in these groups.
Abstract: Study objectives To examine possible relationships between excessive sleepiness (Epworth Sleepiness Scale score >10), and age, sex, ethnicity, socioeconomic deprivation, usual sleep, and self-reported symptoms of obstructive sleep apnea Design Mail-out survey to a stratified random sample of 10,000 people aged 30 to 60 years, selected from the electoral roll Setting Nationwide survey of adults in New Zealand (71% response rate) Participants The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each age decade Interventions N/A Measurements and results Two-page questionnaire Maori participants had higher mean Epworth Sleepiness Scale scores than non-Maori (75 versus 60) and were more likely to have an Epworth Sleepiness Scale score of more than 10 Logistic multiple regression modeling identified the following significant independent risk factors for having an Epworth Sleepiness Scale score >10: being Maori, male, older, reporting more or less than 75 to 80 hours usual sleep, never or rarely getting enough sleep, never or rarely waking refreshed, larger neck circumference, observed apneas, and not drinking alcohol (compared with moderate alcohol consumption) Conclusions The relationships between an Epworth Sleepiness Scale score >10 and sleep habits and risk factors for obstructive sleep apnea are as expected The relationships between an ESS score > 10 and being Maori, a man, older, or more socioeconomically deprived could be related to a higher prevalence of sleep disorders in these groups However, more research is needed to understand possible differences not only in pathophysiologic processes, but also in the wider societal trends and pressures that may impact differentially on sleep and sleepiness
TL;DR: It is demonstrated that daytime sleepiness is not present in untreated patients but emerges later during dopaminergic treatment, and total daily l‐dopa dose is predictive of objective daytimeSleepiness.
Abstract: Sleep disturbances and daytime sleepiness are well-known phenomena in Parkinson's disease (PD). Fifteen previously untreated PD patients underwent clinical evaluation, subjective sleep evaluation and polysomnographic evaluation (PSG) before and after a treatment period of mean 8+/-3.1 months with dopaminergic drugs. Both mean Unified Parkinson's Disease Rating Scale (UPDRS) total score and mean subset III of the UPDRS were significantly improved with dopaminergic treatment. PSG revealed that administration of dopaminergic drugs resulted in significant increase in mean percentage of stages 1 and 2. The mean Epworth Sleepiness Scale (ESS) score was significantly increased and mean Multiple Sleep Latency Test (MSLT) score was significantly decreased after dopaminergic treatment indicating subjective and objective daytime sleepiness. The differences in MSLT scores were best explained by a higher dose of L-dopa, whereas other variables such as disease duration, treatment duration, Hoehn and Yahr stage, sleep efficiency index or dopamine agonists did not increase the significance. In contrast, any of the variables appeared to explain ESS score variability. This study demonstrates that daytime sleepiness is not present in untreated patients but emerges later during dopaminergic treatment. Total daily L-dopa dose is predictive of objective daytime sleepiness. Furthermore, subjective assessment of sleepiness may cause underestimation of the severity of daytime sleepiness.
TL;DR: Findings from the present analysis on a general population sample support the hypothesis that subjective daytime sleepiness has multiple dimensions.
Abstract: Study objective Discrepancies between several widely used assessment tools suggest that subjective daytime sleepiness is not a unitary phenomenon. Most research, however, has been based on patients. The aim of this study was to examine whether qualitatively different facets of subjective daytime sleepiness exist in the general population and to assess how different aspects of subjective sleepiness varied by age, gender, education status, body mass index, sleep debt, Stanford Sleepiness Scale, and objectively measured sleepiness (Multiple Sleep Latency Test). Design Cross-sectional study. Setting and participants Population-based sample of 1562 women and 1351 men, mean age of 46.6 +/- 7.9 years, including a subset of 145 participants who underwent an Multiple Sleep Latency Test. Measurements Self-reported sleepiness problems, Epworth Sleepiness Scale items, sleep habits, Multiple Sleep Latency Test, and Stanford Sleepiness Scale. Results Principal-axis factor analysis of 13 self-reported daytime-sleepiness measures yielded 3 factors, labeled perceived daytime sleepiness (Cronbach's alpha = 0.74), subjective sleep propensity in active situations (alpha = 0.82), and subjective sleep propensity in passive situations (alpha = 0.63). The factor-based scores were all related to increased body mass index and lower education status, but the associations of scores for perceived and subjective propensity factors differed with gender, age, sleep debt, MSLT, and Stanford Sleepiness Scale. Worse perceived sleepiness factor-based score was significantly related to female gender, younger age, higher sleep debt, and worse Stanford Sleepiness Scale scores. Worse factor-based scores for subjective sleep propensity in both active and passive situations were significantly associated with male gender, older age, and worse Multiple Sleep Latency Test scores. Conclusion Findings from the present analysis on a general population sample support the hypothesis that subjective daytime sleepiness has multiple dimensions.
TL;DR: Although patients with severe OSAS have poorer QOL than control subjects, nasal CPAP appears to improve QOL by alleviating depression and no relationship was evident between treatment-associated score changes in SF-36 domains and ESS score change.
Abstract: Objective To assess changes in response to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) concerning excessive daytime sleepiness (EDS), depressive state, and quality of life (QOL)Patients and Methods We assessed for EDS using the Epworth sleepiness scale (ESS), for mood using The Zung self-depression scale (SDS), and for QOL using Short-Form 36 (SF-36) in 132 patients with obstructive sleep apnea syndrome (OSAS) and control subjects Patients had severe OSAS (apnea-hypopnea index, 594±238/h) and were more hypersomnolent and depressed, and had poorer QOL than 38 age- and gender-matched controlsResults Before treatment most QOL domains in the SF-36 were significantly associated with patients’ SDS scores With nasal CPAP, ESS and SDS scores were respectively decreased from 97±45 to 40±24 (p<00001) and from 492±104 to 451±96 (p<00005) Total SF-36 score and scores for seven of eight domains were increased significantly with treatment Thus, nasal CPAP lessens EDS and depression, and improves QOL, in patients with severe OSAS Further, magnitudes of changes in total SF-36 scores and in five of eight domains correlated significantly with magnitude of change in SDS score upon nasal CPAP treatment No relationship was evident between treatment-associated score changes in SF-36 domains and ESS score changeConclusion Although patients with severe OSAS have poorer QOL than control subjects, nasal CPAP appears to improve QOL by alleviating depression
TL;DR: Evaluating the prevalence of depressive symptoms, sleep habits, and possible sleep disturbances in college students found diverse sleep alterations in a large proportion of the studied subjects, which were more severe in those who showed depressive symptoms.