scispace - formally typeset
Search or ask a question

Showing papers on "Epworth Sleepiness Scale published in 2007"


Journal ArticleDOI
01 Jun 2007-Sleep
TL;DR: It is suggested that a greater percentage of patients will achieve normal functioning with longer nightly CPAP durations, but what constitutes adequate use varies between different outcomes.
Abstract: CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) CURRENTLY IS CONSIDERED THE MOST EFFECTIVE TREATMENT FOR OBSTRUCTIVE SLEEP APNEA (OSA) THIS device provides a pneumatic splint to prevent nocturnal airway collapse In randomized clinical trials that included use of sham CPAP as a placebo, treatment with this device has been shown to produce improvements in symptoms, quality of life, sleepiness, neuropsychological performance, and hypertension1 It has also been established that optimal effectiveness depends on consistent use Skipping even 1 night of treatment reverses improvements in daytime sleepiness, response performance, and the physiologic measure of disease severity, the apnea-hypopnea index (AHI)2–4 Although these benefits have been shown in randomized clinical trials, there is considerable variation in use of CPAP by patients in routine clinical practice,5–8 with approximately half using it consistently every night on average 6 hours per night and the other half skipping from 1 to 7 nights per week using it on average 35 hours per night5 It is not known, however, what the impact of differential use of CPAP is on effectiveness of therapy in routine clinical practice It may be that individuals with shorter hours of use are, in general, less well treated with respect to improvements in outcomes such as sleepiness, than are those with longer durations of use Alternatively, there might be individual variation in need for CPAP so that, even though some individuals have shorter hours of CPAP use, they are effectively treated with respect to sleepiness This individual variation might be mediated by biologic mechanisms similar to those of the recently described individual variation in response to sleep deprivation9 To address this question, we conducted a multisite effectiveness study in which we evaluated clinical status outcomes before and after 3 months of routine clinical care that included measurement of CPAP adherence during the entire follow-up period This multisite international study capitalized on patient heterogeneity with regard to average nightly use of CPAP, in order to estimate relationships between the likelihood of achieving a “normal” value on salient clinical measures of sleepiness and functional status and the “dose” of CPAP treatment received (ie, hours of CPAP use per night) Because there is no consensus regarding which outcomes are primary with regard to the assessment of CPAP treatment response, we chose those deemed most applicable to the clinical management of OSA—subjective sleepiness (Epworth Sleepiness Scale [ESS]10), physiologic sleepiness (Multiple Sleep Latency Test [MSLT]11), and disease-specific functional status (Functional Outcomes of Sleep Questionnaire [FOSQ]12) By evaluating the nightly duration of CPAP relative to obtaining normal values in those impaired on each of these measures, we provide data that the clinician can employ in determining optimal treatment response within the context of treatment goals, eg, to reduce daytime sleepiness, improve daily functioning, or both

848 citations


Journal ArticleDOI
01 Jul 2007-Brain
TL;DR: It is suggested that sleep-wake disturbances, particularly EDS, fatigue and hypersomnia are common after TBI, and significantly impair quality of life, particularly in patients with post-traumatic EDS.
Abstract: Sleep-wake disturbances (SWD) are common after traumatic brain injury (TBI). In acute TBI, we recently found decreased CSF levels of hypocretin-1, a wake-promoting neurotransmitter. In the present study, we aimed to delineate the frequency and clinical characteristics of post-traumatic SWD, to assess CSF hypocretin-1 levels 6 months after TBI, and to identify risk factors for posttraumatic SWD. A total of 96 consecutive patients were enrolled within the first 4 days after TBI. Six months later, out of 76 TBI patients, who did not die and who did not move to foreign countries, we included 65 patients (86%, 53 males, mean age 39 years) in our study. Patients were examined using interviews, questionnaires, clinical examinations, computed tomography of the brain, laboratory tests (including CSF hypocretin-1 levels, and HLA typing), conventional polysomnography, maintenance of wakefulness and multiple sleep latency tests (MSLT) and actigraphy. Potential causes of post-traumatic SWD were assessed according to international criteria. New-onset sleep-wake disturbances following TBI were found in 47 patients (72%): subjective excessive daytime sleepiness (EDS; defined by the Epworth Sleepiness Scale > or = 10) was found in 18 (28%), objective EDS (as defined by mean sleep latency or = 2 h per 24 h compared to pre-TBI) in 14 (22%) patients and insomnia in 3 patients (5%). In 28 patients (43% of the study population), we could not identify a specific cause of the post-traumatic SWD other than TBI. Low CSF hypocretin-1 levels were found in 4 of 21 patients 6 months after TBI, as compared to 25 of 27 patients in the first days after TBI. Hypocretin levels 6 months after TBI were significantly lower in patients with post-traumatic EDS. There were no associations between post-traumatic SWD and severity or localization of TBI, general clinical outcome, gender, pathological neurological findings and HLA typing. However, post-traumatic SWD correlated with impaired quality of life. These results suggest that sleep-wake disturbances, particularly EDS, fatigue and hypersomnia are common after TBI, and significantly impair quality of life. In almost one out of two patients, post-traumatic SWD appear to be directly related to the TBI. An involvement of the hypocretin system in the pathophysiology of post-traumatic SWD appears possible. Other risk factors predisposing towards the development of post-traumatic SWD were not identified.

339 citations


Journal ArticleDOI
TL;DR: There is a high prevalence of sleep disorders and of excessive daytime sleepiness in subjects with TBI and there is a clinical indication for NPSG and MSLT.
Abstract: STUDY OBJECTIVES: Determine prevalence and consequences of sleepiness and sleep disorders after traumatic brain injury (TBI). METHODS: Prospective evaluation with polysomnography (PSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS) and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ). SETTING: Three academic medical centers with level I trauma centers, accredited sleep disorders centers, and rehabilitative medicine programs. Participants; Eighty-seven (87) adults at least 3 months post TBI. Measurements And Results: Abnormal sleep studies were found in 40 subjects (46%), including 20 (23%) with obstructive sleep apnea (OSA), 10 (11%) with posttraumatic hypersomnia (PTH), 5 (6%) with narcolepsy, and 6 (7%) with periodic limb movements in sleep (PLMS). Among all subjects, 22 (25%) were found to have objective excessive daytime sleepiness with MSLT score or =30, p Language: en

295 citations


01 Jan 2007
TL;DR: Die folgenden Fragen beziehen sich auf Ihre normale Lebensweise in der letzten Zeit und versuchen sie sich bitte vorzustellen, wie Sie in dieser Situation gefühlt hätten.
Abstract: dabei um EINNICKEN und EINSCHLAFEN, nicht nur um eine geringe Müdigkeit. Die folgenden Fragen beziehen sich auf Ihre normale Lebensweise in der letzten Zeit. Auch wenn Sie einige dieser Dinge kürzlich nicht getan haben, versuchen sie sich bitte vorzustellen, wie Sie in dieser Situation gefühlt hätten. benutzen Sie bitte die folgende Scala, und ordnen Sie die zutreffende Zahl der jeweiligen Situation zu:

291 citations


Journal ArticleDOI
TL;DR: This analysis confirms prior reports of significant heritability of sleepiness, usual bedtime, and usual sleep duration and identifies NPSR1 and PDE4D as possible mediators of bedtime and sleepiness.
Abstract: Numerous studies suggest genetic influences on sleepiness and circadian rhythms. The Sleep Heart Health Study collected questionnaire data on sleep habits and sleepiness from 2848 Framingham Heart Study Offspring Cohort participants. More than 700 participants were genotyped using the Affymetrix 100K SNP GeneChip, providing a unique opportunity to assess genetic linkage and association of these traits. Sleepiness (defined as the Epworth Sleepiness Scale score), usual bedtime and usual sleep duration were assessed by self-completion questionnaire. Standardized residual measures adjusted for age, sex and BMI were analyzed. Multipoint variance components linkage analysis was performed. Association of SNPs to sleep phenotypes was analyzed with both population-based and family-based association tests, with analysis limited to 70,987 autosomal SNPs with minor allele frequency ≥10%, call rate ≥80%, and no significant deviation from Hardy-Weinberg equilibrium (p ≥ 0.001). Heritability of sleepiness was 0.29, bedtime 0.22, and sleep duration 0.17. Both genotype and sleep phenotype data were available for 749 subjects. Linkage analysis revealed five linkage peaks of LOD >2: four to usual bedtime, one to sleep duration. These peaks include several candidate sleep-related genes, including CSNK2A2, encoding a known component of the circadian molecular clock, and PROK2, encoding a putative transmitter of the behavioral circadian rhythm from the suprachiasmatic nucleus. Association tests identified an association of usual bedtime with a non-synonymous coding SNP in NPSR1 that has been shown to encode a gain of function mutation of the neuropeptide S receptor, whose endogenous ligand is a potent promoter of wakefulness. Each copy of the minor allele of this SNP was associated with a 15 minute later mean bedtime. The lowest p value was for association of sleepiness with a SNP located in an intron of PDE4D, which encodes a cAMP-specific phosphodiesterase widely expressed in human brain. Full association results are posted at http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?id=phs000007 . This analysis confirms prior reports of significant heritability of sleepiness, usual bedtime, and usual sleep duration. Several genetic loci with suggestive linkage to these traits are identified, including linkage peaks containing circadian clock-related genes. Association tests identify NPSR1 and PDE4D as possible mediators of bedtime and sleepiness.

234 citations


Journal ArticleDOI
TL;DR: Although melatonin significantly improved subjective quality of sleep as evaluated by the PSQI index, PSG abnormalities were not changed and motor dysfunction was not improved by the use of melatonin.
Abstract: Insomnia, sleep fragmentation and excessive daytime sleepiness are common in Parkinson's disease (PD) and may contribute to the reduction of cognition and alertness in those patients. Melatonin has been shown to improve sleep in several conditions. In experimental models of PD, melatonin can ameliorate motor symptoms. To evaluate the effect of melatonin on sleep and motor dysfuntion in PD, we studied 18 patients (Hoehn & Yahr I to III) from a PD clinic. Prior to treatment, motor dysfunction was assessed by UPDRS II, III and IV. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence by the Epworth Sleepiness Scale (ESS). Full polysomnography (PSG) was performed in all subjects. Patients were then randomized to receive melatonin (3mg) or placebo one hour before bedtime for four weeks. All measures were repeated at the end of treatment. On initial assessment, 14 patients (70%) showed poor quality sleep (PSQI > 6) and eight (40%) excessive daytime sleepiness (ESS > 10). Increased sleep latency (50%), REM sleep without atonia (66%), and reduced sleep efficiency (72%) were found on PSG. Eight patients had an apnea/ hipopnea index greater than 15 but no severe oxygen desaturation was observed. Sleep fragmentation tended to be more severe in patients on lower doses of levodopa (p = 0.07). Although melatonin significantly improved subjective quality of sleep (p = 0.03) as evaluated by the PSQI index, PSG abnormalities were not changed. Motor dysfunction was not improved by the use of melatonin. Undetected differences in motor scores and PSG findings may have been due to a small sample size and a type II error.

228 citations


Journal ArticleDOI
01 Apr 2007-Thorax
TL;DR: CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective.
Abstract: Background: Patients with mild to moderate obstructive sleep apnoea (OSA) may be managed with different treatment options. This study compared the effectiveness of three commonly used non-surgical treatment modalities. Methods: Subjects with mild to moderate OSA were randomised to one of three treatment groups for 10 weeks: conservative measures (sleep hygiene) only, continuous positive airways pressure (CPAP) in addition to conservative measures or an oral appliance in addition to conservative measures. All overweight subjects were referred to a weight-reduction class. OSA was assessed by polysomnography. Blood pressure was recorded in the morning and evening in the sleep laboratory. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Health-related quality of life (HRQOL) was assessed with the 36-Item Short-Form Health Survey (SF-36) and Sleep Apnoea Quality of Life Index (SAQLI). Results: 101 subjects with a mean (SEM) apnoea–hypopnoea index (AHI) of 21.4 (1.1) were randomised to one of the three groups. The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group, and the CPAP group was significantly better than the oral appliance group. Relief from sleepiness was significantly better in the CPAP group. CPAP was also better than the oral appliance or conservative measures in improving the “bodily pain” domain, and better than conservative measures in improving the “physical function” domain of SF-36. Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI, although no difference was detected between the CPAP and oral appliance groups. CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values, but there was no difference in the changes in blood pressure between the groups. There was also a linear relationship between the changes in AHI and body weight. Conclusion: CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective.

219 citations


Journal ArticleDOI
TL;DR: The severity of chronic TBI as measured by GAF scores is correlated with some of the measures of sleep disruption but not others, indicating a complex and multifactorial pathogenesis.
Abstract: Traumatic brain injury occurs in 100–400 per 100,000 people per year in North America and Europe. The common causes are road traffic accidents, falls, assaults, sport injuries, and domestic accidents. Males are more often affected than women. The most common age group which suffers from traumatic brain injury is 15–35 years. It is the most frequent cause of death between ages 1–15.1 Sleep related problems secondary to chronic TBI have been described anecdotally or in case-report format since 1941. 2–10 Some commonly reported disorders include hypersomnia, narcolepsy, delayed sleep phase, insomnia, fatigue, alteration of sleepwake schedule, and movement disorders. Sleep disorders are a common finding after the acute phase of TBI. They result in daytime somnolence which in turn may lead to poor daytime performance, altered sleep-wake schedule, heightened anxiety, and poor individual sense of well being, insomnia, and depression. Only recently have the attempts have been made to investigate this relationship more systematically in chronic TBI11–14 The most critical study is that of Guilleminault et al who concluded that impaired daytime functioning and somnolence is present in 98% of all patients with TBI, and sleep disordered breathing is a common finding.4 Pain caused by associated cervical whiplash may be an important contributing factor. Sleep related abnormalities are more prevalent in more severely head-injured patients, such as those in coma for >24 hours, those with skull fractures, or those requiring neurosurgical intervention. Kauffman et al14 reached similar conclusions in adolescents with minor head injury and found that sleep disturbances may be long-term. This study was undertaken to extend these systematic observations in the evolving knowledge of sleep disorders in TBI survivors, as the sleep disorders make an impact on the rehabilitation of these patients15,16 and can exacerbate other symptoms such as pain, cognitive deficits, fatigue, and irritability. 16

217 citations


Journal ArticleDOI
TL;DR: Patients with obstructive sleep apnoea syndrome and excessive daytime sleepiness are characterised by shorter sleep latency, increased sleep efficiency and worse nocturnal oxygenation than those without excessive daytimeSleepiness.
Abstract: Excessive daytime sleepiness (EDS) is not invariably present in patients with obstructive sleep apnoea syndrome (OSAS). The aim of the present study was to investigate polysomnographic determinants of EDS in patients with OSAS. EDS was assessed using the Epworth Sleepiness Scale (ESS) and the multiple sleep latency test (MSLT). Patients showed EDS whenever the ESS score was >10 and the MSLT score 10 min. In total, 23 male patients with EDS (mean+/-sd ESS and MSLT score 17+/-3 and 4+/-1 min, respectively) and 17 without EDS (ESS and MSLT score 5+/-2 and 16+/-3 min, respectively), were studied. Both groups exhibited a similar apnoea/hypopnoea index (62+/-18 versus 60+/-20 events.h(-1)). Patients with EDS exhibited shorter sleep latency (11+/-16 versus 18+/-18 min) and greater sleep efficiency (90+/-7 versus 82+/-13%) than those without EDS. Patients with EDS showed lower oxygenation (lowest arterial oxygen saturation 69+/-12 versus 79+/-8%; mean arterial oxygen saturation 87+/-6 versus 90+/-5%). Sleep stage distribution and arousal index did not differ between the groups. Patients with obstructive sleep apnoea syndrome and excessive daytime sleepiness are characterised by shorter sleep latency, increased sleep efficiency and worse nocturnal oxygenation than those without excessive daytime sleepiness. Nocturnal hypoxaemia can be a major determinant of excessive daytime sleepiness in patients with obstructive sleep apnoea syndrome.

199 citations


Journal ArticleDOI
TL;DR: There is a clear relationship between excessive sleepiness and decreased work productivity in a population referred for suspected sleep-disordered breathing and screening for sleepiness in the workplace has the potential to identify a reversible cause of low work productivity.

199 citations


Journal ArticleDOI
TL;DR: Sleep deprivation is hyperalgesic in patients with GERD and provides a potential mechanism for increase in GERD symptom severity in sleep-deprived patients.

Journal ArticleDOI
TL;DR: There is an excessively high prevalence of undiagnosed sleep apnea syndrome in paced patients according to pacing indications: heart failure, symptomatic diurnal bradycardia, and atrioventricular block.
Abstract: Background— Cardiovascular diseases leading to pacemaker implantations are suspected of being associated with a high rate of undiagnosed sleep apnea syndrome (SAS). We sought to determine the prevalence and consequences of SAS in pacemaker patients according to pacing indications: heart failure, symptomatic diurnal bradycardia, and atrioventricular block. Methods and Results— Ninety-eight consecutive patients (mean age, 64±8 years) not known to have sleep apnea were included; 29 patients were paced for dilated cardiomyopathy (29%), 33 for high-degree atrioventricular block (34%), and 36 for sinus node disease (37%). All underwent Epworth Sleepiness Scale assessment and polysomnography with the pacemaker programmed to right ventricular DDI pacing mode (lower pacing rate, 50 pulses per minute). SAS was defined as an apnea-hypopnea index ≥10/h. Mean Epworth Sleepiness Scale was in the normal range (7±4), although 13 patients (25%) had an abnormal score >11/h. Fifty-seven patients (59%) had SAS; of these, 21 ...

Journal ArticleDOI
01 Mar 2007-Surgery
TL;DR: Surgically induced weight loss significantly improves obesity-related OSA and parameters of sleep quality after bariatric surgery.

Journal ArticleDOI
TL;DR: Obstructive sleep apnea is associated with seizure exacerbation in older adults with epilepsy, and its treatment may represent an important avenue for improving seizure control in this population.
Abstract: Background: Although epileptic seizures occur more commonly in older adults, their occurrence in this age group is often unexplained. One unexplored precipitant of seizures in older adults is obstructive sleep apnea (OSA), which is also more common in this age group. Our objective was to investigate whether OSA is associated with seizure exacerbation in older adults with epilepsy. Methods: Polysomnography was performed in older adult patients with late-onset or worsening seizures (Group 1, n = 11) and those who were seizure-free or who had improvement of seizures (Group 2, n = 10). Results: Patients in Group 1 had a significantly higher apnea-hypopnea index than patients in Group 2 ( p = 0.002). Group 1 patients also had higher Epworth Sleepiness Scale scores ( p = 0.009) and higher scores on the Sleep Apnea Scale of the Sleep Disorders Questionnaire ( p = 0.04). The two groups were similar in age, body mass index, neck circumference, number of antiepileptic drugs currently used, and frequency of nocturnal seizures. Conclusions: Obstructive sleep apnea is associated with seizure exacerbation in older adults with epilepsy, and its treatment may represent an important avenue for improving seizure control in this population. GLOSSARY: AED = antiepileptic drug; AHI = apnea-hypopnea index; CPAP = continuous positive airway pressure; EDS = excessive daytime sleepiness; ESS = Epworth Sleepiness Scale; OSA = obstructive sleep apnea; PSG = polysomnography; SA-SDQ = Sleep Apnea section of the Sleep Disorder Questionnaire.

Journal ArticleDOI
01 Jan 2007-Chest
TL;DR: In OHS patients, the lower the daytime CO(2) response, the higher the proportion of REM sleep hypoventilation and daytime sleepiness, and short-term therapy with NIV improves all of these parameters.

Journal ArticleDOI
01 May 2007-Sleep
TL;DR: The prevalence of EDS was high in this adult Norwegian population sample and EDS seems to be related to several symptoms of sleep disorders.
Abstract: Study Objectives: The aim of this study was to investigate the prevalence and risk factors of self-reported excessive daytime sleepiness (EDS) in Norway. Design: The Epworth Sleepiness Scale was administered by a telephone interview to a random sample of 2301 adult inhabitants of Norway. Questions of demography, symptoms of sleep disorders, and depression were included. Setting: Norway Participants: Two thousand three hundred one subjects, 18 years and older. Interventions: N/A. Measurements and Results: The mean score of the Epworth Sleepiness Scale was 6.95 (SD = 3.8), and 17.7% had a score (>10), indicating EDS. Univariate logistic regression analyses showed that being a man; living in southern Norway; working nights; being young; having symptoms of cataplexy, restless legs, or periodic limb movement in sleep; having breathing pauses in sleep; and having symptoms of depression were significantly related to EDS. Of these 9 predictors, only symptoms of restless legs did not maintain the significant relationship with EDS when a multiple logistic regression analysis was performed. Conclusions: The prevalence of EDS was high in this adult Norwegian population sample. EDS seems to be related to several symptoms of sleep disorders.

Journal ArticleDOI
TL;DR: Although group differences were small, BLT led to significant improvement of tremor, UPDRS I, II, and IV, and depression in the active treatment group but not in the placebo group, and was very well tolerated.
Abstract: Several observations suggest a beneficial effect of melatonin antagonism for Parkinson's disease (PD). Although bright light therapy (BLT) suppresses melatonin release and is an established treatment for depression and sleep disturbances, it has not been evaluated in PD. We examined effects of BLT on motor symptoms, depression, and sleep in PD in a randomized placebo-controlled double-blind study in 36 PD patients, using Parkinson's Disease Rating Scale (UPDRS) I-IV, Beck's Depression Inventory, and Epworth Sleepiness Scale. All patients received BLT for 15 days in the morning, 30 min daily. Illuminance was 7.500 lux in the active treatment group and 950 lux in the placebo group. Although group differences were small, BLT led to significant improvement of tremor, UPDRS I, II, and IV, and depression in the active treatment group but not in the placebo group. It was very well tolerated. Follow up studies in more advanced patient populations employing longer treatment durations are warranted.

Journal ArticleDOI
TL;DR: RLS is frequent in patients with PD, though this condition doesn't apparently affect quality of life or lead to an increased presence of diurnal hypersomnia, and it would be advisable to validate the diagnostic criteria of RLS in this specific group of patients.
Abstract: The present study explores the frequency of RLS in PD and focuses on the clinical differences between patients with and without restless legs syndrome (RLS). A cross-sectional study was designed, comprising 114 patients diagnosed with PD. Those patients positive for RLS were assessed for intensity of the syndrome (IRLS). We compared the clinical characteristics of the patients with and without RLS, using specific scales: Unified Parkinson's Disease Rating Scale (UPDRS I-IV), quality of life (Parkinson's Disease Questionnaire, PDQ 39), sleep symptoms (Parkinson's Disease Sleep Scale, PDSS), and diurnal hypersomnia (Epworth Sleepiness Scale). Twenty-five patients (21.9%) out of a total of 114 subjects diagnosed with PD met the RLS diagnostic criteria. RLS was more frequent in women (68%). The patients with RLS showed poorer scores on the PDSS (PD-RLS+: 102.4 +/- 15.1 vs PD-RLS-: 113.2 +/- 16.4) (P = 0.005) and in the bodily discomfort dimension of the PDQ-39 (PD-RLS+ 6.1 +/- 3.4 vs PD-RLS- 3.8 +/- 2.6) (P = 0.002). Analysis of the subscales of the PDSS showed significant differences (P < 0.001) between both groups of patients in items 4 and 10, and to a lesser degree in items 5 (P = 0.01) and 11 (P = 0.02) There was no increased incidence of diurnal hypersomnia in the group of patients with RLS. There were no differences in the rest of the variables. RLS is frequent in patients with PD, though this condition doesn't apparently affect quality of life or lead to an increased presence of diurnal hypersomnia. It would be advisable to validate the diagnostic criteria of RLS in this specific group of patients.

Journal ArticleDOI
01 Oct 2007-Obesity
TL;DR: The objective was to look for clinical, anthropometric, biochemical, and polysomnographic predictors of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale in obese patients.
Abstract: DIXON, JOHN B., MAUREEN E. DIXON, MARGARET L. ANDERSON, LINDA SCHACHTER, AND PAUL E. O’BRIEN. Daytime sleepiness in the obese: not as simple as obstructive sleep apnea. Obesity. 2007;15:2504–2511. Objective: Excessive daytime sleepiness is a common symptom in obese patients, but what drives this condition is unclear. The objective was to look for clinical, anthropometric, biochemical, and polysomnographic predictors of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS) in obese patients. Research Methods and Procedures: The ESS questionnaire was completed by 1055 consecutive patients presenting for obesity surgery. Those at high risk for obstructive sleep apnea (n 331) had diagnostic overnight polysomnography preoperatively. All patients had preoperative clinical, hematologic, and biochemical measurements and completed multiple questionnaires. Results: There was no significant relationship between ESS score and any measure of diagnostic polysomnography factors, including total apnea hypopnea index. Subtle increases in ESS scores were reported in men, older patients, and those with type 2 diabetes. However, general demographic, anthropometric, and biochemical measures of the metabolic syndrome explained only 3% of ESS score variance, and inflammatory markers of C-reactive protein and total white cell count were not predictive. Poor Short Form-36 energy scores (b 0.18, p 0.001) and high Beck Depression Inventory scores were predictive of higher ESS scores (b 0.15, p 0.001) and, along with increasing age and male gender, explained 10% of variance. Symptoms related to disturbed nocturnal sleep explained 30% of variance. Conclusion: In severely obese subjects, increased daytime sleepiness does not seem to be driven by obstructive sleep apnea, the degree of obesity, or anthropometric, metabolic, or inflammatory markers of the metabolic syndrome. It is, however, associated with poor energy, symptoms of depression, and symptoms of nocturnal sleep disturbance.

Journal ArticleDOI
TL;DR: This work compared subjective sleep quality and excessive daytime somnolence in controls, Parkinson's disease with and without dementia, and investigated whether sleep dysfunction and EDS associate with motor phenotype in PD, PDD and DLB.
Abstract: Objective We compared subjective sleep quality and excessive daytime somnolence (EDS) in controls, Parkinson's disease with (PDD) and without dementia (PD), dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). We investigated whether sleep dysfunction and EDS associate with motor phenotype in PD, PDD and DLB. Method Assessments included the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results EDS was more frequent in PD, DLB and PDD patients than in AD. PDD, PD and DLB patients also had worse sleep quality when compared with AD and controls. Baseline postural instability-gait difficulty (PIGD) motor phenotype in PDD was associated with a higher ESS score and frequency of EDS, but this association was lost at two years. PSQI scores did not differ between PIGD dominant and non-dominant PD, PDD and DLB patients. Conclusion EDS and poor sleep quality are greater in PD, PDD and DLB, compared with AD. The dissociation of EDS and motor phenotype suggests their pathophysiology is anatomically and/or temporally distinct. Copyright © 2006 John Wiley & Sons, Ltd.

Journal ArticleDOI
TL;DR: RLS can be screened with high sensitivity and good reliability in large patient groups by means of the single question and the final diagnosis should always be confirmed by the diagnostic features of RLS and accompanied by a careful search for comorbid conditions.
Abstract: The purposes of this study were to validate the use of a single standard question for the rapid screening of restless legs syndrome (RLS) and to analyze the eventual effects of the presence of RLS on self-assessed daytime sleepiness, global clinical severity and cognitive functioning. We evaluated a group of 521 consecutive patients who accessed our neurology clinic for different reasons. Beside the answer to the single question and age, sex, and clinical diagnosis, the following items were collected from all patients and normal controls: the four criteria for RLS, the Epworth Sleepiness Scale (ESS), the Clinical Global Impression of Severity (CGI-S), and the Mini-Mental State evaluation. RLS was found in 112 patients (70 idiopathic). The single question had 100% sensitivity and 96.8% specificity for the diagnosis of RLS. ESS and CGI-S were significantly higher in both RLS patient groups than in normal controls. RLS severity was significantly higher in idiopathic than in associated/symptomatic RLS patients. RLS can be screened with high sensitivity and good reliability in large patient groups by means of the single question; however, the final diagnosis should always be confirmed by the diagnostic features of RLS and accompanied by a careful search for comorbid conditions.

Journal ArticleDOI
TL;DR: Adjunct treatment with armodafinil significantly improved alertness, overall clinical condition, and long-term memory and reduced fatigue and the impact of sleepiness on daily activities in patients with OSA/HS who have residual excessive sleepiness notwithstanding regular use of nCPAP.

Journal ArticleDOI
TL;DR: EDS is common in ambulatory patients with PD and is a major risk factor for dozing and for SOS episodes behind the wheel in patients who drive, and risk factors for EDS were male gender, reduced activity of daily living, and high daily levodopa equivalent dosage.
Abstract: To determine the prevalence of excessive daytime sleepiness (EDS) and that of dozing and sudden onset of sleep episodes (SOS) while driving in ambulatory patients with Parkinson's disease (PD) in France, a national sample of private and public neurologists was asked to recruit the first 10 consecutive nondemented PD patients. Each patient completed a questionnaire including the Epworth Sleepiness Scale (ESS) and the likelihood of dozing off and experiencing SOS episodes behind the wheel. Clinical and demographic data were collected. One thousand six hundred and twenty-five patients with PD were included in the survey. Twenty-nine percent of the patients suffered from EDS (ESS score ≥10) but only 0.8% declared a high chance of dozing while driving and 0.5% reported totally unpredictable SOS episodes while driving. Risk factors for EDS were male gender, reduced activity of daily living, and a high daily levodopa equivalent dosage. Risk factors for SOS episodes while driving were an ESS score ≥10, male gender, and low Hoehn and Yahr staging. EDS is common in ambulatory patients with PD and is a major risk factor for dozing and for SOS episodes behind the wheel in patients who drive. © 2007 Movement Disorder Society

Journal ArticleDOI
TL;DR: A significant number of craniofacial and pharyngeal anatomical factors directly related to obstructive sleep apnoea are identified.
Abstract: The aim of the study was to identify craniofacial and pharyngeal anatomical factors directly related to obstructive sleep apnoea (OSA). The design and setting was a hospital-based, case-controlled study. Ninety-nine subjects (78 males and 21 females) with a confirmed diagnosis of OSA, who were referred to the Dental Hospital for construction of a mandibular advancement splint were recruited. A similar number of control subjects, matched for age and sex, were recruited after completing snoring and Epworth Sleepiness Scale questionnaires to exclude habitual snoring and daytime sleepiness. An upright cephalogram was obtained and skeletal and soft tissue landmarks were traced and digitized. In OSA subjects the anteroposterior skeletal measurements, including maxillary and mandibular length were reduced (P < 0.001). The intermaxillary space was found to be 3.1 mm shorter in OSA subjects (P = 0.001). The nasopharyngeal airway in OSA subjects was narrower (P < 0.001) but pharyngeal length showed no difference. The tongue size was increased (P = 0.021), soft plate length, thickness and area were all greater (P < 0.001) and the hyoid bone was more inferiorly positioned in OSA subjects (P < 0.001). This study identifies a significant number of craniofacial and pharyngeal anatomical factors directly related to OSA.

Journal ArticleDOI
TL;DR: Investigation of side effects and possible changes in the dentofacial complex associated with long term use of Mandibular advancement splints found side effects are common but mild and well tolerated by most patients, and dentof facial changes are negligible.

Journal ArticleDOI
TL;DR: It seems that a plateau has been reached and that it is unrealistic to aim at a substantially higher compliance rate of nCPAP therapy, in spite of many efforts to improve it.
Abstract: In a retrospective cohort study, we evaluated whether improvements in nasal continuous positive airway pressure (nCPAP) technology, particularly the introduction of automatic adjustment of the nCPAP pressure (auto-CPAP), have led to better acceptance and (long-term) compliance in patients with obstructive sleep apnea syndrome (OSAS) as compared to earlier reported data. Questionnaires were sent to 256 patients, who were referred to our clinic for an overnight polysomnography from January 1997 to July 2005 and received nCPAP therapy for OSAS. Of the 256 patients, 24 patients were unavailable for follow-up. Of the remaining 232 patients, 58 patients (25%) had discontinued therapy, while 174 patients (75%) were still using nCPAP after 2 months to 8 years of follow-up. One Hundred and thirty eight (79%) of these 174 patients used nCPAP for at least 4 h/night during ≥ 5 nights/week, 82,1% of the conventional nCPAP (fixed pressure CPAP) group (n = 78) and 77,1% of the auto-CPAP group (n = 96). Therefore, including the 58 failures, only 59.5% of patients can be seen as compliant. There were no statistical differences between the fixed pressure CPAP and auto-CPAP users, and between the compliant and non-compliant users according to age, BMI, AHI and Epworth sleepiness scale (ESS). Auto-CPAP patients used significantly more cm H2O. The long-term compliance of nCPAP therapy has have increased only slightly since the introduction of the fixed pressure CPAP 25 years ago, in spite of many efforts to improve it. It seems that a plateau has been reached and that it is unrealistic to aim at a substantially higher compliance rate.

Journal ArticleDOI
01 May 2007-Sleep
TL;DR: Compared with age- and sex-matched controls, patients with UARS have higher electroencephalogram arousal indexes and important non-rapid eye movement sleep disturbances that correlate with subjective symptoms of sleepiness and fatigue.
Abstract: OBJECTIVE To clarify the relationship between sleep instability and subjective complaints in patients with upper airway resistance syndrome (UARS). METHODS Thirty subjects (15 women) with UARS and 30 age- and sex-matched controls in a prospective, single-blind, case-control study. Blinded cyclic alternating pattern (CAP) electroencephalogram analysis and scales of fatigue and sleepiness were completed. ANALYSIS Mann-Whitney U tests for independent, nonparametric variables between groups and chi2 tests for nonparametric variables with defined standard values. RESULTS Patients with UARS had significantly more complaints of fatigue and sleepiness, compared with controls, demonstrated on their Fatigue Severity Scale (P < 0.001) and Epworth Sleepiness Scale (P < 0.001). By design, the mean apnea-hypopnea index was normal in both groups, whereas the respiratory disturbance index was greater in patients with UARS than in those without (14.5 +/- 3.0 vs 9 +/- 5.2, respectively [P < 0.001]). CAP analysis demonstrated abnormal non-rapid eye movement sleep with abnormally increased CAP rate, electroencephalogram arousals, A2 index, and A3 index. Decreased A1 index in controls was consistent with their more normal progression of sleep. CAP rate correlated with both the Epworth Sleepiness Scale (r = 0.38, P < 0.01) and the Fatigue Severity Scale (r = 0.51, P < 0.0001), and there was a positive trend between the Fatigue Severity Scale and phase A2 index (r = 0.29, P < 0.05). CONCLUSION Compared with age- and sex-matched controls, patients with UARS have higher electroencephalogram arousal indexes and important non-rapid eye movement sleep disturbances that correlate with subjective symptoms of sleepiness and fatigue. These disturbances are identifiable with sensitive measures such as CAP analysis but not with traditional diagnostic scoring systems.

Journal ArticleDOI
TL;DR: This study provides an evidence base for using the Epworth Sleepiness Scale in PD by demonstrating good psychometric properties and a stable hierarchical item structure and addition of new items and use of Rasch scoring has potential to further enhance the clinical usefulness of the ESS.
Abstract: The aim of this work was to evaluate the measurement properties and hierarchical item structure of the Epworth Sleepiness Scale (ESS) in patients with Parkinson's disease (PD). Data were taken from a cross-sectional study regarding fatigue and sleep-related aspects of PD. One hundred and eighteen consecutive patients with neurologist-diagnosed PD without significant co-morbidities (54% men; mean age, 64 years; mean PD duration, 8.4 years) from four Swedish neurological outpatient clinics participated. The ESS displayed good data quality with few missing items (0-2.5%): good reliability (Cronbach's alpha, 0.84), marginal floor and no ceiling effects (1.7% and 0% respectively), and differentiated between those reporting problems staying awake during the past month and those who did not. Item-total correlations, factor and Rasch analyses indicated that items tap a single underlying construct. Rasch analysis supported basic rating scale assumptions and demonstrated an item hierarchy similar to that previously found in patients with other sleep disorders. Gaps in the levels of sleep propensity covered by ESS items and their response options were identified at the higher and lower ends of the underlying sleepiness continuum. This study provides an evidence base for using the ESS in PD by demonstrating good psychometric properties and a stable hierarchical item structure. However, addition of new items and use of Rasch scoring has potential to further enhance the clinical usefulness of the ESS.

Journal ArticleDOI
TL;DR: It is suggested that Digit Vigilance-Time might be the most sensitive neuropsychological test for measuring the effects of the treatments of CPAP or oxygen-supplementation treatment, as compared with placebo-CPAP.
Abstract: Obstructive sleep apnea (OSA) can be a devastating illness, leaving patients exhausted from sleep deprivation. Some patients with OSA also have cognitive impairment1; however, the research results are mixed regarding the nature, cause, and extent of cognitive deficits in these patients.2–8 Cognitive impairment in OSA seems to be exacerbated by the level of hypoxemia,3,8–15 apnea hypopnea index (AHI),9,10,12,16,17 and arousals,9 but there is still some debate on which aspects of OSA are associated with cognitive impairment. Substantial proportions of patients with OSA also show clinical depression or mood alteration, irritability, lethargy, and tiredness.18 Therefore, higher levels of depression14 or fatigue14, or less motivation might also influence the detection of decrements in neuropsychological test performance. Continuous positive airway pressure (CPAP) treatment of OSA corrects the respiratory disturbances and the resultant transient desaturations.13,15 Most research that has examined cognitive functioning before and after treatment with CPAP has reported improvements, but the findings are inconsistent. In a previous study, we evaluated the effectiveness of 1-week CPAP treatment versus placebo-CPAP (ie, CPAP administered at subtherapeutic pressure) on cognitive functioning in patients with OSA. Although CPAP improved overall cognitive functioning, no beneficial effects in any specific domain were found. Indeed, only 1 of the 22 neuropsychological tests scores (Digit Vigilance—Time, a measure of speed of information processing, vigilance, or sustained attention and alertness) showed significant changes specific to CPAP treatment, a finding that could have occurred by chance. These findings might reflect an insufficient duration of the treatment trial (1 week) or, alternatively, they may imply powerful placebo effects of short-term CPAP therapy on cognitive functioning.17 The current study employs a design similar to that of our previous study but with 4 significant modifications. We lengthened the treatment time from 1 to 2 weeks. We modified the placebo-CPAP to provide less than 0.5 cm h2o pressure at the nose. We assessed CPAP compliance using a hidden compliance clock and aggressively followed the patients to ensure compliance. Finally, we added nocturnal supplemental oxygen as a third treatment group. In some patients with OSA who cannot tolerate CPAP and who are not candidates for a surgical procedure, supplemental oxygen therapy is often administered to reduce the harmful effects of transient desaturations during sleep.19,20 Supplemental oxygen as a therapy for OSA and its effect on neuropsychological functioning have not been extensively evaluated, although supplemental oxygen has been reported to improve the subjective symptoms of OSA and reduce the Epworth Sleepiness Scale (ESS) score in uncontrolled studies19 This study thus investigated 2 questions: (1) What aspects of OSA best account for impairment of neuropsychological functioning? (2) In a double-blind trial, are the effects of CPAP different from those of supplemental oxygen or placebo-CPAP in terms of their impact on cognitive functioning?

Journal ArticleDOI
TL;DR: Results of this pooled analysis provide further evidence suggesting that modafinil is an effective and well-tolerated augmentation therapy for partial responders to SSRI therapy, particularly when patients continue to experience fatigue and excessive sleepiness.
Abstract: Background. Partial response, no response, or residual symptoms following antidepressant therapy is common in clinical psychiatry. This study evaluated modafinil in patients with major depressive disorder (MDD) who were partial responders to adequate selective serotonin reuptake inhibitor (SSRI) therapy and excessive sleepiness and fatigue.Methods. This retrospective analysis pooled the data of patients (18–65 yrs) who participated in two randomized, double-blind, placebo-controlled studies of modafinil (6-week, flexible-dose study of 100–400 mg/day or 8-week, fixed-dose study of 200 mg/day) plus SSRI therapy. Patients (n = 348) met criteria for several residual symptoms (Epworth Sleepiness Scale [ESS] score ≥10; 17-item Hamilton Depression Scale [HAM-D] score between 4 and 25; and Fatigue Severity Scale [FSS] score ≥4).Results. Compared to placebo, modafinil augmentation rapidly (within 1 week) and significantly improved overall clinical condition (Clinical Global Impression–Improvement), wakefulness (ES...