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Sunwoo BY, Kaufmann CN, Murez A, Lee E, Gilbertson D, Bosompra NO, DeYoung P, Malhotra A. The language of sleepiness in obstructive sleep apnea beyond the Epworth. Sleep Breath 2023; 27:1057-1065. [PMID: 36098927 PMCID: PMC9469060 DOI: 10.1007/s11325-022-02703-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/06/2022] [Accepted: 08/26/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is underdiagnosed, partially from variable clinical presentations. Emphasis is often placed on Epworth Sleepiness Scale (ESS), a subjective measure of sleepiness, but variable in OSA. We hypothesized that daytime complaints measured with Language of Sleepiness Questionnaire (LOS) in OSA are not being captured by ESS. METHODS Adults referred to a tertiary sleep clinic undergoing sleep studies completed ESS and LOS questionnaires (20 items with various patient-reported descriptors). LOS was examined in patients who had or did not have OSA without sleepiness based on ESS < 10. Cluster analysis was performed to assess whether or not groups of individuals differed based on classification with or without OSA and with or without ESS-based sleepiness. RESULTS Approximately half the study population (n = 185 completed) had OSA. ESS score (mean ± SD) was 9.0 ± 5.4. There was no significant difference in ESS between patients with and without OSA (9.0 ± 5.1 vs 9.1 ± 5.7, p = 0.969). In patients with OSA, females, older patients and white patients were significantly less likely to have an ESS ≥ 10 when compared to patients with an ESS < 10. In patients with an ESS < 10, there were no significant differences in descriptors of sleepiness between patients with and without OSA with the most common descriptors selected being "I lack energy," "I wake up sleepy," "I keep waking up," and "I don't sleep enough." CONCLUSIONS The ESS failed to discriminate patients with OSA from those without OSA. Despite an ESS < 10, both daytime and sleep complaints using the LOS questionnaire were present in patients with OSA. Asymptomatic OSA may be less common than previously reported.
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Affiliation(s)
- Bernie Y Sunwoo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, 92121, USA.
| | - Christopher N Kaufmann
- Division of Epidemiology and Data Science in Gerontology, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, USA
| | - Andrea Murez
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ellen Lee
- Division of Psychiatry, University of California San Diego, San Diego, USA
| | - Dillon Gilbertson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, 92121, USA
| | - Naa-Oye Bosompra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, 92121, USA
| | - Pamela DeYoung
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, 92121, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, 92121, USA
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Pordzik J, Seifen C, Ludwig K, Hackenberg B, Huppertz T, Bahr-Hamm K, Matthias C, Gouveris H. Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes. J Pers Med 2023; 13:jpm13030532. [PMID: 36983714 PMCID: PMC10059915 DOI: 10.3390/jpm13030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Hypoglossal-nerve stimulation (HGNS) is an established second-line therapy for patients with obstructive sleep apnea (OSA). Existing studies investigating the effect of preoperative drug-induced sleep endoscopic (DISE) findings on HGNS outcomes have mainly focused on the apnea/hypopnea index (AHI) among polysomnography (PSG) parameters, and have less frequently tested other PSG parameters such as the apnea index (AI), hypopnea index (HI), oxygen desaturation index (ODI), snoring index, and arousal index, or patient-reported excessive daytime sleepiness. The aim of this study was to investigate the correlation between DISE findings and the above-mentioned metrics after HGNS therapy. We only included patients with DISE findings providing detailed information about the degree of the anteroposterior velar (APV), oropharyngeal lateral wall (OPLW), or tongue-base (BT) obstruction based on the velum, oropharynx, base of tongue, and epiglottis (VOTE) classification. The data of 25 patients (9 female (36%)) were retrospectively evaluated. The mean age at the date of implantation was 54.52 ± 9.61 years, and the mean BMI was 29.99 ± 3.97 kg/m2. Spearman’s rho correlation coefficients were calculated. Significant correlations were found between the degree of APV obstruction and postoperative HI (r = −0.5, p < 0.05), and between the degree of OPLW obstruction and postoperative snoring index (r = 0.42, p < 0.05). BT obstruction was strongly correlated with postoperative metrics such as AHI (r = −0.57, p < 0.01), AI (r = −0.5, p < 0.05), ODI (r = −0.57, p < 0.01), ∆ AHI (r = 0.58, p < 0.01), ∆ AI (r = 0.54, p < 0.01) and ∆ ODI (r = 0.54, p < 0.01). No significant correlation was found between DISE findings and postoperative Epworth Sleepiness Scale values. These findings suggest that preoperative DISE findings, especially the degree of BT obstruction, are important for predicting an HGNS therapy outcome.
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Sampat AC, Avidan AY. Multiple Sleep Latency Test/Maintenance of Wakefulness Test and Central Hypersomnias: Evolving Diagnostic and Therapeutic Approaches. J Clin Neurophysiol 2023; 40:203-214. [PMID: 36872499 DOI: 10.1097/wnp.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
SUMMARY Central disorders of hypersomnolence include a spectrum of conditions, such as narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome, in which excessive daytime sleepiness is the primary feature. Subjective testing with tools, such as sleep logs and sleepiness scales, are often helpful in the evaluation of these disorders but do not necessarily correlate well with objective testing, such as polysomnography and multiple sleep latency test and maintenance of wakefulness test. The most recent International Classification of Sleep Disorders-Third Edition has incorporated biomarkers, such as cerebrospinal fluid hypocretin level, into the diagnostic criteria and have restructured the classification of conditions based on our evolved understanding of their underlying pathophysiologic mechanisms. Therapeutic approaches largely consist of behavioral therapy, with a focus on optimizing sleep hygiene, optimizing opportunity for sleep, and strategic napping, along with judicious use of analeptic and anticataleptic agents when necessary. Emerging therapy has revolved around hypocretin-replacement therapy, immunotherapy, and nonhypocretin agents, with the goal of better targeting the underlying pathophysiology of these disorders rather than addressing symptoms. The most novel treatments have targeted the histaminergic system (pitolisant), dopamine reuptake transmission (solriamfetol), and gamma-aminobutyric acid modulation (flumazenil and clarithromycin) to promote wakefulness. Continued research is required for a more solid understanding of the biology of these conditions to develop a more robust armamentarium of therapeutic options.
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Affiliation(s)
- Ajay C Sampat
- Department of Neurology, UC Davis School of Medicine, Sacramento, California, U.S.A.; and
| | - Alon Y Avidan
- Department of Neurology, UCLA School of Medicine; UCLA Sleep Disorders Center, Los Angels, California, U.S.A
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4
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Long H, Scott H, Lack L. Sleepy, tired, drowsy, and fatigue have different meanings for a university student sample. J Clin Sleep Med 2022; 18:1235-1241. [PMID: 35023472 PMCID: PMC9059599 DOI: 10.5664/jcsm.9780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This pilot study aimed to investigate differences in the semantic meanings that individuals attribute to the words "sleepy," "fatigued," "tired," and "drowsy." METHODS Ninety-six undergraduate students ranked the target words on three independent dimensions (Evaluative, Potency, and Activity) to assess their meaning using the Semantic Differential Technique. Participants also completed online questionnaires to assess their sleep difficulties and current states of sleepiness and fatigue. RESULTS There were significant differences between all four words in connotative meaning on the Evaluative dimension, p < .05 for all post-hoc comparisons, with differences largest between "sleepy" and "fatigued." "Drowsy" was significantly closer in meaning to "sleepy" than to "fatigued," p = .04, and "tired" was not significantly closer in meaning to "sleepy" or "fatigued," p = .13. No significant association was found between insomnia severity index scores and "sleepy" ratings, r(s) = 0.08, p = .42, but a small effect was found with "fatigued" ratings, r(s) = 0.24, p = .02. CONCLUSIONS These preliminary findings indicate that individuals consider these words as distinct concepts, relatively unaffected by the current severity of their insomnia symptoms. This adds to the argument for not using these words interchangeably, which we encourage sleep medicine researchers and clinicians to consider when employing these words in research and clinical practice.
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Affiliation(s)
- Hannah Long
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Hannah Scott
- College of Medicine and Public Health, Adelaide Institute for Sleep Health: A, Flinders Centre of Research Excellence, Flinders University, Adelaide, Australia
| | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.,College of Medicine and Public Health, Adelaide Institute for Sleep Health: A, Flinders Centre of Research Excellence, Flinders University, Adelaide, Australia
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Peter-Derex L, Subtil F, Lemaitre G, Ricordeau F, Bastuji H, Bridoux A, Onen F, Onen SH. Observation and Interview-based Diurnal Sleepiness Inventory for measurement of sleepiness in patients referred for narcolepsy or idiopathic hypersomnia. J Clin Sleep Med 2021; 16:1507-1515. [PMID: 32406372 DOI: 10.5664/jcsm.8574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES First, to determine whether the 3-item Observation and Interview-based Diurnal Sleepiness Inventory (ODSI) measures the degree of excessive daytime sleepiness in patients with suspected narcolepsy or idiopathic hypersomnia (IH). Second, to assess the correlation between the ODSI and the Epworth Sleepiness Scale (ESS) as well as objective polysomnographic measurements. Third, to test the accuracy of the ODSI to detect narcolepsy or IH (narcolepsy/IH) compared with the ESS. METHODS A total of 181 patients complaining of excessive daytime sleepiness filled in the ESS and the ODSI and underwent measurements including actigraphy, full-night polysomnography, Multiple Sleep Latency Test, and 24-hour bedrest sleep recording. RESULTS Narcolepsy or IH was diagnosed in 76 patients. The ODSI found excessive daytime sleepiness in 92.3% of all patients and in 98.7% of those diagnosed with narcolepsy/IH. In the whole population, the ODSI was significantly positively correlated with the ESS (R = .547; 95% confidence interval: .436, .642; P < .001) and weakly with 24-hour total sleep time on bedrest recording (R = .208; 95% confidence interval: .056, .350; P = .047) but not with the Multiple Sleep Latency Test. The ODSI offered a higher negative (92.9%) and positive (44.9%) predictive value to detect narcolepsy/IH than did the ESS (66.7% and 43.3%, respectively). In the IH group, the ODSI's third-item score (daily sleepiness duration) was significantly higher in patients with than without increased 24-hour total sleep time (P = .023). CONCLUSIONS The ODSI is a brief, simple first-line questionnaire that explores both intensity and duration of daytime sleepiness and offers a high sensitivity to detect narcolepsy and IH.
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Affiliation(s)
- Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS 5292, INSERM U1028, Lyon, France
| | - Fabien Subtil
- Lyon 1 University, Lyon, France.,Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
| | | | - François Ricordeau
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hélène Bastuji
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, CNRS 5292, INSERM U1028, Lyon, France
| | - Agathe Bridoux
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fannie Onen
- Centre Hospitalier Universitaire Bichat Claude Bernard, Service de gériatrie, Assistance Publique, Hôpitaux de Paris, Paris, France.,INSERM 1178 and Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris Sud, Paris, France.,Center for Sleep and Circadian Neurobiology, Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S-Hakki Onen
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, CNRS 5292, INSERM U1028, Lyon, France
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Sleep quality and daytime sleepiness in epilepsy: Systematic review and meta-analysis of 25 studies including 8,196 individuals. Sleep Med Rev 2021; 57:101466. [PMID: 33838598 DOI: 10.1016/j.smrv.2021.101466] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/26/2022]
Abstract
We sought to gain a better understanding of the relationship between epilepsy and sleep quality and daytime sleepiness by performing a literature search of PubMed for case-control studies that compared patients with epilepsy to controls and reported the Pittsburgh sleep quality index (PSQI) and/or the Epworth sleepiness scale (ESS). Study-specific mean differences in the PSQI and ESS between cases and controls were extracted from the publications and pooled using random-effects meta-analysis. Twenty-five studies (2964 cases, 5232 controls) were included. Fifteen studies reported the PSQI and 24 the ESS. Mean age was 40 years; 50.4% were women. When comparing cases to controls, the pooled mean differences in the PSQI and ESS were 1.27 (95% confidence interval (CI): 0.76, 1.78; P < 0.001; I2: 81.4%) and 0.38 (95% CI: -0.07, 0.84; P = 0.099; I2: 81.0%). Subgroup analyses revealed that mean differences in the ESS were significantly lower in studies with a higher proportion of patients with focal epilepsy (P = 0.004). In this large-scale meta-analysis patients with epilepsy had a higher PSQI, close to the pathological cut-off, compared to controls, but a similar and unremarkable ESS. Further studies are needed to investigate potential effect modifiers, such as specific antiepileptic drugs or seizure frequency.
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Postural stability and fall risk in patients with obstructive sleep apnea: a cross-sectional study. Sleep Breath 2021; 25:1961-1967. [PMID: 33608798 DOI: 10.1007/s11325-021-02322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/05/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Nocturnal hypoxia and daytime sleepiness resulting from fragmented sleep may impair the ability of postural stability in subjects with OSA. This study investigates the effect of disease severity on postural stability and whether or not it poses a fall risk in individuals with obstructive sleep apnea (OSA). METHODS Forty-nine patients with OSA diagnosed by all-night polysomnography (apnea-hypopnea index (AHI) ≥ 5) and aged 51.4 ± 7.2 years were included in the study. The patients were divided into two groups as severe OSA (AHI ≥ 30, n = 24) and non-severe OSA (5 ≤ AHI ≤ 30, n = 25). All patients were subjected to testing for postural stability (PS), limits of stability (LOST), and the stability index for fall risk (fall risk SI) with the Biodex Balance System®. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Biodex measurements and daytime sleepiness were compared between severe and non-severe OSA groups. Univariate analysis was conducted to explore if AHI, ESS score, lowest SaO2 (%), sleep stages (%), or total arousal index predict postural stability scores. RESULTS Overall and anterior-posterior PS indices were higher in the severe OSA group (p < 0.05). Dynamic PS and fall risk indices did not differ between groups. AHI and lowest SaO2 (%) were found to be an independent predictor for both overall PS (r = 0.300 and r = 0.286, respectively) and fall risk SI (r = 0.296 and r = 0.374, respectively), whereas stage N1 (%) and stage N3 (%) were an independent predictor for overall LOST score (r = -0.328 and r = 0.298, respectively) (p < 0.05). CONCLUSION Static postural stability of individuals with severe OSA is worse than those with non-severe OSA. Static postural stability worsens, and fall risk increases as AHI increases and the lowest SaO2 decreases in individuals with OSA. On the other hand, dynamic postural stability worsens as stage N1 (%) sleep increases and stage N3 (%) sleep decreases. While nocturnal hypoxia indicators such as AHI and lowest SaO2 are associated with static postural stability, sleep structure-related variables are associated with dynamic stability. Including postural stability assessments in the clinical practice for OSA may help addressing workplace accidents or tendency to fall. TRIAL REGISTRATION www.ClinicalTrials.gov registration number: NCT03589417.
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8
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Differential relationship of two measures of sleepiness with the drives for sleep and wake. Sleep Breath 2021; 25:2179-2187. [PMID: 33404964 DOI: 10.1007/s11325-020-02269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/01/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Since disagreement has been found between an objective sleep propensity measured by sleep onset latency (SOL) and subjective sleepiness assessment measured by the Epworth sleepiness scale (ESS) score, distinct underlying causes and consequences were suggested for these two sleepiness measures. We addressed the issue of validation of the ESS against objective sleepiness and sleep indexes by examining the hypothesis that these two sleepiness measures are disconnected due to their differential relationship with the antagonistic drives for sleep and wake. METHODS The polysomnographic records of 50-min napping attempts were collected from 27 university students on three occasions. Scores on the first and second principal components of the electroencephalographic (EEG) spectrum were calculated to measure the sleep and wake drives, respectively. Self-assessments of subjective sleepiness and sleep were additionally collected in online survey of 633 students at the same university. RESULTS An ESS score was disconnected with the polysomnographic and self-assessed SOL in the nap study and online survey, respectively. An ESS score but not SOL was significantly linked to the spectral EEG measure of the sleep drive, while SOL but not ESS showed a significant association with the spectral EEG measure of the opposing wake drive. CONCLUSIONS Each of two sleepiness measures was validated against objective indicators of the opposing sleep-wake regulating processes, but different underlying causes were identified for two distinct aspects of sleepiness. A stronger sleep drive and a weaker opposing drive for wake seem to contribute to a higher ESS score and to a shorter SOL, respectively.
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9
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Zhang X, Zhang N, Yang Y, Wang S, Yu P, Guan BY, Wang CX. Characteristics of Obstructive Sleep Apnea Patients With Hypertension and Factors Associated With Autotitration Acceptance. Front Psychiatry 2021; 12:706275. [PMID: 35058810 PMCID: PMC8764373 DOI: 10.3389/fpsyt.2021.706275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022] Open
Abstract
In order to explore the characteristics and treatment status of obstructive sleep apnea (OSA) patients with hypertension, a retrospective study was conducted on 306 patients admitted from October 2018 to December 2019. According to the apnea hypopnea index (AHI), OSA patients with hypertension were divided into three groups. 69 cases were mild OSA (5 ≤ AHI < 15), 86 cases were moderate (15 ≤ AHI < 30), and 151 cases were severe (AHI ≥ 30). Compared with patients in the mild and moderate groups, the severe group had more male patients, with higher body mass index (BMI) and non-rapid eye movement stage 1 accounted for total sleep time (N1%), and lower non-rapid eye movement stage 2 accounted for total sleep time (N2%), average and minimum blood oxygen. Among all the patients, those who underwent the titration test accounted for 20.6% (63/306). Multivariate analysis showed that sleep efficiency (p < 0.001) and AHI (p < 0.001) were independent factors for patients to accept titration test. OSA patients with hypertension had a low acceptance of titration therapy. These people with higher sleep efficiency and AHI were more likely to receive autotitration.
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Affiliation(s)
- Xuan Zhang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Yang Yang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ping Yu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Bo-Yuan Guan
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chun-Xue Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Clinical Psychology, Capital Medical University, Beijing, China.,Beijing Institute of Brain Disorders, Beijing, China
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10
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Packard A, Bautista R, Smotherman C, Gautham S. Gender differences in Epworth Sleepiness Scale revealed by paired patient-spouse scoring. Epilepsy Behav 2021; 114:107272. [PMID: 32651121 DOI: 10.1016/j.yebeh.2020.107272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Evaluation of daytime sleepiness in the clinical sleep practice is commonly performed by administering the Epworth Sleepiness Scale (ESS). Our study investigates gender differences of ESS responses in patients (PTs) with a primary complaint of nighttime sleep disruption as they relate to ESS responses obtained from PTs' spouses (Ss). METHODS One hundred and sixty-four patient-spouse (PT-S) pairs were recruited for the study and asked to independently complete ESS questionnaires consisting of 8 sleepiness scenarios (Q1-Q8). Descriptive summaries were frequencies and percentages for categorical data, and medians and quartiles for continuous variables. Differences between PT-S pairs and different data sets were evaluated using a two-tail independent T test and Wilcoxon's Rank Sum Test. All analyses were done in SAS for Windows 9.4. RESULTS Eighty-five male and 75 female PTs were recruited for the study. Female PTs reported significantly higher total ESS scores than male PTs (12.16 vs 9.64, p < 0.0001) and had significantly higher sleepiness for scenarios Q1, Q4, Q6, and Q8. When compared with their Ss' responses, male PTs underestimated, while female PTs overestimated their sleepiness with statistical significance observed for total ESS score as well as for all sleepiness scenarios except for Q5 ("lying down to rest in the afternoon"). African-American (AA) males reported significantly higher total ESS scores than Caucasian (C) males, while AA females reported lower total ESS scores than C females. Discrepancy between PT-S ESS scores was higher in C than in AA PTs. CONCLUSIONS Significant gender differences were noted when PT-S ESS responses were compared. Demonstrated gender differences were further influenced by the PT's race.
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Affiliation(s)
- Andreja Packard
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL, 580 W. 8th St, Tower 1, 9th floor, UF Department of Neurology, Jacksonville, FL 32209, United States of America.
| | - Ramon Bautista
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL, 580 W. 8th St, Tower 1, 9th floor, UF Department of Neurology, Jacksonville, FL 32209, United States of America
| | - Carmen Smotherman
- Center for Health Equity and Quality Research (CHEQR), University of Florida College of Medicine, Jacksonville, FL, 580 W. 8th St, Tower 1, 9th floor, UF Department of Neurology, Jacksonville, FL 32209, United States of America
| | - Shiva Gautham
- Center for Health Equity and Quality Research (CHEQR), University of Florida College of Medicine, Jacksonville, FL, 580 W. 8th St, Tower 1, 9th floor, UF Department of Neurology, Jacksonville, FL 32209, United States of America
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Nikkonen S, Korkalainen H, Kainulainen S, Myllymaa S, Leino A, Kalevo L, Oksenberg A, Leppänen T, Töyräs J. Estimating daytime sleepiness with previous night electroencephalography, electrooculography, and electromyography spectrograms in patients with suspected sleep apnea using a convolutional neural network. Sleep 2020; 43:zsaa106. [PMID: 32459856 PMCID: PMC7734478 DOI: 10.1093/sleep/zsaa106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/14/2020] [Indexed: 01/12/2023] Open
Abstract
A common symptom of obstructive sleep apnea (OSA) is excessive daytime sleepiness (EDS). The gold standard test for EDS is the multiple sleep latency test (MSLT). However, due to its high cost, MSLT is not routinely conducted for OSA patients and EDS is instead evaluated using sleep questionnaires. This is problematic however, since sleep questionnaires are subjective and correlate poorly with the MSLT. Therefore, new objective tools are needed for reliable evaluation of EDS. The aim of this study was to test our hypothesis that EDS can be estimated with neural network analysis of previous night polysomnographic signals. We trained a convolutional neural network (CNN) classifier using electroencephalography, electrooculography, and chin electromyography signals from 2,014 patients with suspected OSA. The CNN was trained to classify the patients into four sleepiness categories based on their mean sleep latency (MSL); severe (MSL < 5min), moderate (5 ≤ MSL < 10), mild (10 ≤ MSL < 15), and normal (MSL ≥ 15). The CNN classified patients to the four sleepiness categories with an overall accuracy of 60.6% and Cohen's kappa value of 0.464. In two-group classification scheme with sleepy (MSL < 10 min) and non-sleepy (MSL ≥ 10) patients, the CNN achieved an accuracy of 77.2%, with sensitivity of 76.5%, and specificity of 77.9%. Our results show that previous night's polysomnographic signals can be used for objective estimation of EDS with at least moderate accuracy. Since the diagnosis of OSA is currently confirmed by polysomnography, the classifier could be used simultaneously to get an objective estimate of the daytime sleepiness with minimal extra workload.
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Affiliation(s)
- Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Henri Korkalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Akseli Leino
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Laura Kalevo
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital—Rehabilitation Center, Raanana, Israel
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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12
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Huang Y, Aumüller P, Fietze I, Penzel T, Veauthier C. Comparison of the Oxford Sleep Resistance Test and the Multiple Sleep Latency Test. Physiol Meas 2020; 41:104005. [PMID: 32580182 DOI: 10.1088/1361-6579/ab9feb] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Oxford Sleep Resistance Test (OSLER) consists of four tests over 40 min conducted in a dark and quiet room. If a dim light flashes the patient has to briefly depress a button and then press it again immediately, which indicates that the patient resists sleep. The Maintenance of Wakefulness test (MWT) is another test to assess the ability to maintain wakefulness. Previous studies found a good correlation between the sleep latencies measured with the Osler and the MWT. The most widely used Multiple Sleep Latency Test (MSLT) measures the propensity to fall asleep and not the inability to stay awake. Up to this date there have been no studies comparing the Osler and the MSLT, which is the aim of the study presented here. APPROACH After a night of polysomnography we investigated the sleep latencies the following day with the Osler and the MSLT in 43 patients suffering from moderate or severe obstructive sleep apnea (OSA) (33 men and 10 women; median age 59 years; median apnea hypopnea index 30.5 per hour sleep). We analysed the correlation between these two tests and between values in the Epworth Sleepiness Scale (ESS) and the Karolinska Sleepiness Scale (KSS) and these two tests. MAIN RESULTS We did not find a correlation between the Osler and the MSLT nor between these two tests and the questionnaires (ESS, KSS). The only significant correlation was found between the mean MSLT latency and the sleep onset latency in the polysomnography the night before. Seven patients stayed awake during the Osler and showed a decreased mean sleep latency in the MSLT. SIGNIFICANCE The Osler, the MSLT and the questionnaires measure different objective and subjective aspects of sleepiness. In untreated OSA patients an increased propensity to fall asleep was not automatically associated with the inability to stay awake.
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Affiliation(s)
- Ying Huang
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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13
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Chu P, Ju YES, Hinze AM, Kim AH. Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient-Reported Outcomes in Rheumatologic Diseases. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:410-430. [PMID: 33091275 PMCID: PMC7586459 DOI: 10.1002/acr.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Philip Chu
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yo-El S. Ju
- Sleep Medicine Center, Department of Neurology, Washington University School of Medicine, Saint Louis, MO
| | - Alicia M. Hinze
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alfred H.J. Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
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14
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Wang X, Li W, Zhou J, Wei Z, Li X, Xu J, Zhang F, Wang W. Smoking and sleep apnea duration mediated the sex difference in daytime sleepiness in OSA patients. Sleep Breath 2020; 25:289-297. [PMID: 32529520 DOI: 10.1007/s11325-020-02109-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Daytime sleepiness is a common symptom of obstructive sleep apnea (OSA) and is more common in men, but the underlying mechanism remains unclear. The aim of this study was to assess whether or not sex differences in daytime sleepiness persisted after controlling for age and OSA severity and to explore the factors contributing to daytime sleepiness in patients with OSA. METHODS A total of 104 pairs of patients with OSA, matched by age and apnea-hypopnea index (AHI), were enrolled in this retrospective study. Demographic data were collected; daytime sleepiness was measured by the Epworth Sleepiness Scale (ESS); and polysomnography (PSG) was performed on each participant. These measurements were compared between sexes, and the factors affecting daytime sleepiness were explored with correlation and multivariate linear regression analyses. RESULTS Men had significantly higher ESS scores (p = 0.021) than women. Regarding demographics, BMI, neck/height ratio, and proportion of habitual smoking and alcohol intake were significantly higher in men. Regarding PSG findings, men had more rapid eye movement sleep, a longer mean apnea-hypopnea duration, and a longer mean apnea duration (MAD). Regression analysis showed that two sex-associated variables, habitual smoking (β = 0.189, p = 0.006) and MAD (β = 0.154, p = 0.024), had the strongest association with ESS scores. Further analysis revealed that MAD was significantly influenced by apnea index (β = 0.306, p < 0.001) and sex (β = - 0.193, p = 0.003). CONCLUSION The sex difference in daytime sleepiness persists in patients with OSA, even after matching AHI and age. The difference is mediated by sex-specific smoking habits and sex differences in apnea duration.
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Affiliation(s)
- Xingjian Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenyang Li
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiawei Zhou
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhijing Wei
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaomeng Li
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiahuan Xu
- Department of Respiratory Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Fang Zhang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wei Wang
- Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China.
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15
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Goldstein CA, Berry RB, Kent DT, Kristo DA, Seixas AA, Redline S, Westover MB. Artificial intelligence in sleep medicine: background and implications for clinicians. J Clin Sleep Med 2020; 16:609-618. [PMID: 32065113 PMCID: PMC7161463 DOI: 10.5664/jcsm.8388] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022]
Abstract
None Polysomnography remains the cornerstone of objective testing in sleep medicine and results in massive amounts of electrophysiological data, which is well-suited for analysis with artificial intelligence (AI)-based tools. Combined with other sources of health data, AI is expected to provide new insights to inform the clinical care of sleep disorders and advance our understanding of the integral role sleep plays in human health. Additionally, AI has the potential to streamline day-to-day operations and therefore optimize direct patient care by the sleep disorders team. However, clinicians, scientists, and other stakeholders must develop best practices to integrate this rapidly evolving technology into our daily work while maintaining the highest degree of quality and transparency in health care and research. Ultimately, when harnessed appropriately in conjunction with human expertise, AI will improve the practice of sleep medicine and further sleep science for the health and well-being of our patients.
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Affiliation(s)
- Cathy A. Goldstein
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Richard B. Berry
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - David T. Kent
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Azizi A. Seixas
- Department of Population Health, Department of Psychiatry, NYU Langone Health, New York, New York
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Huang Y, Hennig S, Fietze I, Penzel T, Veauthier C. The Psychomotor Vigilance Test Compared to a Divided Attention Steering Simulation in Patients with Moderate or Severe Obstructive Sleep Apnea. Nat Sci Sleep 2020; 12:509-524. [PMID: 32821184 PMCID: PMC7419631 DOI: 10.2147/nss.s256987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sleepiness at the wheel affects 10% to 15% of drivers and is one major cause of death on highways with one-third of fatal accidents. Obstructive sleep apnea (OSA) is one of the most common sleep disorders leading to sleepiness at the wheel. The aim of this study was to compare the psychomotor vigilance test reaction time (PVT RT) in OSA patients and controls (morning and afternoon) with the results of a divided attention steering simulator (DASS). A second purpose was to compare these results with the mean sleep latencies in the multiple sleep latency test (MSLT), the Epworth Sleepiness Scale (ESS) values and a neurocognitive test (test of attentional performance, TAP). PATIENTS AND METHODS Thirty eight OSA patients and 16 age and sex matched healthy controls were investigated by ESS, PVT, TAP, MSLT, and DASS (response time, failed responses, lane deviation, and off-road-events). RESULTS With increasing age, the performance in the DASS decreased. There was no correlation between the DASS and the results of the MSLT and ESS. The controls showed a significantly faster DASS response time in the morning compared to OSA patients (median 2.1 versus 3.0; p=0.044) and fewer off-road events (9 versus 37; p=0.042). We found a moderate correlation between the PVT RT and all parameters of the DASS, as well as the TAP "alertness" subtest. CONCLUSION The increase of PVT RT as well as the decreased tonic alertness in the TAP in untreated OSA patients correlated with an impairment of simulated driving performance. The PVT and the TAP are both suitable diagnostic tools for measuring impaired driving ability in OSA patients. The MSLT did not correlate with the simulated driving performance. We recommend investigation of a longer version of the PVT in order to increase its sensitivity.
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Affiliation(s)
- Ying Huang
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Berlin 10117, Germany
| | - Steve Hennig
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Berlin 10117, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Berlin 10117, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Berlin 10117, Germany.,Department of Biology, Saratov State University, Saratow, Russia
| | - Christian Veauthier
- Interdisciplinary Center of Sleep Medicine, Charité University Medicine Berlin, Berlin 10117, Germany
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D'Ambrosio S, Castelnovo A, Guglielmi O, Nobili L, Sarasso S, Garbarino S. Sleepiness as a Local Phenomenon. Front Neurosci 2019; 13:1086. [PMID: 31680822 PMCID: PMC6813205 DOI: 10.3389/fnins.2019.01086] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022] Open
Abstract
Sleep occupies a third of our life and is a primary need for all animal species studied so far. Nonetheless, chronic sleep restriction is a growing source of morbidity and mortality in both developed and developing countries. Sleep loss is associated with the subjective feeling of sleepiness and with decreased performance, as well as with detrimental effects on general health, cognition, and emotions. The ideas that small brain areas can be asleep while the rest of the brain is awake and that local sleep may account for at least some of the cognitive and behavioral manifestations of sleepiness are making their way into the scientific community. We herein clarify the different ways sleep can intrude into wakefulness, summarize recent scientific advances in the field, and offer some hypotheses that help framing sleepiness as a local phenomenon.
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Affiliation(s)
- Sasha D'Ambrosio
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Ottavia Guglielmi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Genoa, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS, Child Neuropsychiatry Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Simone Sarasso
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Genoa, Italy
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18
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Laird S, Ney LJ, Felmingham KL, Gogos A. Hormonal Contraception and the Brain: Examining Cognition and Psychiatric Disorders. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190521113841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background:The combined oral contraceptive pill (OC), containing synthetic estrogens and progestins, is used by millions of women worldwide, yet little is known about its effects on cognition or on psychiatric disorders. The progestin component of OCs determines their androgenicity, i.e. whether the OC has androgen binding components with masculinising effects or antiandrogenic components with feminising effects.Objective:The present review discusses the literature surrounding OC use and cognition in healthy women. Given the important role that sex hormones play in psychiatric disorders, we also consider the influence of OCs on symptoms of schizophrenia, post-traumatic stress disorder, depression, bipolar disorder, anxiety disorders and indirectly, sleep quality.Results:Research has shown that while there are no differences between OC users and non-users, androgenic OCs enhance visuospatial ability and anti-androgenic OCs enhance verbal fluency. Little is known about OCs effects on other cognitive domains, such as memory and executive function. There is little research examining OC use in schizophrenia, post-traumatic stress disorder, bipolar disorder and anxiety disorders. There is some evidence that OC use is associated with depression, however the exact causality of this association remains to be verified.Conclusion:We maintain that future studies need to address several methodological limitations, such as separating OCs based on androgenicity to avoid the masking effects that occur when various OCs are considered as one group. As this review highlights several significant effects of OC use on the brain, the implications of OC use needs to be considered in future research.
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Affiliation(s)
- Stephanie Laird
- School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Luke J. Ney
- School of Medicine (Psychology), University of Tasmania, Sandy Bay, TAS, Australia
| | - Kim L. Felmingham
- School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Gogos
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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19
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Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses. Sleep Breath 2019; 24:37-47. [PMID: 31342234 DOI: 10.1007/s11325-019-01903-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs). Obstructive sleep apnea (OSA) is the most frequent medical cause of EDS. Therefore, the European Union Directive 2014/85/EU determined that "untreated moderate to severe OSA coincident with EDS constitutes a medical disorder leading to unfitness to drive." The paper aims are to provide a brief review of sleepiness and its implications for driving safety, as well as to describe the subjective and objective methods to accurately evaluate EDS in order to assess fitness to drive in patients with OSA. METHODS We examined databases including PubMed, Medline, and EMBASE using the search terms "sleepiness at the wheel, excessive daytime sleepiness, sleepiness measure, sleep-wake cycle, obstructive sleep apnea, driving license, fitness to drive." RESULTS Significant interindividual variability in EDS exists in patients with comparable severity of OSA. Objective methods of measuring EDS are too expensive and time consuming to be suitable for the certification of driving licenses. The reliability of subjective methods depends upon the clinical setting and subjective tools assess only limited aspects of EDS. Objective measures, such as biochemical biomarkers, must, therefore, support subjective methods. CONCLUSIONS Extensive data have supported different subjective and objective methods for the appraisal of EDS in patients with OSA depending upon the clinical and experimental setting. Challenges remain to determine an appropriate tool for the evaluation of fitness to drive.
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Feketeová E, Mucska I, Klobučníková K, Grešová S, Stimmelová J, Paraničová I, Trojová I, Rosenberger J, Rimárová K, Dorko E. EU questionnaire to screen for obstructive sleep apnoea validated in Slovakia. Cent Eur J Public Health 2019; 26 Suppl:S32-S36. [PMID: 30817870 DOI: 10.21101/cejph.a5278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 09/19/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea syndrome (OSAS) associated with daytime sleepiness (DS) contributes to a higher incidence of motor vehicle accidents. Validation of fitness to drive in driving license applicants, with special concern regarding OSAS accompanied by excessive DS, became mandatory under new EU legislation in January 2016. The aim of the study was to translate and validate the recommended questionnaire to screen for OSAS (Q-OSAS) in the Slovak population. No data on any Q-OSAS validation has previously been published. METHODS The translated Q-OSAS was administered to 311 Slovak patients prior to a planned overnight polysomnography. The diagnostic accuracy of the Q-OSAS in OSAS with an apnoea-hypopnoea index of 15 or more/h of sleep was evaluated by calculating the area under the ROC curve. RESULTS The sensitivity and specificity of the cut-off at 10 points for the Q-OSAS was 57% and 67%, respectively, with an increase of sensitivity and a decrease of specificity with a lowering of the cut-off values. Excluding the Epworth Sleepiness Scale (ESS) score from the final statistics yielded the best sensitivity (77%), specificity (50%), and an area under the ROC curve (0.637) for the cut-off value of 8 points (an equivalent of 10 points with the full version of the Q-OSAS). CONCLUSION The Q-OSAS is an appropriate screening tool to facilitate the screening of subjects potentially at risk from moderate and severe OSAS. A modified two-step interpretation of the Q-OSAS in Slovakia yielded the best sensitivity, and in the future could promote evaluation of sleepiness in sleep and wake disorders other than OSAS for fitness to drive.
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Affiliation(s)
- Eva Feketeová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Imrich Mucska
- Outpatient Clinic for Sleep-Disordered Breathing, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Katarina Klobučníková
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Soňa Grešová
- Department of Medical Physiology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Judita Stimmelová
- Department of Medical Physiology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Ivana Paraničová
- Department of Pneumology and Phtiseology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Ivana Trojová
- Department of Pneumology and Phtiseology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Kvetoslava Rimárová
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Erik Dorko
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
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DSPS-4: a Brief Measure of Perceived Daytime Sleepiness. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-017-9638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee SA, No YJ, Jo KD, Kwon JH, Kim JY, Shin DJ. Factors contributing to excessive daytime sleepiness in Korean adults with epilepsy: A sleep questionnaire-based study. Epilepsy Behav 2019; 90:61-65. [PMID: 30513436 DOI: 10.1016/j.yebeh.2018.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We determined factors contributing to excessive daytime sleepiness (EDS) in Korean adults with epilepsy (AWE). METHODS A total of 147 AWE who had been treated for >1 year were included. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Subjective sleep disturbances were assessed with the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ) and questionnaires about insomnia and restless legs syndrome (RLS). The Hospital Anxiety and Depression Scale (HADS) was also used. An ESS score >10 was considered indicative of EDS. Multivariate logistic regression analyses using the backward elimination method were performed for variables with a p < 0.10 on univariate analysis. RESULTS The mean ESS score was 6.8 (standard deviation [SD]: 4.4). Among the 147 subjects, 36 (24.5%) had EDS. Multivariate logistic regression analysis showed that being employed (odds ratio [OR]: 4.469, p < 0.01), the presence of at least one sleep disturbance (OR: 3.626, p < 0.01), and antiepileptic drug (AED) polytherapy (OR: 2.663, p < 0.05) were independently associated with EDS in the overall group of AWE. In contrast, being employed (p < 0.05) and higher Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) scores (p < 0.05) in a model for men with epilepsy, as well as having at least one sleep disturbance (p < 0.05) in a model for women with epilepsy, were identified as independent factors for EDS. CONCLUSIONS Excessive daytime sleepiness in AWE may have a multifactorial origin. Being employed, subjective sleep disturbances, and AED polytherapy are independent predictors of EDS. There may be sex differences in factors associated with EDS.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Young-Joo No
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jeong Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University, Seoul, Republic of Korea
| | - Dong-Jin Shin
- Department of Neurology, Gil Medical Center, Gachon Medical School, Incheon, Republic of Korea
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Kaambwa B, Mpundu-Kaambwa C, Adams R, Appleton S, Martin S, Wittert G. Suitability of the Epworth Sleepiness Scale (ESS) for Economic Evaluation: An Assessment of Its Convergent and Discriminant Validity. Behav Sleep Med 2018; 16:448-470. [PMID: 27754703 DOI: 10.1080/15402002.2016.1228647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D]). METHODS Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman's correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests. RESULTS All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities. CONCLUSIONS The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter.
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Affiliation(s)
- Billingsley Kaambwa
- a Health Economics Unit, School of Medicine, Flinders University , Adelaide , Australia
| | | | - Robert Adams
- b The Health Observatory, Discipline of Medicine, University of Adelaide , Adelaide , Australia
| | - Sarah Appleton
- b The Health Observatory, Discipline of Medicine, University of Adelaide , Adelaide , Australia
| | - Sean Martin
- c Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide , Adelaide , Australia
| | - Gary Wittert
- c Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide , Adelaide , Australia
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Veqar Z, Hussain ME. Psychometric analysis of Epworth Sleepiness Scale and its correlation with Pittsburgh sleep quality index in poor sleepers among Indian university students. Int J Adolesc Med Health 2018; 31:/j/ijamh.ahead-of-print/ijamh-2016-0151/ijamh-2016-0151.xml. [PMID: 30048235 DOI: 10.1515/ijamh-2016-0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/22/2017] [Indexed: 06/08/2023]
Abstract
Background The Epworth Sleepiness Scale (ESS) is an 8-item scale to detect excessive daytime sleepiness. Although its psychometric properties are well established on a number of populations the same has not been done for an Indian population, hence this study was designed to cover this knowledge gap. Aims The purpose of this study was to establish the test-retest reliability, validity and internal consistency of the ESS and its correlation with the Pittsburgh Sleep Quality Index (PSQI) in poor sleepers in India. Materials and methods Twenty-five poor sleepers were randomly chosen from a university population. All the subjects were administered the two scales on the test day and the same was repeated after 1 week, which was the retest. Statistical analysis Intraclass coefficient (ICC) and standard error of measurement (SEM) were calculated for the reliability which was further supported by the Bland-Altman graph and a scatterplot. Cronbach's alpha and Pearson's coefficient were calculated for internal consistency and correlation, respectively. Results Twenty-five poor sleepers with mean age 25.24 ± 7.04 years were recruited. The test-retest reliability for ESS displayed good reliability (ICC2,1: 0.86) which was supported by the Bland-Altman graph and the scatterplot. Cronbach's alpha was reported as 0.86 and Pearson's coefficient was r: 0.62, p-value: 0.001. Conclusion The results suggest that the ESS has good internal consistency and test-retest reliability for a university population of poor sleepers in India.
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Affiliation(s)
- Zubia Veqar
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Okhla, New Delhi,India
| | - M Ejaz Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Okhla, New Delhi,India
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Jung SY, Cho CH, Rhee MK, Kim L, Lee HJ. Development of a Modified Korean Version of the Epworth Sleepiness Scale Reflecting Korean Sociocultural Lifestyle. Psychiatry Investig 2018; 15:687-694. [PMID: 30032593 PMCID: PMC6056696 DOI: 10.30773/pi.2018.04.15.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/15/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The Epworth Sleepiness Scale is a measure used for the diagnosis of sleep disorders including obstructive sleep apnea (OSA) syndrome, insomnia, and narcolepsy. Although a Korean version has been developed (the KESS), Korean lifestyle such as the floor culture and low driving rates has not been considered. We aim to develop and validate a modified KESS (mKESS) that reflects the Korean lifestyle. METHODS The sample consisted of 795 healthy participants and 323 OSA patients. The mKESS was developed by modifying several questions to concern the floor culture (questions 1, 2, 6, and 7) and low driving rates (question 8). Feasibility of the modification was tested by comparing the KESS and mKESS using paired samples t-test and by examining internal consistency reliability. Then, mKESS scores of the OSA patients and general participants were compared to test its validity. RESULTS Questions 1, 2, 7, and 8 were significantly different when comparing the performances of the general population on both scales. Especially, the mean scores on question 8 were significantly different in the non-driver group, but not in the driver group. Cronbach's alpha of the mKESS was relatively higher than that of the KESS. Total mKESS scores of the OSA patients were significantly higher than that of the general population. CONCLUSION The mKESS is more universally applicable for the clinical evaluation of people that live in Korea. Results support that the mKESS can be administered to measure the average daytime sleep propensity of the Korean population as an alternative to the KESS.
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Affiliation(s)
- Seo-Yeon Jung
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.,Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Min Kyu Rhee
- Department of Psychology, Gyeongsang National University, Jinju, Republic of Korea
| | - Leen Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.,Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.,Korea University Chronobiology Institute, Seoul, Republic of Korea
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Park YK, Noh KH, Hong SB, Joo EY. Clinical and Polysomnographic Characteristics of Patients with Excessive Daytime Sleepiness. SLEEP MEDICINE RESEARCH 2018. [DOI: 10.17241/smr.2018.00157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prasad B, Steffen AD, Van Dongen HPA, Pack FM, Strakovsky I, Staley B, Dinges DF, Maislin G, Pack AI, Weaver TE. Determinants of sleepiness in obstructive sleep apnea. Sleep 2018; 41:4850639. [PMID: 29444292 DOI: 10.1093/sleep/zsx199] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/18/2017] [Indexed: 01/15/2023] Open
Abstract
STUDY OBJECTIVES Significant interindividual variability in sleepiness is observed in clinical populations with obstructive sleep apnea (OSA). This phenomenon is only partially explained by the apnea-hypopnea index (AHI). Understanding factors that lead to sleepiness is critical to effective management of patients with OSA. We examined demographic and other factors associated with sleepiness in OSA. METHODS Prospective study of 283 patients with newly diagnosed OSA by polysomnography (AHI ≥ 5 per hour). Subjective sleepiness (Epworth Sleep Scale [ESS] ≥ 11) and objective sleepiness (psychomotor vigilance task [PVT] mean lapse ≥ 2) were assessed. RESULTS Participants were classified into four groups (1: sleepy by ESS and PVT, 2: sleepy by PVT only, 3: sleepy by ESS only, and 4: nonsleepy reference group) and compared by generalized logit model. Shorter daily sleep duration by actigraphy and less morningness were associated with higher risk of sleepiness (Odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.33-0.82 and OR = 0.89, CI 0.80-0.98, respectively). African-American race was associated with sleepiness (group 1, OR = 8.8, CI 2.8-27.3; group 2, OR = 16.6, CI 3.3-83.6; and group 3, OR = 3.3, CI 1.0-10.1). IL-6 level was higher in groups 1 and 3 (OR = 1.9, CI 1.0-3.4 and OR 2.0, CI 1.1-3.7, respectively). CONCLUSIONS African-American race, short sleep duration, chronotype, and increased proinflammatory cytokine IL-6 level were associated with sleepiness in OSA. These findings will inform future investigations determining mechanisms of sleepiness in OSA.
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Affiliation(s)
- Bharati Prasad
- Department of Medicine, Pulmonary, Critical Care, Sleep and Allergy, College of Medicine, University of Illinois at Chicago, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Alana D Steffen
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
| | - Francis M Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Inna Strakovsky
- Office of Clinical Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bethany Staley
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David F Dinges
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Terri E Weaver
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
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Lim JH, Park P, Wee JH, Gelera JE, Shrestha KK, Rhee CS, Kim JW. Evaluation of the success of obstructive sleep apnea surgery using criteria based on long-term symptoms and incident hypertension. Eur Arch Otorhinolaryngol 2018; 275:1015-1022. [PMID: 29423748 DOI: 10.1007/s00405-018-4894-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify appropriate success criteria, based on long-term symptoms and incident hypertension, after surgery for obstructive sleep apnea (OSA). METHODS This observational cohort study included 97 adult OSA patients (90 men) who underwent surgical treatment at our tertiary medical center. Subjective symptoms [witnessed sleep apnea and snoring, and Epworth sleepiness scale (ESS) scores] were evaluated through a telephone survey, and incident hypertension was assessed from medical records. The subjects were divided into success and failure groups according to seven different criteria, and data were analyzed to identify the criteria that could significantly differentiate the success from failure groups. RESULTS The participants had a mean age of 48.8 ± 11.9 years and a mean preoperative body mass index of 26.5 ± 3.5 kg/m2. The mean preoperative and postoperative apnea-hypopnea index (AHI) values were 36.1/h and 19.4/h, respectively. The mean follow-up duration was 77.0 ± 31.1 months. Postoperative witnessed apnea, snoring, and the ESS scores decreased significantly compared to preoperative scores in both the success and failure groups based on most of the seven criteria. Among the seven criteria, success and failure groups based on a postoperative AHI cutoff of 15 or 20/h differed significantly in witnessed apnea, snoring, or ESS scores. Kaplan-Meier survival analysis based on incident hypertension revealed that no criterion could significantly distinguish between the two groups. CONCLUSIONS Our results suggest that some of the success criteria analyzed may be more useful in differentiating between success and failure groups after surgery, in terms of long-term improvement of subjective OSA-related symptoms.
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Affiliation(s)
- Jae Hyun Lim
- Department of Otolaryngology-Head and Neck Surgery, National Police Hospital, Seoul, South Korea
| | - Pona Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, Seoul, South Korea
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, South Korea
| | - January E Gelera
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Kundan Kumar Shrestha
- Department of Otolaryngology and Head and Neck Surgery, Nepal Medical College Teaching Hospital, Jorpati, Nepal
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
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Trimmel K, Żebrowska M, Böck M, Stefanic A, Mayer D, Klösch G, Auff E, Seidel S. Wanted: a better cut-off value for the Epworth Sleepiness Scale. Wien Klin Wochenschr 2018; 130:349-355. [PMID: 29340766 PMCID: PMC5966487 DOI: 10.1007/s00508-017-1308-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
Background Excessive daytime sleepiness (EDS) is the main complaint in many neurological sleep disorders, such as idiopathic hypersomnia, narcolepsy, or obstructive sleep apnea/hypopnea syndrome (OSAS). The validity of the Epworth Sleepiness Scale (ESS) as a screening tool for EDS remains controversial. We therefore investigated (1) the interrelation of the ESS total score and the mean sleep latency (MSL) during the multiple sleep latency test (MSLT) and (2) the diagnostic accuracy of the ESS total score to detect EDS in patients with the chief complaint of subjective EDS. Methods A total of 94 patients (48 males) with subjective EDS were included in this study. Regression analyses and ROC curve analyses were carried out to assess the predictive value of the ESS score for MSL. Results The ESS score significantly predicted a shortened MSL (p = 0.01, β = −0.29). After dichotomizing into two groups, the ESS score predicted MSL only in patients with hypersomnia or narcolepsy (p = 0.01, β = −0.33), but not in patients with other clinical diagnoses (e. g. OSAS; p = 0.36, β = −0.15). The ROC curve analyses indicated an optimal ESS cut-off value of 16 with a sensitivity of 70%; however, specificity remained unsatisfactory (55.6%). Conclusions Our results suggest that the predictive value of the ESS score in patients with subjective EDS is low and patient subgroup-specific (superior in hypersomnia/narcolepsy vs. other diagnoses) and that the commonly used cut-off of 11 points may be insufficient for clinical practice.
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Affiliation(s)
- Karin Trimmel
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Magdalena Żebrowska
- Section for Medical Statistics, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Marion Böck
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andrijana Stefanic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Mayer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard Klösch
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Trotti LM. Characterizing Sleepiness: Are We Drawing the Right Line in the Sand? J Clin Sleep Med 2017; 13:1369-1370. [PMID: 29151431 DOI: 10.5664/jcsm.6824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology and Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia
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Relationship between Travel Time from Home to a Regional Sleep Apnea Clinic in British Columbia, Canada, and the Severity of Obstructive Sleep. Ann Am Thorac Soc 2017; 13:719-23. [PMID: 26814425 DOI: 10.1513/annalsats.201509-613bc] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In the majority of people with obstructive sleep apnea, the disorder remains undiagnosed. This may be partly a result of inadequate access to diagnostic sleep services. We thus hypothesized that even modest travel times to a sleep clinic may delay diagnosis and reduce detection of milder disease. OBJECTIVES We sought to determine whether travel time between an individual's home and a sleep clinic is associated with sleep apnea severity at presentation. METHODS We recruited patients referred for suspected sleep apnea to the University of British Columbia Hospital Sleep Clinic between May 2003 and July 2011. The patient's place of residence was geocoded at the postal code level. Travel times between the population-weighted dissemination areas for each patient and the sleep clinic were calculated using ArcGIS (ESRI, Redlands, CA) network analyst and the Origin-Destination matrix function. All patients underwent full polysomnography. MEASUREMENTS AND MAIN RESULTS There were 1,275 patients; 69% were male, the mean age was 58 years. (SD = 11.9), and the mean apnea-hypopnea index was 22 per hour (SD = 21.6). In the univariate model, travel time was a significant predictor of obstructive sleep apnea severity (P = 0.02). After controlling for confounders including sex, age, obesity, and education, travel time remained a significant predictor of sleep apnea severity (P < 0.01). In the multivariate model, each increase in 10 minutes of travel time was associated with an increase in the apnea-hypopnea index of 1.4 events per hour. CONCLUSIONS For reasons that remain to be determined, travel times are associated with the severity of obstructive sleep apnea at presentation to a sleep clinic. If the results can be verified at other centers, this may help guide the geographic distribution of sleep centers within a health care system.
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Stavem K, Kristiansen HA, Kristoffersen ES, Kværner KJ, Russell MB. Association of excessive daytime sleepiness with migraine and headache frequency in the general population. J Headache Pain 2017; 18:35. [PMID: 28321593 PMCID: PMC5359193 DOI: 10.1186/s10194-017-0743-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/07/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Some previous studies have postulated an association between migraine and excessive daytime sleepiness (EDS). This study evaluated the association of EDS with migraine and headache frequency in a general population, after adjusting for potential confounding variables. METHODS The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. RESULTS A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31─1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05─3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis. CONCLUSIONS In a general population, the odds for EDS increased significantly with the headache frequency, irrespective of migraine status. EDS was not associated with reported migraine in multivariable analysis.
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Affiliation(s)
- Knut Stavem
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Lørenskog, Norway. .,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway. .,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
| | - Håvard Anton Kristiansen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Lørenskog, Norway
| | - Espen Saxhaug Kristoffersen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Kari Jorunn Kværner
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,C3 Centre for Connected Care, Oslo University Hospital, Oslo, Norway.,BI Norwegian Business School, Oslo, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Lørenskog, Norway
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Veauthier C, Hasselmann H, Gold SM, Paul F. The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue. EPMA J 2016; 7:25. [PMID: 27904656 PMCID: PMC5121967 DOI: 10.1186/s13167-016-0073-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 12/11/2022]
Abstract
More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Helge Hasselmann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany ; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany ; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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Bonzelaar LB, Salapatas AM, Yang J, Friedman M. Validity of the epworth sleepiness scale as a screening tool for obstructive sleep apnea. Laryngoscope 2016; 127:525-531. [DOI: 10.1002/lary.26206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/28/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | - Anna M. Salapatas
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
| | - Junhua Yang
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
| | - Michael Friedman
- Chicago ENT: Advanced Center for Specialty Care; Chicago Illinois U.S.A
- Rush University Medical Center; Chicago Illinois U.S.A
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The utility of patient-completed and partner-completed Epworth Sleepiness Scale scores in the evaluation of obstructive sleep apnea. Sleep Breath 2016; 20:1347-1354. [DOI: 10.1007/s11325-016-1370-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/13/2016] [Accepted: 06/07/2016] [Indexed: 12/29/2022]
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Cross-Sectional Study of Obstructive Sleep Apnea Syndrome in Japanese Public Transportation Drivers: Its Prevalence and Association With Pathological Objective Daytime Sleepiness. J Occup Environ Med 2016; 58:455-8. [PMID: 27158952 DOI: 10.1097/jom.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigates obstructive sleep apnea syndrome (OSAS) prevalence among Japanese occupational drivers and factors associated with a pathological level of objective daytime sleepiness. METHODS Portable monitoring device (PMD) screening was applied to 2389 Japanese male public transportation traffic drivers. Nocturnal polysomnography (n-PSG) and multiple sleep latency tests (MSLT) were administered to subjects with apnea-hypopnea index (AHI) at least 15 on PMD. RESULTS In all, 235 subjects were diagnosed as having OSAS (9.8%). AHI on n-PSG at least 40 and Epworth Sleepiness Scale score at least 11 were extracted as factors associated with mean sleep latency on MSLT less than 5 minutes. CONCLUSION Prevalence of OSAS in male Japanese public transportation traffic drivers was 9.8% or greater. Individuals aware of excessive daytime sleepiness and with severe OSAS were inferred as exhibiting a pathological level of objective daytime sleepiness.
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Ryu HS, Lee SA, Lee GH, Chung YS, Kim WS. Subjective apnoea symptoms are associated with daytime sleepiness in patients with moderate and severe obstructive sleep apnoea: a retrospective study. Clin Otolaryngol 2016; 41:395-401. [PMID: 27086649 DOI: 10.1111/coa.12659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Most previous studies have failed to show a relation between daytime sleepiness and apnoea severity in patients with obstructive sleep apnoea (OSA). We determined the relation between daytime sleepiness and subjective and objective apnoea severity in newly diagnosed patients with moderate-to-severe OSA. DESIGN Retrospective cross-sectional study. SETTING Tertiary referral centre. PARTICIPANTS A total of 559 adults with newly diagnosed moderate and severe OSA. MAIN OUTCOME MEASURES Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). Subjective and objective apnoea severities were assessed using the Sleep Breathing Scale (SBS) and polysomnography respectively. Sleep quality and depressive symptoms were evaluated using Medical Outcomes Study-Sleep Scale and Beck Depression Inventory (BDI) respectively. RESULTS The mean ESS score was 9.8 (SD 5.0). ESS score was correlated with SBS score (P < 0.001), apnoea-hypopnoea index (AHI) (P = 0.027), minimal oxygen saturation (MinSaO2 ) (P = 0.021), body mass index (BMI) (P = 0.007) and BDI score (P < 0.001). Linear regression analysis showed that higher SBS (P = 0.005) and BDI scores (P < 0.001) were associated with higher ESS score after controlling for gender, BMI and AHI. Apnoea-hypopnoea index, MinSaO2 and BMI were not independently related to ESS score. CONCLUSIONS Daytime sleepiness was related to subjective OSA symptoms but not objective apnoea severity measured by polysomnography in patients with moderate-to-severe OSA. These findings suggest the usefulness of the subjective apnoea severity as an indicator of OSA disease severity.
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Affiliation(s)
- H S Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S A Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G H Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y S Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W S Kim
- Department of Pulmonary Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Poor Sleep in Multiple Sclerosis Correlates with Beck Depression Inventory Values, but Not with Polysomnographic Data. SLEEP DISORDERS 2016; 2016:8378423. [PMID: 26885399 PMCID: PMC4739473 DOI: 10.1155/2016/8378423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022]
Abstract
Objectives. Pittsburgh Sleep Quality Index (PSQI) values correlate with depression, but studies investigating the relationship between PSQI values and polysomnographic (PSG) data showed inconsistent findings. Methods. Sixty-five consecutive patients with multiple sclerosis (MS) were retrospectively classified as “good sleepers” (GS) (PSQI ≤ 5) and “poor sleepers” (PS) (PSQI > 5). The PSG data and the values of the Visual Analog Scale (VAS) of fatigue, Modified Fatigue Impact Scale (MFIS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and the Beck Depression Inventory (BDI) were compared. Results. No significant differences were found either for PSG data or for ESS, MFIS, and FSS values; but PS showed significantly increased BDI and VAS values. Conclusions. Poor sleep is associated with increased depression and fatigue scale values.
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Khan Z, Trotti LM. Central Disorders of Hypersomnolence: Focus on the Narcolepsies and Idiopathic Hypersomnia. Chest 2015; 148:262-273. [PMID: 26149554 DOI: 10.1378/chest.14-1304] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The central disorders of hypersomnolence are characterized by severe daytime sleepiness, which is present despite normal quality and timing of nocturnal sleep. Recent reclassification distinguishes three main subtypes: narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia (IH), which are the focus of this review. Narcolepsy type 1 results from loss of hypothalamic hypocretin neurons, while the pathophysiology underlying narcolepsy type 2 and IH remains to be fully elucidated. Treatment of all three disorders focuses on the management of sleepiness, with additional treatment of cataplexy in those patients with narcolepsy type 1. Sleepiness can be treated with modafinil/armodafinil or sympathomimetic CNS stimulants, which have been shown to be beneficial in randomized controlled trials of narcolepsy and, quite recently, IH. In those patients with narcolepsy type 1, sodium oxybate is effective for the treatment of both sleepiness and cataplexy. Despite these treatments, there remains a subset of hypersomnolent patients with persistent sleepiness, in whom alternate therapies are needed. Emerging treatments for sleepiness include histamine H3 antagonists (eg, pitolisant) and possibly negative allosteric modulators of the gamma-aminobutyric acid-A receptor (eg, clarithromycin and flumazenil).
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Affiliation(s)
- Zeeshan Khan
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA
| | - Lynn Marie Trotti
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA.
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41
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Abma IL, van der Wees PJ, Veer V, Westert GP, Rovers M. Measurement properties of patient-reported outcome measures (PROMs) in adults with obstructive sleep apnea (OSA): A systematic review. Sleep Med Rev 2015; 28:18-31. [PMID: 26433776 DOI: 10.1016/j.smrv.2015.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 01/30/2023]
Abstract
This systematic review summarizes the evidence regarding the quality of patient-reported outcome measures (PROMs) validated in patients with obstructive sleep apnea (OSA). We performed a systematic literature search of all PROMs validated in patients with OSA, and found 22 measures meeting our inclusion criteria. The quality of the studies was assessed using the consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist. The results showed that most of the measurement properties of the PROMs were not, or not adequately, assessed. For many identified PROMs there was no involvement of patients with OSA during their development or before the PROM was tested in patients with OSA. Positive exceptions and the best current candidates for assessing health status in patients with OSA are the sleep apnea quality of life index (SAQLI), Maugeri obstructive sleep apnea syndrome (MOSAS) questionnaire, Quebec sleep questionnaire (QSQ) and the obstructive sleep apnea patient-oriented severity index (OSAPOSI). Even though there is not enough evidence to fully judge the quality of these PROMs as outcome measure, when interpreted with caution, they have the potential to add value to clinical research and clinical practice in evaluating aspects of health status that are important to patients.
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Affiliation(s)
- Inger L Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Vik Veer
- James Cook University Hospital, Middlesbrough, England, UK
| | - Gert P Westert
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Maroeska Rovers
- Radboud University Medical Center, Radboud Institute of Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute of Health Sciences, Department for Operating Rooms, Nijmegen, The Netherlands
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42
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Shattuck NL, Matsangas P. Psychomotor vigilance performance predicted by Epworth Sleepiness Scale scores in an operational setting with the United States Navy. J Sleep Res 2014; 24:174-80. [PMID: 25273376 DOI: 10.1111/jsr.12243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/10/2014] [Indexed: 11/30/2022]
Abstract
It is critical in operational environments to identify individuals who are at higher risk of psychomotor performance impairments. This study assesses the utility of the Epworth Sleepiness Scale for predicting degraded psychomotor vigilance performance in an operational environment. Active duty crewmembers of a USA Navy destroyer (N = 69, age 21-54 years) completed the Epworth Sleepiness Scale at the beginning of the data collection period. Participants wore actigraphs and completed sleep diaries for 11 days. Psychomotor vigilance tests were administered throughout the data collection period using a 3-min version of the psychomotor vigilance test on the actigraphs. Crewmembers with elevated scores on the Epworth Sleepiness Scale (i.e. Epworth Sleepiness Scale >10) had 60% slower reaction times on average, and experienced at least 60% more lapses and false starts compared with individuals with normal Epworth Sleepiness Scale scores (i.e. Epworth Sleepiness Scale ≤ 10). Epworth Sleepiness Scale scores were correlated with daily time in bed (P < 0.01), sleep (P < 0.05), mean reaction time (P < 0.001), response speed 1/reaction time (P < 0.05), slowest 10% of response speed (P < 0.001), lapses (P < 0.01), and the sum of lapses and false starts (P < 0.001). In this chronically sleep-deprived population, elevated Epworth Sleepiness Scale scores identified that subset of the population who experienced degraded psychomotor vigilance performance. We theorize that Epworth Sleepiness Scale scores are an indication of personal sleep debt that varies depending on one's individual sleep requirement. In the absence of direct performance metrics, we also advocate that the Epworth Sleepiness Scale can be used to determine the prevalence of excessive sleepiness (and thereby assess the risk of performance decrements).
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Affiliation(s)
- Nita Lewis Shattuck
- Operations Research Department, Naval Postgraduate School, Monterey, CA, USA
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43
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Koehler U, Buchholz C, Cassel W, Hildebrandt O, Redhardt F, Sohrabi K, Töpel J, Nell C, Grimm W. Daytime sleepiness in patients with obstructive sleep apnea and severe obesity: prevalence, predictors, and therapy. Wien Klin Wochenschr 2014; 126:619-25. [DOI: 10.1007/s00508-014-0591-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 08/09/2014] [Indexed: 12/11/2022]
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44
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Kendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA. Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review. Sleep Med Rev 2014; 18:321-31. [DOI: 10.1016/j.smrv.2013.08.002] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 07/27/2013] [Accepted: 08/13/2013] [Indexed: 12/26/2022]
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45
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Li Y, Zhang J, Lei F, Liu H, Li Z, Tang X. Self-evaluated and close relative-evaluated Epworth Sleepiness Scale vs. multiple sleep latency test in patients with obstructive sleep apnea. J Clin Sleep Med 2014; 10:171-6. [PMID: 24533000 DOI: 10.5664/jcsm.3446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aims of this study were to determine (1) the agreement in Epworth Sleepiness Scale (ESS) evaluated by patients and their close relatives (CRs), and (2) the correlation of objective sleepiness as measured by multiple sleep latency test (MSLT) with self-evaluated and close relative-evaluated ESS. METHODS A total of 85 consecutive patients with obstructive sleep apnea (OSA) (70 males, age 46.7 ± 12.9 years old) with an apnea-hypopnea index (AHI) > 5 events per hour (mean 38.9 ± 26.8/h) were recruited into this study. All participants underwent an overnight polysomnographic assessment (PSG), MSLT, and ESS rated by both patients and their CRs. Mean sleep latency < 8 min on MSLT was considered objective daytime sleepiness. RESULTS Self-evaluated global ESS score (ESSG) was closely correlated with evaluation by CRs (r = 0.79, p < 0.001); the mean ESSG score evaluated by patients did not significantly differ from that evaluated by CRs (p > 0.05). However, Bland- Altman plot showed individual differences between self-evaluated and CR-evaluated ESS scores, with a 95%CI of -9.3 to 7.0. The mean sleep latency on MSLT was significantly associated with CR-evaluated ESSG (r = -0.23, p < 0.05); significance of association with self-evaluated ESSG was marginal (r = -0.21, p = 0.05). CONCLUSIONS CR-evaluated ESS has a good correlation but also significant individual disagreement with self-evaluated ESS in Chinese patients with OSA. CR-evaluated ESS performs as well as, if not better than, self-evaluated ESS in this population when referring to MSLT.
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Affiliation(s)
- Yun Li
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jihui Zhang
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Fei Lei
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Liu
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China ; Department of Internal Medicine, First People's Hospital of Yibin, Yibin, Sichuan, China
| | - Zhe Li
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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46
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Veauthier C, Paul F. Sleep disorders in multiple sclerosis and their relationship to fatigue. Sleep Med 2014; 15:5-14. [DOI: 10.1016/j.sleep.2013.08.791] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/14/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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47
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An 84-Year-Old Woman with Long-Standing Excessive Daytime Sleepiness. Ann Am Thorac Soc 2013; 10:400-2. [DOI: 10.1513/annalsats.201305-114sf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Hayley AC, Williams LJ, Berk M, Kennedy GA, Jacka FN, Pasco JA. The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women. Aust N Z J Psychiatry 2013; 47:772-8. [PMID: 23677847 DOI: 10.1177/0004867413490036] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Excessive daytime sleepiness (EDS) is a common clinical symptom that affects women more than men. However, the association of excessive sleepiness with depressive and anxiety disorders in the broader population is unclear. The aim of this study was, therefore, to examine the association between excessive daytime sleepiness as measured by the Epworth Sleepiness Scale, and depressive and anxiety disorders in a population-based sample of women. METHODS Using the Structured Clinical Interview for DSM-IV Disorders (Non-Patient) (SCID-I/NP), 944 women aged 20-97 years (median 49 years, IQR 33-65 years) were assessed for depressive and anxiety disorders as part of the Geelong Osteoporosis Study. EDS was assessed using the Epworth Sleepiness Scale (ESS, cut-off > 10). Lifestyle factors were documented by self-report, height and weight were measured, and socioeconomic status categorised according to the Index of Relative Socio-Economic Advantage and Disadvantage. RESULTS Overall, 125 (13.2%) of the women were identified with EDS. EDS was associated with an increased likelihood for both current (OR = 2.11, 95% CI 1.10-4.06) and lifetime history (OR = 1.95, 95% CI 1.28-2.97) of depressive disorders, but not anxiety disorders, independent of age and alcohol consumption. These findings were not explained by antidepressant or sedative use, body mass index, physical activity, smoking, or socioeconomic status. CONCLUSIONS These results suggest that excessive daytime sleepiness is associated with current and lifetime depressive, but not anxiety disorders. Clinically, this highlights the need to take into account the possible bidirectional relationship between depressive disorders and excessive sleepiness when assessing mental health issues in patients with EDS.
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Affiliation(s)
- Amie C Hayley
- School of Medicine, Deakin University, Geelong, Australia.
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Strohl KP, Brown DB, Collop N, George C, Grunstein R, Han F, Kline L, Malhotra A, Pack A, Phillips B, Rodenstein D, Schwab R, Weaver T, Wilson K. An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 Statement. Am J Respir Crit Care Med 2013; 187:1259-66. [PMID: 23725615 DOI: 10.1164/rccm.201304-0726st] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. METHODS A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. RESULTS A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low-quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. DISCUSSION The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available.
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50
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Lewis I, Pairman J, Spickett G, Newton JL. Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome. J Intern Med 2013. [PMID: 23206180 DOI: 10.1111/joim.12022] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A significant proportion of patients with chronic fatigue syndrome (CFS) also have postural orthostatic tachycardia syndrome (POTS). We aimed to characterize these patients and differentiate them from CFS patients without POTS in terms of clinical and autonomic features. METHODS A total of 179 patients with CFS (1994 Centers for Disease Control and Prevention criteria) attending one of the largest Department of Health-funded CFS clinical services were included in this study. Outcome measures were as follows: (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS-A and -D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing. RESULTS CFS patients with POTS (13%, n = 24) were younger (29 ± 12 vs. 42 ± 13 years, P < 0.0001), less fatigued (Chalder fatigue scale, 8 ± 4 vs. 10 ± 2, P = 0.002), less depressed (HADS-D, 6 ± 4 vs. 9 ± 4, P = 0.01) and had reduced daytime hypersomnolence (ESS, 7 ± 6 vs. 10 ± 5, P = 0.02), compared with patients without POTS. In addition, they exhibited greater orthostatic intolerance (OGS, 11 ± 5; P < 0.0001) and autonomic dysfunction. A combined clinical assessment tool of ESS ≤9 and OGS ≥9 identifies accurately CFS patients with POTS with 100% positive and negative predictive values. CONCLUSIONS The presence of POTS marks a distinct clinical group of CFS patents, with phenotypic features differentiating them from those without POTS. A combination of validated clinical assessment tools can determine which CFS patients have POTS with a high degree of accuracy, and thus potentially identify those who require further investigation and consideration for therapy to control heart rate.
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Affiliation(s)
- I Lewis
- Institute for Ageing & Health, Newcastle University, Newcastle, UK
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