Showing papers on "Epworth Sleepiness Scale published in 2008"

Relationships Between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Clinical/Polysomnographic Measures in a Community Sample

Abstract: Study Objectives: 1) To characterize PSQI and ESS scores, and their relationship to each other, in an adult community sample; 2) To determine whether PSQI and ESS scores, in combination with each other, were associated with distinct demographic, clinical, and sleep characteristics.

Sleep-Wake Patterns and Sleep Disturbance among Hong Kong Chinese Adolescents

Abstract: INSUFFICIENT SLEEP AND IRREGULAR SLEEP-WAKE SCHEDULES AMONG ADOLESCENTS HAS BECOME A MAJOR INTERNATIONAL HEALTH CONCERN. Self-report studies show that many adolescents do not obtain adequate sleep; they tend to stay up late during school nights and “sleep in” on weekends.1–7 The evidence suggests that teenagers in Japan and Korea are more severely sleep deprived than those in Western countries and Mainland China. In a survey study of 3478 Japanese high school students, Tagaya and colleagues found that 10th through 12th graders slept an average of 6.3 hr, going to bed at 00:03 and rising at 06:33.1 A survey of 1457 grade 5 to 12 students in Korea showed that 11th and 12th grade students only slept 5.4 hr on school nights, and 9th and 10th graders slept approximately 6.6 hr. The school night bedtime for 9th and 10th graders and 11th and 12th graders was 00:00 and 00:54, respectively.2 Wolfson and Carskadon assessed the sleep-wake habits of 3120 high school students aged 13–19 years in the United States. They found that the average school night sleep duration was 7.3 hr. The school night bedtime and rise time were 22:33 and 06:05; during weekends, the bedtime and rise time were delayed until 00:25 and 09:32.3 Liu and colleagues reported data on 1365 high school students in Mainland China. Similar to U.S. figures, the mean sleep duration during the previous month was 7.6 hr.4 In another study, Lazaratou and colleagues found that the weeknight sleep duration of 713 senior high school students in Greece was 7 hr.5 In a survey of 9567 secondary school students in New Zealand, Dorofaeff and Denny found that the amount students slept was 8.7 hr during the week and 9.4 hr during the weekend. The bedtime and rise times during weekdays were 22:17 and 06:57; on the weekend, their bedtime and rise times were 00:09 and 09:31.6 In another study, Gibson and colleagues found that the school night sleep duration of 3235 high school students in Canada was 7.8 hr.7 The amount of sleep on school nights during adolescence decreases with age1–3 and is substantially less than 9.2 hr.1–7 This contrasts with the evidence that, when given a nocturnal sleep opportunity of 10 hr per night in laboratory assessments, those going through puberty recorded a total sleep time unchanged at 9.2 hr.8 Academic pressure was cited as a major reason for the profound sleep deprivation in Japanese and Korean teenagers.1,2 However, there are also extensive biological, personal, and psychosocial influences on adolescent sleep.9 Such sleep disturbance manifested as insomnia, daytime sleepiness, tiredness, and other symptoms is frequently found in adolescents. Although the actual prevalence of insomnia symptoms recorded varies depending on the methodology and country sampled, most estimates range from 10% to 30%.10–15 Ohayon et al. reported data on 1125 adolescents from France, Great Britain, Germany, and Italy. In this study, 25.7% of the 15 to 18-year-old adolescents had difficulty initiating or maintaining sleep, early morning wakening, or nonrestorative sleep in the previous 4 weeks; daytime sleepiness was reported by nearly 20% of the adolescents.10 In a U.S. sample, 12.4% of 5118 ninth grade students met insomnia criteria on almost every day of the preceding month11 while Roberts et al. reported that 26.8% of 11 to 17-year-olds had nonrestorative sleep or experienced difficulty initiating or maintaining sleep.12 In the Middle East and Japan, a sizeable percentage of adolescents also struggle to sleep. In a study of 5044 Kuwaiti adolescents aged 14 to 19 years old, 17.5% of the adolescents had problems getting to sleep during the previous month, and the prevalence of repeated wakening and early morning wakening was 12.3% and 33.8% respectively.13 Of 106,297 high school students in Japan, approximately 16% had difficulty falling asleep during the previous month.14 In another group of 102451 Japanese high school students, the prevalence of difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening was 14.8%, 11.3%, and 5.5%, respectively; with 23.5% having one or more insomnia symptoms.15 Clearly there is a copious supply of data describing the extent of sleep deprivation, insomnia, and daytime sleepiness in adolescents. However, studies on their impact are few. Cross-sectional studies have found insomnia to be linked with behavioral and emotional problems, such as anxiety, depression, daytime sleepiness, poor social competence, and substance abuse.16,17 The one prospective study carried out to date confirmed an association between insomnia and impaired interpersonal and psychological functioning at one-year follow-up.18 Together the existing data suggest that adolescents with daytime sleepiness are likely to experience impairment in mood, performance, learning, and other daytime functioning,19 making excessive sleepiness among adolescents a significant public health concern. Adolescents in Hong Kong, similar to teenagers in other countries, are under biological, personal, and psychosocial influences that may leave them susceptible to inadequate sleep, irregular sleep-wake schedules, and sleep disturbance. Some cross-sectional surveys on sleep problems have been carried out among adults and children in Hong Kong,20,21 however no comprehensive countrywide assessment of adolescents has been conducted. We therefore performed the first systematic study of sleep-wake patterns and sleep disturbance among secondary school students in Hong Kong. Sleep disturbance manifested as poor sleep and daytime sleepiness was assessed. We recorded the age and sex differences in sleep-wake patterns and sleep disturbance among adolescents aged 12-19 years. We investigated the factors associated with irregular sleep-wake habits and sleep disturbance. The relationship of sleep-wake variables and academic performance was also examined. The findings could add to the database on sleep disturbance in different ethnic groups and would be useful for local preventive sleep medicine programs.

Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale

Abstract: The Epworth Sleepiness Scale (ESS) is a self-administered eight-item questionnaire that is widely used in English speaking countries for assessment of daytime sleepiness in adults. The aim of this study was to investigate the reliability and validity of the ESS in the Turkish language. The Turkish version of the ESS (ESStr) was applied to 194 healthy controls and 150 consecutive subjects attending the sleep centre with symptoms of sleep-disordered breathing. Test–retest reliability of the ESStr was tested in a separate group of 30 subjects. The ESStr scores of 60 subjects with mild to severe obstructive sleep apnoea (OSA) were compared with the ESStr scores of 60 healthy controls matched for age, gender, and body mass index (BMI). Concurrent validity with the Functional Outcomes of Sleep Questionnaire (FOSQtr) was also assessed in 12 subjects. The questionnaire had a high level of internal consistency as measured by Cronbach’s alpha (≥0.86). The test–retest intraclass correlation coefficient was r = 0.81 (95% confidence interval: 0.64–0.90) (p < 0.001) and Spearman’s correlation coefficient was r = 0.80 (p = 0.01). The control group had lower ESStr scores than subjects with sleep-disordered breathing (3.6 ± 3 vs 12.6 ± 6, respectively; p < 0.001). Subjects with mild sleep-disordered breathing also had lower scores of the ESStr than those with moderate and severe sleep-disordered breathing (10 ± 6.2 vs 14 ± 5. and 10 ± 6.2 vs 16 ± 5.4, respectively; both p < 0.05), but there were no significant differences between moderate and severe subjects with sleep apnoea. There were significant correlations between the ESStr and total FOSQtr and its subscales (r = −0.22 to r = −0.92; all p = 0.05). Factor analysis of item scores showed that the ESStr had only one factor. The ESStr is a reliable and valid measure of daytime sleepiness. These features and the simplicity of the ESStr make it a valuable measure for clinical management and research.

Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS).

Abstract: THE LAST 50 YEARS HAVE WITNESSED STEADILY INCREASING SURVIVAL RATES AMONG PEDIATRIC MALIGNANCIES THAT ARE NOW APPROACHING NEARLY 80%1 With improved survival has come recognition of the late effects of prior cancer treatment, such as second malignancies, infertility, growth delays, cardiopulmonary disease, endocrinopathies, and neuropsychological deficits2–9 As many as two thirds of childhood cancer survivors report a chronic medical condition, with over 25% being severe or life-threatening10 Understanding these late effects will enable the medical community to better care for the growing population of childhood cancer survivors Fatigue is a distressing symptom frequently reported by adult cancer patients11 Its etiology is likely multifactorial, involving anemia, inactivity, infection, sleep disturbance, anxiety, and depression The prevalence of fatigue in the general population has been estimated between 7% and 45%,12 but as high as 70% to 96% in recently treated adult cancer patients13 Cancer-related fatigue (CRF) includes diminished energy and mental capacity and an increased need to rest disproportionate to any recent change in activity, present nearly every day during any 2-week period in the past month14,15 CRF is not relieved by rest and can severely diminish a patient's ability to interact socially and maintain a reasonable quality of life16 Fatigue and disrupted sleep have been described by survivors across diagnoses and may occur months to years following therapy17–19 The prevalence and impact of excessive fatigue and sleep disturbance among long-term survivors of childhood cancer has been the subject of limited investigation20–26 The aim of this investigation was to describe the prevalence of and risk factors for fatigue and sleep disturbance among a large population of survivors of childhood and adolescent cancers We hypothesized that this population would have more complaints of fatigue, disrupted sleep, and daytime sleepiness compared with a sibling comparison group and that there would be significant associations with central nervous system (CNS)-directed radiation therapy and late medical complications, including depression

Approved and investigational uses of modafinil : an evidence-based review.

Abstract: Modafinil is a wake-promoting agent that is pharmacologically different from other stimulants. It has been investigated in healthy volunteers, and in individuals with clinical disorders associated with excessive sleepiness, fatigue, impaired cognition and other symptoms. This review examines the use of modafinil in clinical practice based on the results of randomized, double-blind, placebo-controlled clinical trials available in the English language in the MEDLINE database. In sleep-deprived individuals, modafinil improves mood, fatigue, sleepiness and cognition to a similar extent as caffeine but has a longer duration of action. Evidence for improved cognition in non-sleep-deprived healthy volunteers is controversial.

Prevalence and correlates of neuropsychiatric symptoms in Parkinson's disease without dementia

Abstract: A cross-sectional study of the profile of psychiatric symptoms and their relationships to medications, executive performance, and excessive daytime somnolence (EDS) was conducted on 1351 consecutive Parkinson's disease patients without dementia (PD-ND). Ratings were: neuropsychiatric inventory (NPI); hospital anxiety and depression scale (HADS); executive performance (semantic, phonemic, and alternating verbal fluencies); and the Epworth sleepiness scale (ESS). Eighty-seven percent of the subjects reported at least one psychiatric symptom. The most common were depression (70%), anxiety (69%), apathy (48%), and irritability (47%). Fifty percent of the patients had HADS-depression scores ranging from possible (8-10; 22%) to probable (>or=11; 28%) depression. Executive impairment was found in 41% and EDS in 26% of subjects. All considered variables were significantly more common with longer duration and more severe disease. Only depression appeared to be influenced by type of medication, being less prevalent among patients treated with DAs. Five NPI clusters were identified among patients scoring >or=1 on the NPI (87.3%): patients exhibiting predominantly apathy (12.7%), psychosis (3%), depression (13%), anxiety (15.6%), and "low-total NPI" (43.2%). Neuropsychiatric symptoms are common in nondemented PD patients suggesting that they are an integral part of PD from the beginning of the disease and appears more related to disease progression than to the type of antiparkinsonian medication. Apathy emerged as an independent construct in PD-ND, indicating the need to address specific therapeutical approaches targeted toward this particular symptom.

Endothelial Function and Arterial Stiffness in Minimally Symptomatic Obstructive Sleep Apnea

Abstract: Rationale: Moderate–severe obstructive sleep apnea (OSA) is associated with endothelial dysfunction, increased arterial stiffness, and hypertension. It is not known whether minimally symptomatic OSA is also associated with impaired vascular function.Objectives: To determine whether minimally symptomatic OSA is associated with impaired vascular function.Methods: In 64 patients (7 females) with minimally symptomatic OSA (oxygen desaturation index, 23.1 [SD, 15.6]; Epworth Sleepiness Scale score, 8 [SD, 3.8]), and 15 matched control subjects without OSA, endothelial function was assessed by ultrasonographic measurement of flow-mediated dilatation, and by applanation tonometry–derived pulse wave analysis (forearm ischemia and salbutamol-induced changes in augmentation index, AIx). Arterial stiffness was assessed by AIx and ambulatory blood pressure (ABP) was measured over 1 week.Measurements and Main Results: In patients with OSA, flow-mediated dilatation was significantly lower than in control subjects (5.0%...

The Epworth sleepiness scale in the identification of obstructive sleep apnea.

Abstract: The Epworth sleepiness scale (ESS) is often used clinically to screen for the manifestations of the behavioral morbidity associated to obstructive sleep apnea (OSA). The purpose of this study was to assess the sensitivity of the ESS in the identification of OSA, as defined by an elevated apnea-hypopnea index. A retrospective chart review of 268 consecutive patients diagnosed with OSA at a multidisciplinary sleep medicine clinic was conducted. The ESS obtained a relatively low sensitivity (66%) in the identification of an apnea-hypopnea index of 5 and above at the suggested cutoff of 10 and increased to 76% at 8. The results of the study showed only fair discriminatory ability of the ESS as a screener for OSA. A score of 8 (instead of 10) is suggested as the cutoff among clinic populations being screened for a sleep disorder.

Insulin resistance and daytime sleepiness in patients with sleep apnoea

Abstract: Background: Excessive daytime sleepiness (EDS), obesity and insulin resistance (IR) occur frequently in patients with obstructive sleep apnoea syndrome (OSAS) We hypothesised that in these patients, EDS is a marker of IR, independent of obesity Methods: We studied 44 patients with OSAS (22 with and 22 without EDS) matched for age (±5 years), body mass index (BMI ±3 kg/m 2 ) and severity of OSAS (as determined by the apnoea–hypopnoea index (AHI)), and 23 healthy controls Patients (n = 35) were re-examined after 3 months of effective therapy with continuous positive airway pressure (CPAP) EDS was assessed by both subjective (Epworth Sleepiness Scale) and objective (Multiple Sleep Latency Test) methods IR was determined by the HOMA index Serum levels of glucose, triglycerides, cholesterol, cortisol, insulin, thyrotropin, growth hormone and insulin-like growth factor I (IGF-I) were also determined Results: Despite the fact that age, BMI and AHI were similar, patients with EDS had higher plasma levels of glucose (p Conclusion: EDS in OSAS is associated with IR, independent of obesity Hence EDS may be a useful clinical marker to identify patients with OSAS at risk of metabolic syndrome

A randomized trial of modafinil for the treatment of fatigue and excessive daytime sleepiness in individuals with chronic traumatic brain injury.

Abstract: Background This study examines the efficacy of modafinil in treating fatigue and excessive daytime sleepiness in individuals with traumatic brain injury (TBI). Methods A single-center, double-blind, placebo-controlled cross-over trial, where 53 participants with TBI were randomly assigned to receive up to 400 mg of modafinil, or equal number of inactive placebo tablets. Main eligibility criteria were being at least 1 year post-TBI severe enough to require inpatient rehabilitation. The primary outcome measures were fatigue (Fatigue Severity Scale, FSS) and daytime sleepiness (Epworth Sleepiness Scale, ESS). Results After adjusting for baseline scores and period effects, there were no statistically significant differences between improvements seen with modafinil and placebo in the FSS at week 4 (-0.5 +/- 1.88; P = .80) or week 10 (-1.4 +/- 2.75; P = .61). For ESS, average changes were significantly greater with modafinil than placebo at week 4 (-1.2 +/- 0.49; P = .02) but not at week 10 (-0.5 +/- 0.87; P = .56). Modafinil was safe and well tolerated, although insomnia was reported significantly more often with modafinil than placebo (P = .03). Conclusions While there were sporadic statistically significant differences identified, a clear beneficial pattern from modafinil was not seen at either week 4 or week 10 for any of the 12 outcomes. There was no consistent and persistent clinically significant difference between treatment with modafinil and placebo.

Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial.

Abstract: OBSTRUCTIVE SLEEP APNEA (OSA) IS CHARACTERIZED BY REPETITIVE APNEAS AND HYPOPNEAS DURING SLEEP ASSOCIATED WITH OXYGEN DESATURATION, leading to sleep disruption and excessive daytime sleepiness. It has been estimated that OSA is present in 9% to 24%1 of adults, being clinically significant in 2% to 4%,1 and becoming more prevalent as the average population body weight rises.2 Excessive daytime sleepiness related to increased sleep fragmentation and impaired sleep quality clearly has an adverse impact on quality of life and health status.3 Nasal continuous positive airways pressure (CPAP) is considered to be the treatment of choice for OSA. Excessive daytime sleepiness remains the main indication for CPAP treatment in OSA,4 although cardiovascular benefits are thought to result as well. Results from previous studies, including a randomized double-blind controlled parallel trial of therapeutic versus subtherapeutic CPAP showed that CPAP has beneficial effects on excessive daytime sleepiness and on self-reported functioning and well-being, affecting quality of life of OSA patients.4–8 The cost-effectiveness of this treatment has also been demonstrated.9 Despite an increasing amount of information on the efficacy of CPAP treatment in OSA patients, data from randomized double-blind controlled trials on treatment outcome measures that included quality of life assessment have been reported in only 2 previous studies.4,7 Particularly, it remains unclear which aspects of symptomatic improvement are the most sensitive to CPAP treatment and carry independent information in predicting response to CPAP. To address this uncertainty we investigated, using data from a randomized double-blind controlled trial, which outcome measures best identify the effect of real CPAP compared to nonspecific placebo effects. The overall aim of this study is to improve the current knowledge about the efficacy of CPAP treatment on symptoms and health status. This issue may be relevant in clinical practice and for future treatment trials.

Influence of sleep disturbance on quality of life of patients with epilepsy.

Abstract: The frequency of sleep disturbances in patients with epilepsy and their impact on quality of life (QoL) have been documented in a few reports, and the results are conflicting. We identified 124 consecutive epilepsy out-patients who visited the epilepsy out-patient clinics at the University Hospital of Alexandroupolis, the AHEPA Hospital in Thessaloniki and the Aeginitio Hospital in Athens. We measured excessive daytime sleepiness (EDS) with the Epworth Sleepiness Scale (ESS), obstructive sleep apnea (OSA) with the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ), and insomnia with the Athens Insomnia Scale (AIS). We evaluated quality of life by the Quality of Life in Epilepsy Inventory (QOLIE-31). EDS was found in 16.9% (21/124) of epileptic patients, OSA in 28.2% (35/124), and insomnia in 24.6% (30/122). In multivariate analysis, we found that insomnia was an independent negative factor for Total score (p<0.001), Overall QoL (p=0.002), Emotional well-being (p<0.001), Energy/fatigue (p<0.001), Cognitive functioning (p=0.04) and Social functioning (p=0.03), and OSA only for Cognitive functioning (p=0.01). According to our findings, EDS, OSA, and insomnia are frequent in epileptic patients. Epileptic patients with sleep disturbance, mainly insomnia, have significant QoL impairment.

Sleep disordered breathing and hypertension: does self-reported sleepiness modify the association?

Abstract: EPIDEMIOLOGICAL STUDIES INDICATE THAT PEOPLE WITH SIGNIFICANT LEVELS OF SLEEP DISORDERED BREATHING (SDB) ARE AT INCREASED RISK FOR developing hypertension and may have increased risk for other cardiovascular events.1–3 In contrast to patients referred for clinical evaluation of SDB, however, only a small proportion of participants in these epidemiologic studies who had an elevated apnea-hypopnea index (AHI) complained of significant sleepiness.4 Among Sleep Heart Health Study (SHHS) participants with moderate to severe SDB (AHI ≥ 15), only 46% reported an elevated score on the Epworth Sleepiness Scale (ESS) or frequent feelings of sleepiness or feeling unrested.5 Several epidemiologic studies have shown a relation between self-reported sleepiness and cardiovascular disease, though these studies have not used polysomnography to measure SDB. In the Cardiovascular Health Study, daytime sleepiness was the only sleep disturbance symptom associated with incident myocardial infarction, heart failure, overall cardiovascular morbidity and mortality, and all-cause mortality.6 The risk of stroke was independently associated with taking frequent daytime naps in the first National Health and Nutrition Survey.7 In the Caerphilly cohort, a population-based study of older men, daytime sleepiness was found to be associated with increased ischemic heart disease events.8 A prospective study of 157 healthy older adults found significant relationships between an elevated Epworth Sleepiness Scale score (ESS ≥ 10) and blood pressure, as well as incident diagnosed hypertension.9 Studies in clinical patient samples in which polysomnography was performed also point to a relation between self-reported sleepiness and cardiovascular disease. Higher ESS was related to lower stroke volume index and cardiac index in middle-aged obstructive sleep apnea patients after controlling for polysomnographic measures of sleep apnea severity.10 A review of randomized trials evaluating the effect of continuous positive airway pressure (CPAP) on blood pressure in persons with SDB found that studies with less sleepy participants show a smaller decrease in blood pressure on CPAP therapy.11–13 These findings suggest that the symptom of excessive self-reported sleepiness may identify a subset of individuals with SDB at greatest risk of cardiovascular sequelae, including hypertension. If so, this would have important implications for the clinical management of the large proportion of individuals with polysomnographic evidence of SDB who report no significant daytime sleepiness. We use cross-sectional data from the Sleep Heart Health Study (SHHS) to explore whether self-reported sleepiness modifies the relationship between SDB and prevalent hypertension.

Association between depressive symptoms and sleep disturbances in community-dwelling older men

Abstract: OBJECTIVES: To examine the association between depressive symptoms and subjective and objective measures of sleep in community-dwelling older men. DESIGN: Cross-sectional. SETTING: Six U.S. clinical centers. PARTICIPANTS: Three thousand fifty-one men aged 67 and older. MEASUREMENTS: Depressive symptoms assessed using the 15-item Geriatric Depression Scale and categorized as 0 to 2 (normal, referent group), 3 to 5 (some depressive symptoms), and 6 to 15 (depressed); objective sleep measures ascertained using wrist actigraphy (mean duration 5.2 nights); and subjective sleep measures assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. RESULTS: There was a strong multivariable-adjusted association between level of depressive symptoms and subjective sleep disturbances (P-trend <.001). For example, the odds of reporting poor sleep quality were 3.7 times (95% confidence interval (CI)=2.5–5.3) higher for depressed men as for normal men, and 2.1 times (95% CI=1.7–2.6) higher for men with some depressive symptoms. For objectively measured sleep disturbances, men with more depressive symptoms had greater odds of sleep latency of 1 hour or more (P-trend=.006). There was no association between level of depressive symptoms and sleep efficiency, awakening after sleep onset, multiple long-wake episodes, or total sleep time. Excluding 384 men taking antidepressants, benzodiazepines, or other anxiolytic or hypnotics did not alter the results. CONCLUSION: Depressive symptoms have a strong, graded association with subjective sleep disturbances and are moderately associated with objectively measured prolonged sleep latency. Future studies should address temporality of depression and sleep disturbances.

Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design

Abstract: The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non-advancement appliance (MNA); and (c) no intervention. The appliances were custom made, in one piece. The MAAs had a mean protrusion of the mandible of 74% (range 64-85%). Outcome measures, assessed after continuous use for 4 weeks, were AHI (polysomnography), daytime sleepiness (Epworth) and quality of life (SF-36). Eighty-one patients (87%) completed the trial. The MAA group achieved mean AHI and Epworth scores significantly lower (P or = 75% ending with an AHI 30. Sensitivity analyses confirmed these results. MAA had a significant beneficial effect on the vitality domain of SF-36. Four MAA patients (14.8%) and two MNA patients (8%) discontinued interventions because of adverse effects. Our conclusion is that MAA has significant beneficial effects on OSA, including cure in some cases of severe OSA. Protrusion of the mandible is essential for the effect. MNA has no placebo effect. MAA may be a good alternative to CPAP in subsets of OSA patients.

Sodium oxybate for excessive daytime sleepiness in Parkinson disease: an open-label polysomnographic study.

Abstract: Background Many patients with Parkinson disease (PD) have excessive daytime sleepiness and numerous nocturnal sleep abnormalities. Objective To determine the safety and efficacy of the controlled drug sodium oxybate in a multicenter, open-label, polysomnographic study in subjects with PD and sleep disorders. Design, Setting, and Patients Inclusion required an Epworth Sleepiness Scale (ESS) score greater than 10 and any subjective nocturnal sleep concern, usually insomnia. An acclimation and screening polysomnogram was performed to exclude subjects with sleep-disordered breathing. The following evening, subjects underwent another polysomnogram, followed by an evaluation with the Unified Parkinson Disease Rating Scale (UPDRS) while practically defined off (“off”) PD medications, ESS (primary efficacy point), Pittsburgh Sleep Quality Inventory, and Fatigue Severity Scale. Subjects then started sodium oxybate therapy, which was titrated from 3 to 9 g per night in split doses (at bedtime and 4 hours later) across 6 weeks, and returned for subjective sleep assessments. They then returned at 12 weeks after initiating therapy for a third polysomnogram, an off-medication UPDRS evaluation, and subjective sleep assessments. Data are expressed as mean (SD). Results We enrolled 38 subjects. At screening, 8 had sleep apnea (n = 7) or depression (n = 1). Twenty-seven of 30 subjects completed the study. Three dropped out owing to dizziness (n = 3) and concurrent depression (n = 1). The mean dose of sodium oxybate was 7.8 (1.7) g per night. The ESS score improved from 15.6 (4.2) to 9.0 (5.0) ( P P P P = .005). Changes in off-medication UPDRS scores were not significant, from 28.4 (10.3) to 26.2 (9.6). Conclusion Nocturnally administered sodium oxybate improved excessive daytime sleepiness and fatigue in PD. Trial Registration clinicaltrials.gov Identifier:NCT00641186

Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences

Abstract: Background: Apnea, depression, and metabolic abnormalities are independent predictors of excessive daytime sleepiness (EDS) in patients with sleep apnea. Exercise is beneficial for apnea, depression, and metabolic abnormalities; however, its association with EDS is not known. Study Objectives: To evaluate the contribution of lack of regular exercise, depression, and apnea severity on daytime sleepiness in patients with sleep apnea. Participants and Design: One thousand one hundred six consecutive patients (741 men and 365 women) referred to the sleep disorders clinic for symptoms consistent with sleep apnea. Daytime sleepiness was assessed with the Epworth Sleepiness Scale and activity was evaluated with a quantifiable Physical Activity Questionnaire. Results: Compared with women, men had a higher apnea hypopnea index (AHI) (40.4 ± 1.2 vs 31.0 ± 1.8), lower body mass index (BMI) (35.3 ± 0.3 kg/m 2 vs 39.6 ± 0.5 kg/m 2 ), and higher rate of regular exercise (39.1% vs 28.8%)( p < 0.05). Linear regression analysis of the total sample after adjusting for age, BMI, sex, central nervous system medication, and diabetes showed that logAHI, depression, and lack of regular exercise were significant predictors of sleepiness. Predictors of mild or moderate sleepiness for both sexes were depression and logAHI, whereas predictors of severe sleepiness for men were lack of regular exercise, depression, and minimum SaO 2 and, for women, logAHI. conclusions: In obese apneic patients, lack of regular exercise (only in men), depression, and degree of apnea are significant predictors of EDS. This association is modified by sex and degree of sleepiness. Assessment and management of depression and physical exercise should be part of a thorough evaluation of patients with sleep apnea.

Maintenance of Wakefulness Test, obstructive sleep apnea syndrome, and driving risk

Abstract: OBJECTIVE: Sleepiness at the wheel is a major risk factor for traffic accidents. Because of the potential medical and legal implications, in this study, we evaluated the correlation between subjective and objective measures of sleepiness and driving performances in patients suffering from excessive daytime sleepiness. METHODS: Thirty-eight untreated sleep apnea patients (mean age +/- standard deviation, 51 +/- 9 years; mean apnea-hypopnea index +/- standard deviation, 41 +/- 25), and 14 healthy control subjects (mean age +/- standard deviation, 46 +/- 9 years) were included in the study. Nocturnal polysomnography, mean sleep latency as measured by four 40-minute Maintenance of Wakefulness Test (MWT) trials, Epworth Sleepiness Scale, Karolinska Sleepiness Scale, and the number of inappropriate line crossings during a 90-minute real-life driving session were analyzed. RESULTS: The number of inappropriate line crossings correlated with MWT scores (Spearman's Rho: r = -0.339; p Language: en

Sleep Pattern Differences Between Older Adult Dementia Caregivers and Older Adult Noncaregivers Using Objective and Subjective Measures

Abstract: The majority of persons with dementia (PWD) are cared for in the home setting by informal caregivers, usually a female relative. Researchers have reported a variety of changes in caregiver sleep including changes in sleep quantity and quality.1 Because the results are variable, however, research is needed to determine whether there are factors that predict which caregivers are at risk for poor sleep. Accurate assessment and prevention is critical, because poor sleep in caregivers has been associated with sympathoadrenal medullary arousal,2 changes in immune function,3 poorer psychological state,4,5 and early institutional placement of the PWD.6,7 Additionally, interventions could be better targeted to the factors associated with poor sleep in dementia caregivers. While caregivers consistently report poorer sleep quality than noncaregivers,5,8–11 the picture is not as clear when sleep is measured objectively or subjectively.1,4 In some studies, sleep quantity was considered normal because it was similar to age-matched controls,3 while in other studies, poorer sleep was attributed to causes such as depression or caregiver burden rather than caregiver status.1,12 One reason for inconsistent findings may be the sampling strategy used in previous studies, namely, that all dementia caregivers were sampled regardless of the nighttime activity in the PWD. Approximately 25% to 54% of PWD have significant changes in their sleep-wake cycle, causing awakenings at night. These awakenings could have a significant impact on caregiver sleep quantity, since the PWD often requires supervision when up at night. This supervision is critical to prevent injuries, such as falls13 or inappropriate actions, such as home exits,14 associated with cognitive impairments typically seen in dementia. Thus caregivers who supervise PWD with nighttime activity are potentially most at risk for substantial sleep changes or disturbances. Secondly, inconsistent findings may be due to inadequate measurement of sleep. Thus research on caregiver sleep, using commonly accepted sleep measurements (e.g., sleep diaries and actigraphy over a period of time), is needed to fill this gap in knowledge.15 Caregivers of PWD may develop night-to-night sleep deficits caused by the need to provide supervision or other caregiving tasks, and they may attempt to make up for this by sleeping longer in subsequent nights. If, however, researchers only examine the week's mean values of sleep and wake variables, values may appear normal, and the pattern of high variability in night-to-night sleep would be lost. The perception of sleep adequacy may be affected by this inconsistent pattern of sleep over the week. Hence, analysis of the intra-individual variability of night-to-night sleep may help explain why most caregivers complain of poor sleep quality even if sleep times are in a normal range. The purposes of this study were threefold: 1. To quantify sleep parameters in older adult caregivers of PWD with nighttime activity over a 7-day period in the natural caregiving setting (using both objective and subjective sleep measurement methods) and to compare these findings to a group of noncaregiving older adults. The following measurements and variables were used: Actigraphy (objective): total sleep time (TSTo), sleep onset latency (SOLo), wake after sleep onset (WASOo), and sleep efficiency (SEo). Sleep diary (subjective): total sleep time (TSTs), sleep onset latency (SOLs), wake after sleep onset (WASOs), sleep efficiency (SEs), and sleep quality (SQs) rating. Daytime functioning: Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS). 4. To examine the night-to-night variability in caregivers' sleep patterns and to compare these with sleep patterns of noncaregiving adults. 5. To explore the correlation patterns of sleep measured subjectively and objectively between caregivers and noncaregivers.

Does CPAP lead to change in BMI

Abstract: Obstructive sleep apnea syndrome (OSAS) affects approximately 2% of women and 4% of men aged 30 to 60 years.1 Typical symptoms include loud snoring, restless sleep, and daytime sleepiness or fatigue.2 Anatomical features such as micrognathia or retrognathia, macroglossia, long soft palate, or large uvula can lead to airway obstruction; however, the most common cause of OSAS in adults is obesity.1 An estimated 70% of individuals with OSAS are obese.4,5 Conversely, 40% of obese men and women in the population have OSAS.5 Obesity may narrow the upper airway, making it more easily collapsible and resulting in the block of airflow.5 Factors such as BMI, neck circumference, and the size of the retroglossal space are considered to be the primary determinants of OSAS in obese individuals. Another key factor in obesity is the distribution of fat. An increased waist circumference may lead to OSAS even in non-obese individuals.5 Central obesity is often indicated as the biggest determinant of OSAS. Central obesity results from the buildup of brown adipose tissue, which is an important source of leptin, a satiety hormone that regulates energy intake and expenditure. Obese individuals have high serum leptin levels, which suggest a resistance to this hormone.5 Individuals with OSAS have been found to have even higher serum leptin levels than non-apneic individuals with similar BMIs.5 Leptin has also been shown to improve respiratory control during sleep.6 A resistance to this hormone may increase the likelihood of OSAS in obese individuals. While obesity is a cause of OSAS, it may also be a result of the disorder. For example, a person who experiences daytime sleepiness may be less active and therefore at greater risk for weight gain. In addition, leptin resistance may make weight management difficult for these individuals.7–9 The most common and effective treatment for OSAS is CPAP, which provides a continuous flow of pressurized air to keep the upper airway from collapsing during sleep. CPAP is effective in 80% to 90% of sleep apneics.1 Despite its effectiveness, 20% to 40% of patients do not use CPAP, and others use it only part of the time.3 Some patients do not tolerate CPAP, and some perceive insufficient benefit to justify its use. CPAP can improve daytime sleepiness due to sleep apnea, as evidenced by a decrease in mean Epworth Sleepiness Scale scores (ESS) among regular users.10 Since obesity is a common cause of OSAS, weight loss can be an effective treatment. Weight loss may be difficult to achieve in the face of untreated apnea, however, for several reasons. Daytime sleepiness and fatigue may decrease motivation to lose weight. As previously mentioned, leptin resistance in OSAS patients may lead to increased caloric intake. Effective treatment of apnea may facilitate weight loss in some patients. We hypothesized (1) that subjects with OSAS would lose weight after regular CPAP use for approximately 1 year and (2) that subjects who used CPAP regularly for 1 year would lose more weight or gain less weight than control subjects with OSAS who were not treated or nonadherent with CPAP treatment.

Cost-effectiveness of using continuous positive airway pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK

Abstract: OBJECTIVE: A study was undertaken to estimate the cost-effectiveness of using continuous positive airway pressure (CPAP) in the management of patients with severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS) compared with no treatment from the perspective of the UK's National Health Service (NHS). METHODS: A Markov model was constructed to assess the cost-effectiveness of CPAP compared with no treatment. The model depicted the management of a 55-year-old patient with severe OSAHS as defined by an apnoea-hypopnoea index (AHI) >30 and daytime sleepiness (Epworth Sleepiness Scale score >or=12). The model spans a period of 14 years. RESULTS: According to the model, 57% of untreated patients are expected to be alive at the end of 14 years compared with 72% of patients treated with CPAP. Untreated patients are expected to cost the NHS pound10 645 (95% CI pound7988 to pound14,098) per patient over 14 years compared with pound9672 (95% CI pound8057 to pound12,860) per CPAP-treated patient. Treatment with CPAP for a period of 1 year was found not to be a cost-effective option since the cost per quality-adjusted life year (QALY) gained is expected to be > pound20,000, but after 2 years of treatment the cost per QALY gained is expected to be pound10,000 or less and, after 13 years of treatment, CPAP becomes a dominant treatment (ie, more effective than no treatment for less cost). CONCLUSION: Within the limitations of the model, CPAP was found to be clinically more effective than no treatment and, from the perspective of the UK's NHS, a cost-effective strategy after a minimum of 2 years of treatment.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients.

Abstract: We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 +/- 14) with disease from 0.4 to 23 years (6.7 +/- 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 +/- 2.0). RLS was detected in 12 cases (27%). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52%) and excessive daytime sleepiness in 3 cases (6.8%). Fatigue was present in 32 subjects (73%) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

Improvement in quality of life after nasal surgery alone for patients with obstructive sleep apnea and nasal obstruction.

Abstract: Objective To evaluate the impact of nasal surgery alone on quality of life (QOL) in patients with obstructive sleep apnea and nasal obstruction using generic and disease-specific QOL questionnaires. Design Prospective, longitudinal cohort study. Patients Fifty-one consecutive patients with obstructive sleep apnea (50 men and 1 woman; mean age, 39 years; mean [SD] apnea-hypopnea index, 37.4 [28.9] events/h; and mean ± SD body mass index [calculated as weight in kilograms divided by height in meters squared], 26.0 [3.5]) with symptoms of nasal obstruction due to a deviated nasal septum. Intervention Septomeatoplasty. Outcome Measures Surgical outcomes were measured using the Snore Outcomes Survey, the Epworth Sleepiness Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) 3 months after surgery. We compared baseline and postoperative scores. Normative SF-36 data obtained from 4591 age- and sex-matched adults were used as references. Results Nasal obstruction symptoms significantly improved (mean [SD] visual analog scale score, −5.2 [1.4]; P P P P P > .05). Conclusions Correction of an obstructed nasal airway significantly improves disease-specific and generic QOL in adult patients with obstructive sleep apnea who also have nasal obstruction symptoms. After nasal surgery, patients may experience greater improvement in snoring and daytime sleepiness than in other generic health status. Our findings substantiate the role of nasal surgery in treating patients with obstructive sleep apnea and nasal obstruction.

Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome

Abstract: OBJECTIVE: Randomized, double-blinded, placebo-controlled, clinical trial to determine the effectiveness of palatal implants for treatment of mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS).STUDY DESIGN AND SETTING: Sixty-two non-obese adults with history of snoring, daytime sleepiness, and mild/moderate OSAHS, were randomized to receive palatal implants (n = 31) or placebo procedure (n = 31). Complete follow-up including quality of life (QOL, SF-36), snoring visual analog scale (VAS), and Epworth Sleepiness Scale (ESS) data were obtained in 62 patients. Seven patients refused follow-up polysomnography for a total of 55 patients (29 implant and 26 placebo).RESULTS: The treatment group (change in score of −7.9 ± 7.7) was significantly improved compared with the placebo group (change in score of 0.9 ± 4.3) for apnea/hypopnea index (AHI) (P < 0.0001), QOL, SF-36 (P < 0.0001), snoring VAS (P < 0.0001), and ESS (P = 0.0002).CONCLUSIONS: Palatal implants improve AHI, QOL, snoring intensity, and ...