Epworth Sleepiness Scale

About: Epworth Sleepiness Scale is a research topic. Over the lifetime, 4742 publications have been published within this topic receiving 155088 citations.

Driving simulator and neuropsychological [corrected] testing in OSAS before and under CPAP therapy.

Abstract: Patients with obstructive sleep apnoea syndrome (OSAS) have an increased car accident rate. Investigations on accident frequency are based on case history, insurance reports and driving simulator studies. The present study combines neuropsychological testing of different attention aspects engaged in driving a car and driving simulation to evaluate a suitable instrument for assessing therapeutic effects of continuous positive airway pressure (CPAP). Driving simulator investigation and neuropsychological testing of alertness, vigilance and divided attention were performed in 31 patients with polysomnographically confirmed OSAS (apnoea-hypopnoea index 24.8+/-21.5.h(-1)) before, and 2 and 42 days after initiation of CPAP. Divided attention and alertness improved significantly during CPAP, whereas vigilance remained unchanged. However, accident frequency (OSAS before therapy: 2.7+/-2.0; 2 days after CPAP: 1.5+/-1.4; 42 days after CPAP: 0.9+/-1.3) and frequency of concentration faults (OSAS before therapy: 12.4+/-5.1; 2 days after CPAP: 6.5+/-3.9; 42 days after CPAP: 4.9+/-3.3) decreased in the simulated driving situation after 2 and 42 days of therapy. There was no relation between accident frequency, concentration faults and daytime sleepiness, as measured by the Epworth Sleepiness Scale, and polysomnographic or neuropsychological findings, respectively. In conclusion, the present results suggest that driving simulation is a possible benchmark parameter of driving performance in obstructive sleep apnoea syndrome patients.

Excessive daytime sleepiness in de novo and treated Parkinson's disease

Abstract: Excessive daytime sleepiness (EDS) in Parkinson's disease (PD) is due to either treatment-related factors or the disease itself. The study of this disturbing phenomenon in de novo parkinsonian patients may contribute to a better understanding of its pathophysiology. We conducted a case control study in which we compared 25 PD patients who had never been treated before with dopaminergic drugs (de novo PD), 50 PD patients being treated with dopaminergic drugs (treated PD), and 25 healthy control subjects, all of whom were matched for age and gender. EDS was measured by means of the Epworth Sleepiness Scale (ESS) and quality of sleep by means of the Pittsburgh Sleep Quality Index (PSQI). ESS and PSQI scores were not statistically different between de novo PD patients and controls, whereas they were significantly higher in treated PD. Differences in ESS score variability were best explained by the treatment effect, whereas there was no clear correlation between PSQI and any of the clinical variables considered.

Neuropsychological effects of 2-week continuous positive airway pressure treatment and supplemental oxygen in patients with obstructive sleep apnea: a randomized placebo-controlled study.

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?

The Effects of Lamotrigine on Sleep in Patients with Epilepsy

Abstract: Summary: Purpose: The older antiepileptic drugs (AEDs) have a variety of effects on sleep, including marked reduction in REM, slow-wave sleep (SWS) and sleep latency, and increased percentage of light sleep. The effects of the newer AEDs on sleep are unknown. Our purpose was to study the effect of lamotrigine (LTG) on sleep. Methods: Ten adults with focal epilepsy, in whom the decision was made to add LTG to either phenytoin (PHT) or carbamazepine (CBZ) for control of seizures, were the subjects of this study. Patients underwent pre- and posttreatment polysomnography (PSG) and completed sleep questionnaires. Polygraphic variables and Epworth Sleepiness Scale (ESS) scores, a subjective measure of sleep propensity, were compared by using the Wilcoxon sign rank test. Results: Seven patients were taking CBZ, and three were treated with PHT. All subjects were titrated to an LTG dose of 400 mg/day. Treatment with LTG produced a significant decrease in SWS and an increase in stage 2 sleep percentage. No significant difference in ESS or any of the other polygraphic variables was observed. However, LTG treatment was associated with a reduction in arousals and stage shifts and an increase in REM periods. No subjects reported insomnia with treatment. Conclusions: LTG appears to be less disruptive to sleep than some of the older AEDs.

Modafinil Augmentation of Selective Serotonin Reuptake Inhibitor Therapy in MDD Partial Responders with Persistent Fatigue and 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...