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Conenna M, Point C, Wacquier B, Lanquart JP, Hein M. Risk of Major Depression Associated with Excessive Daytime Sleepiness in Apneic Individuals. Clocks Sleep 2025; 7:22. [PMID: 40407628 PMCID: PMC12101287 DOI: 10.3390/clockssleep7020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Revised: 04/09/2025] [Accepted: 04/24/2025] [Indexed: 05/26/2025] Open
Abstract
Considering the frequent co-occurrence of major depressive disorder and excessive daytime sleepiness in apneic individuals, this study aimed to explore the relationship between excessive daytime sleepiness and the risk of developing major depressive disorder in this specific subpopulation. Demographic and polysomnographic data were retrospectively extracted from the clinical database of 1849 apneic individuals at the Sleep Unit. Excessive daytime sleepiness was considered present when the Epworth Sleepiness Scale score was >10 and major depressive episodes were diagnosed according to DSM criteria. Logistic regression analyses were performed to assess the risk of major depressive disorder associated with excessive daytime sleepiness in apneic individuals. The prevalence of major depressive disorder was 26.3% in apneic individuals. After controlling for major confounding variables, multivariate logistic regression analyses revealed that apneic individuals with complaints of excessive daytime sleepiness had a higher likelihood of developing major depressive disorder compared to those without complaint of excessive daytime sleepiness. This study highlights the strong association between excessive daytime sleepiness and major depressive disorder in apneic individuals, underlining the importance of systematically assessing and adequately treating excessive daytime sleepiness to better manage depressive symptoms and improve overall treatment outcomes in this specific subpopulation.
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Affiliation(s)
- Matteo Conenna
- Azienda Ospedaliera Universitaria “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Camille Point
- Faculté de Médecine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Jean-Pol Lanquart
- Laboratoire de Recherches Psychiatriques (ULB266), Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Matthieu Hein
- Faculté de Médecine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), CHU Brugmann, Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
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Bonsignore MR, Fanfulla F, Ingrao P, Lombardo S, Tondo P, Lo Nano V, Lombardi C. Management options for excessive daytime sleepiness in patients with obstructive sleep apnea. Expert Rev Respir Med 2025; 19:325-345. [PMID: 40105060 DOI: 10.1080/17476348.2025.2479614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Accepted: 03/11/2025] [Indexed: 03/20/2025]
Abstract
INTRODUCTION Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) associated with the risk of accidents at work or while driving. OSA treatment decreases EDS, but some patients remain sleepy despite optimal control of OSA. Patients who do not tolerate or refuse OSA treatment may be symptomatically treated for EDS. Solriamfetol and pitolisant are wake-promoting agents (WPA) recently approved for use in sleepy OSA patients accepting or refusing OSA treatment. AREAS COVERED This narrative review provides updated information on: how to assess EDS in OSA patients, epidemiology, and management of residual EDS in treated OSA patients and the results of recent studies using new WPAs in patients accepting or refusing CPAP treatment. Literature was accessed from PubMed between 1 December 2024 and 6 January 2025. EXPERT OPINION The new WPAs are useful drugs with a favorable safety profile to be included as a possible therapeutic option for sleepy OSA patients. However, it is still uncertain which subgroups of patients should be treated for the symptom of EDS while maintaining a low-risk profile in terms of the consequences of OSA on health. Until such data is available, use of WPA in OSA patients should be managed by Sleep Specialists.
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Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Palermo, Italy
- Institute of Translational Pharmacology (IFT), Palermo Branch, National Research Council (CNR), Palermo, Italy
| | - Francesco Fanfulla
- Sleep and Respiratory Function Unit of the Pavia and Montescano Institutes, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pietro Ingrao
- PROMISE Department, University of Palermo, Palermo, Italy
| | | | - Pasquale Tondo
- Sleep and Respiratory Function Unit of the Pavia and Montescano Institutes, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Department of Specialistic Medicine, Pulmonary and Critical Care Unit, University-Hospital Polyclinic of Foggia, Foggia, Italy
| | - Vanessa Lo Nano
- Sleep Clinic, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Carolina Lombardi
- Sleep Disorder Center, Cardiology Department, Istituto Auxologico Italiano IRCCS, San Luca Hospital and University of Milano Bicocca, Milan, Italy
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Hoven KM, Aarstad HJ, Moe SE, Steinsvåg SK. Reported daytime sleepiness in relation to orthopnea, restless legs and nocturia in patients evaluated for suspected obstructive sleep apnea. Sleep Breath 2025; 29:140. [PMID: 40140113 PMCID: PMC11946997 DOI: 10.1007/s11325-025-03312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 02/20/2025] [Accepted: 03/21/2025] [Indexed: 03/28/2025]
Abstract
PURPOSE The aim of the study is to explore the extent to which daytime sleepiness in patients with suspected Obstructive Sleep Apnea (OSA) was correlated with OSA itself and OSA-related comorbidities and symptoms. METHODS 1,305 consecutive patients undergoing OSA workup were included. They underwent standard respiratory polygraphy during sleep and completed a 19-item questionnaire about sleep-related symptoms and signs, as well as the Epworth Sleepiness Scale (ESS). Analyses were based on questionnaire responses and the Apnea-Hypopnea Index (AHI) results and were conducted using stepwise regression analysis. RESULTS Using the ESS as the dependent variable, the strongest associations were found with self-reported orthopnea (7%) and restless legs (2%). For daytime sleepiness, self-reported restless legs accounted for 7,6% of the variance, followed by reported orthopnea (3.8%). Regarding daytime irritability, self-reported restless legs accounted for 7.7%, followed by age (4.4%), reported orthopnea (3%), and nocturia (1%) as significant factors. Reported likelihood of falling asleep while driving was best associated with the severity of self-reported restless legs (1,3%), orthopnea (0.6%), and patient age (0.4%). For work performance, restless legs were the strongest predictor (5.9%), followed by age (3.6%) and orthopnea (3%). AHI emerged as a significant explanatory factor regarding ESS score (1.7%) and falling asleep as driver (0.4%) when analyzing the above-mentioned variables. CONCLUSION Daytime sleepiness-associated symptoms were more strongly correlated with reported levels of restless legs, nocturia, and orthopnea than with the AHI score. If restless legs, orthopnea, or nocturia are present, they should be evaluated during the clinical workup for suspected OSA.
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Affiliation(s)
- Kristin Marie Hoven
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway
| | - Hans-Jørgen Aarstad
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway.
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Svein Erik Moe
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway
| | - Sverre K Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Otolaryngology, Head and Neck Surgery, Sørlandet Hospital, 4604, Kristiansand, Norway
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Han X, Li CH, Miao H, Xu S, Yan WJ, Chen J. Sleep patterns and smartphone use among left-behind children: a latent class analysis and its association with depressive symptoms. Front Psychiatry 2025; 15:1500238. [PMID: 39963514 PMCID: PMC11830722 DOI: 10.3389/fpsyt.2024.1500238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 12/18/2024] [Indexed: 02/20/2025] Open
Abstract
Background Left-behind children in China face challenges in sleep patterns, technology use, and mental health. This study uses an individual-centered approach to derive behavioral profiles associated with depressive symptoms. Methods Data from 131,586 left-behind children aged 8 to 18 years from the Chinese Psychological Health Guard for Children and Adolescents Project were analyzed. Participants were recruited from 569 centers across schools, community institutes, orphanages, and children's hospitals throughout China. Latent class analysis was conducted using weekday and weekend sleep duration and smartphone use as indicators. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Results Four distinct classes emerged: Sufficient Sleep Low Users (23.6%), Moderate Sleep Medium Users (25.2%), Limited Sleep High Users (22.1%), and Healthy Sleep Low Users (29.2%). Significant differences in CES-D scores were found between classes (F(3, 131579) = 4929, p <.001, η² = 0.101). The Limited Sleep High Users class reported the highest levels of depressive symptoms (M = 11.60, SE = 0.0658), while the Sufficient Sleep Low Users class reported the lowest (M = 3.67, SE = 0.0346). A linear relationship between sleep duration and depressive symptoms was observed. Significant weekday-weekend differences in smartphone use were noted in the unhealthy categories. Conclusions This study reveals complex associations between sleep patterns, smartphone use, and depressive symptoms among left-behind children. The identified behavioral profiles provide insights into population heterogeneity and inform targeted intervention strategies. Findings emphasize the importance of addressing both sleep and technology use in mental health initiatives for this vulnerable population.
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Affiliation(s)
- Xue Han
- Prevention and Control Department, Wenzhou Seventh People’s Hospital, Wenzhou, China
| | - Cheng-Han Li
- Emergency Department, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Heng Miao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Su Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wen-Jing Yan
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Juan Chen
- Early Intervention 2, Xi’an Mental Health Center, Xi’an, China
- Xi’an Institute of Mental Health, Xi’an, China
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Gurkan CG, Sarac S, Memis EY, Ozbaki F. The deficiencies of epworth sleepiness scale in the evaluation of excessive daytime sleepiness in obstructive sleep apnea and related factors. Sleep Breath 2024; 29:62. [PMID: 39692847 DOI: 10.1007/s11325-024-03233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 12/06/2024] [Accepted: 12/09/2024] [Indexed: 12/19/2024]
Abstract
BACKGROUND Epworth Sleepiness Scale(ESS) is widely used in the assessment of excessive daytime sleepiness (EDS) despite certain deficiencies. It was aimed to evaluate the factors associated with low ESS scores in subjects investigated for OSA. METHODS In this cross sectional study, we recorded the ESS and Pittsburg sleep quality index (PSQI) scores of patients undergoing polysomnography in our sleep center between November 2022-January 2023. Additional questions regarding literacy, vehicle use, driver licence and travelling habits were asked. Sleep indices of patients with AHI ≥ 5 were recorded following PSG. RESULTS 96 patients with mean age 51 ± 12, 68% male, median AHI 34.6 (7-105), ESS 7 (0-22), PSQI 9 (2-15) were included. Among moderate-severe OSA patients without EDS; 10% were illiterate, 67% performed reading only from cellular phone, 88% did not attend the social settings, 53% did not travel frequently and 40% did not use any vehicle. The listed factors were also associated with low ESS (p < 0.001). The sleep indices and PSQI scores of patient groups with and without EDS were similar. There was a correlation between ESS and total PSQI score (β = 0.31, p = 0.002) and subjective sleep quality (β = 0.21, p = 0.04), sleep disturbances (β = 0.29, p = 0.004) and daytime dysfunction (β = 0.49, p < 0.001) domains. CONCLUSION ESS may be inadequate in the assessment of the demographical features and daily habits of patients from different sociocultural settings. Clinicians should be aware that the patients may have severe OSA and poor sleep quality despite low ESS scores and should evaluate each patient individually.
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Affiliation(s)
- Canan Gunduz Gurkan
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Sema Sarac
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Yukcu Memis
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatma Ozbaki
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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McLaurin T, Gardner B, Shriane AE, Rebar AL, Vincent GE. Do people rely more on habits when sleepy? An ecological momentary assessment study. J Sleep Res 2024:e14421. [PMID: 39676132 DOI: 10.1111/jsr.14421] [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: 04/16/2024] [Revised: 09/19/2024] [Accepted: 11/12/2024] [Indexed: 12/17/2024]
Abstract
When self-regulatory resources are depleted, people tend to act more on "autopilot", with minimal forethought. It follows that when sleepy, people should be more likely to act habitually, based on learned cue-behaviour associations that trigger behaviour automatically when the cue is encountered. This ecological momentary assessment study investigated whether, over the course of a week, between-person differences and momentary within-person variation in daytime sleepiness were associated with the reported habit strength of behaviours. Participants (N = 105, 71% female, M age = 35 years) completed a baseline assessment of sleep quality and, six times daily over 7 days, momentary assessments in which they reported the habit strength of the behaviour they were doing when prompted and their momentary sleepiness. Multilevel modelling revealed that people who were more sleepy than others were not more or less likely to act habitually, but on occasions when people were more sleepy than was typical for them, the behaviour they were engaging in tended to be more habitual (Pseudo-R2 = 2%). Our results suggest that sleepiness causes people to rely on non-reflective processes such as habit to regulate their behaviour. Interventions should promote habit formation for desirable behaviours so that when people are sleepy, they can rely on the efficiency of habits to ensure they continue to enact wanted behaviours. Conversely, interventions promoting behaviours that require deliberative thought might encourage performance during times of day when people are more alert.
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Affiliation(s)
- Theresa McLaurin
- Appleton Institute; School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Benjamin Gardner
- Habit Application and Theory group, School of Psychology, University of Surrey, Guildford, UK
| | - Alexandra E Shriane
- Appleton Institute; School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Amanda L Rebar
- Appleton Institute; School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Motivation of Health Behaviors Lab; Health Promotion, Education, & Behavior; Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Grace E Vincent
- Appleton Institute; School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Takano Y, Hirasawa T, Inoue Y. The condition of subjective daytime sleepiness and its related decline in work productivity among daytime workers. J Epidemiol 2024; 35:262-269. [PMID: 39647910 PMCID: PMC12066196 DOI: 10.2188/jea.je20240295] [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: 08/09/2024] [Accepted: 11/18/2024] [Indexed: 12/10/2024] Open
Abstract
BACKGROUND Few have examined the condition of subjective daytime sleepiness in workers and its relation to their work productivity. This study aimed to clarify the association between the presence of subjective daytime sleepiness and work productivity measures, including presenteeism and absenteeism, as well as factors related to the presence of the symptom in daytime workers. METHODS This cross-sectional study included 17963 daytime workers who attended the annual medical check-up. They were categorized into four groups; the daytime sleepiness group was defined as having only subjective daytime sleepiness, the insomnia group as having only insomnia symptoms, the combination group as having both subjective daytime sleepiness and insomnia symptoms, and the healthy group as having no sleep complaints. This study used demographics, health status, workplace, work productivity, and sleep items included in the self-reported medical check-up questionnaire. RESULTS The combination group had significantly worse presenteeism than other groups. The daytime sleepiness and insomnia groups had significantly worse presenteeism than the healthy group. The results of absenteeism were the same as presenteeism. Factors related to the positivity for subjective daytime sleepiness were presence of psychiatric disease, the positivity for habitual snoring and/or witnessed apnea, shorter sleep duration on workdays, long working hours, female sex, living alone, the amount of social jetlag, and younger age. CONCLUSIONS Subjective daytime sleepiness, not just insomnia symptoms, has a significant negative impact on work productivity, and both workplace and individual approaches should not be ignored for addressing subjective daytime sleepiness among daytime workers.
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Affiliation(s)
- Yuta Takano
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Toshiyuki Hirasawa
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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Redeker NS, Conley S, Hwang Y. Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer. Sleep Med Clin 2024; 19:537-548. [PMID: 39455175 DOI: 10.1016/j.jsmc.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2024]
Abstract
Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.
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Affiliation(s)
- Nancy S Redeker
- UCONN School of Nursing, Yale University, University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, USA.
| | - Samantha Conley
- Nursing Research Division, Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Youri Hwang
- Yale School of Nursing, PO Box 27399, West Haven, CT 06516-0972, USA
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Wilder J, Lauderdale D, Qato DM. Use of Medications With Somnolence Adverse Effects and Somnolence Symptoms Among Older Adults in the U.S. J Aging Health 2024:8982643241298734. [PMID: 39599921 DOI: 10.1177/08982643241298734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
OBJECTIVES Nearly half of older adults experience somnolence, but the link between medications with somnolence as an adverse effect and somnolence is unclear. This study investigated the association between polypharmacy and somnolence symptoms (excessive sleepiness or long sleep duration). METHODS Data from the National Social Life, Health, and Aging Project (NSHAP) 2010-2011 was used to examine the concurrent use of medications with potential somnolence as an adverse effect and the prevalence of somnolence symptoms. RESULTS Among the 2638 older adults (mean, 71 years), 49.0% used medications with potential somnolence adverse effects. The adjusted prevalence of somnolence symptoms was significantly higher among those using three or more medications (58%) than those not using such medications (31.2%) (difference, 20.4%; 95% CI 12.5, 28.4). DISCUSSION In this cross-sectional study, medications with somnolence as a potential adverse effect were commonly used, and the findings suggest a link between polypharmacy and the increased risk of somnolence symptoms.
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Affiliation(s)
- Jocelyn Wilder
- NORC at the University of Chicago, Chicago, IL, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Diane Lauderdale
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Dima M Qato
- Program on Medicines and Public Health, University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Los Angeles, CA, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Morris JL, Scott PW, Magalang U, Keenan BT, Patel SR, Pack AI, Mazzotti DR. Symptom subtype progression in obstructive sleep apnea over 5 years. J Clin Sleep Med 2024; 20:1773-1783. [PMID: 38935050 PMCID: PMC11530986 DOI: 10.5664/jcsm.11258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
STUDY OBJECTIVES There is limited knowledge regarding the progression or consistency of symptoms in obstructive sleep apnea (OSA) over time. Our objective was to examine the changes in symptom subtypes and identify predictors over a span of 5 years. METHODS Data of 2,643 participants of the Sleep Heart Health Study with complete baseline and 5-year follow-up visits were analyzed. Latent class analysis on 14 symptoms at baseline and follow-up determined symptom subtypes. Individuals without OSA (apnea-hypopnea index < 5) were incorporated as a known class at each time point. Multinomial logistic regression assessed the effect of age, sex, body mass index, and apnea-hypopnea index on specific class transitions. RESULTS The sample consisted of 1,408 females (53.8%) and mean (standard deviation) age 62.4 (10.5) years. We identified 4 OSA symptom subtypes at both baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy, and excessively sleepy. Nearly half (44.2%) of the sample transitioned to a different subtype; transitions to moderately sleepy were the most common (77% of all transitions). A 5-year older age was associated with a 50% increase in odds to transit from excessively sleepy to moderately sleepy (odds ratio [95% confidence interval]: 1.52 [1.17, 1.97]). Females had 1.97 times higher odds (95% confidence interval: 1.21, 3.18) to transition from moderately sleepy to minimal symptoms. A 5-unit increase in body mass index was associated with 2.39 greater odds (95% confidence interval: 1.30, 4.40) to transition from minimal symptoms to excessively sleepy. Changes in apnea-hypopnea index did not significantly predict any transitions. CONCLUSIONS The symptoms of OSA may fluctuate or remain stable over time. Knowledge of symptom progression in OSA may support clinicians with treatment decisions. CITATION Morris JL, Scott PW, Magalang U, et al. Symptom subtype progression in obstructive sleep apnea over 5 years. J Clin Sleep Med. 2024;20(11):1773-1783.
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Affiliation(s)
- Jonna L Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul W Scott
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ulysses Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brendan T Keenan
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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He B, Zheng W. Post-marketing safety profile of solriamfetol: A real-world disproportionality analysis using FDA adverse event reporting system (FAERS) database. Heliyon 2024; 10:e38450. [PMID: 39391518 PMCID: PMC11466607 DOI: 10.1016/j.heliyon.2024.e38450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 09/24/2024] [Accepted: 09/24/2024] [Indexed: 10/12/2024] Open
Abstract
Solriamfetol is a selective dopamine and noradrenalin reuptake inhibitor applied in adult patients with excessive daytime sleepiness (EDS) associated with narcolepsy or obstructive sleep apnea (OSA). However, the post-marketing safety profile of solriamfetol in large number of people was unrevealed. The purpose of our study is to unravel solriamfetol's adverse events (AEs) in real-world to refine medication safety using Food and Drug Administration Adverse Event Reporting System (FAERS) database. We derived the data associated with solriamfetol from FAERS between 2019 and 2023, and removed the duplicated entries. We evaluated the disproportionality of solriamfetol's AEs by reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN) and the multi-item gamma Poisson shrinker (MGPS). Among 8,846,085 AE reports, 1659 recorded solriamfetol as the 'primary suspected (PS)'. 74 significant disproportionality preferred terms (PTs) were retained across 27 organ systems. Moreover, 16 unexpected AEs not mentioned in the FDA label of solriamfetol were identified. Our findings provided the post-marketing safety profile of solriamfetol, highlighting potential solriamfetol's AEs. Further researches are significant to define the causality between solriamfetol and newly identified AEs.
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Affiliation(s)
- Beili He
- Health Management Center, The First Affiliated Hospital of Fujian Medical University, NO.20 Chazhong Road, Fuzhou, 350001, Fujian, China
| | - Wei Zheng
- Neurological Care Unit, The First Affiliated Hospital of Fujian Medical University, NO.20 Chazhong Road, Fuzhou, 350001, Fujian, China
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Zheng YX, Sun ST, Yu WY, Xu LW, Liu RN, Chu C. Sex differences in the risk of excessive daytime sleepiness in mild and moderate ischaemic stroke patients: a retrospective database study. BMC Neurol 2024; 24:388. [PMID: 39402438 PMCID: PMC11472521 DOI: 10.1186/s12883-024-03895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a common complication of stroke that has a detrimental effect on patients' daily life and functional recovery. The clinical characteristics and risk factors for poststroke EDS may differ between males and females. METHODS A retrospective study based on hospital medical records was conducted on patients with a diagnosis of stroke who participated in polysomnographic monitoring at the Affiliated Hospital of Yangzhou University from February 2022 to May 2024. Baseline data, laboratory test data, polysomnographic data, and related scale scores were retrospectively collected. The Epworth Sleepiness Scale (ESS) score was used to assess EDS after stroke. Binary logistic regression was used to determine the risk factors for daytime sleepiness. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed via IBM SPSS 26.0. RESULTS ESS scores were higher in males than in females, whereas females had higher Pittsburgh Sleep Quality Index (PSQI) scores and Hospital Anxiety and Depression Scale (HADS) scores. Male sex and higher depression scores were risk factors for EDS; among male patients, higher anxiety scores were a risk factor for EDS, whereas smoking was a protective factor. Depression, a higher arousal index and a reduced proportion of N3 sleep periods were risk factors for EDS in females. CONCLUSIONS The characteristics and influencing factors of EDS differ between the sexes in patients with mild and moderate ischaemic stroke. Our study may provide evidence and guidance for clinical diagnosis and treatment. Interventional studies are needed to assess the impact of treating these risk factors in the future.
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Affiliation(s)
- Yi-Xi Zheng
- Yangzhou University, Yangzhou, 225009, Jiangsu Province, China
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Shu-Tong Sun
- Yangzhou University, Yangzhou, 225009, Jiangsu Province, China
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Wen-Yi Yu
- Yangzhou University, Yangzhou, 225009, Jiangsu Province, China
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Li-Wen Xu
- Yangzhou University, Yangzhou, 225009, Jiangsu Province, China
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Ruo-Nan Liu
- Yangzhou University, Yangzhou, 225009, Jiangsu Province, China
| | - Cheng Chu
- Yangzhou University, Yangzhou, 225009, Jiangsu Province, China.
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China.
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Kawada T. Excessive daytime sleepiness in patients with obstructive sleep apnea: a risk assessment. Sleep 2024; 47:zsae170. [PMID: 39120054 DOI: 10.1093/sleep/zsae170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan
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Bochkarev M, Korostovtseva L, Rotar O, Verbitskaya E, Sviryaev Y, Zhernakova Y, Shalnova S, Konradi A, Chazova I, Boytsov S, Shlyakhto E. Predictors of sleepiness in a large-scale epidemiology study ESSE-RF. Front Neurol 2024; 15:1431821. [PMID: 39296956 PMCID: PMC11408917 DOI: 10.3389/fneur.2024.1431821] [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: 05/13/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction To identify predictors of excessive daytime sleepiness we analyzed data from the 'Epidemiology of cardiovascular diseases in regions of Russia (ESSE-RF)' study. Methods Data from participants of the cohort study ESSE-RF (2012-2013), aged 25-64 years, from 13 regions of Russia were analyzed (2012-2013). The participants were interviewed regarding their sleep complaints, including difficulties with initiating and maintaining sleep, sleepiness, and use of sleeping pills. Sleepiness was considered significant if it occurred at least three times a week. The examination encompassed social, demographic, and anthropometric measures, lifestyle factors, self-reported diseases, and laboratory parameters. The final analysis included 13,255 respondents. Results Frequent (≥3 times/week) sleepiness was reported by 5,8%, and occasional sleepiness (1-2 times/week) by 10.8% of respondents. Multivariate regression analysis identified significant predictors of frequent sleepiness. Sleep complaints (insomnia, sleep apnea, snoring) and frequent use of sleep medication were prominent factors. Additionally, age, female gender, higher education, and retirement status were associated with sleepiness. Beyond demographics and sleep, the analysis revealed predictors: abnormal anxiety levels, low high-density lipoprotein, high salt intake and following medical conditions: arrhythmia, hypertension, myocardial infarction, other heart diseases, and renal disease. Conclusion This study identified a significant prevalence of EDS in Russians, aligning with global trends. However, findings suggest potential regional variations. Analysis revealed a complex interplay of factors contributing to EDS, highlighting the importance of individualized treatment approaches for improved sleep health.
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Affiliation(s)
| | | | - Oxana Rotar
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena Verbitskaya
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Yurii Sviryaev
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Svetlana Shalnova
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia
| | | | - Irina Chazova
- National Medical Research Center for Cardiology, Moscow, Russia
| | - Sergey Boytsov
- National Medical Research Center for Cardiology, Moscow, Russia
| | - Evgeny Shlyakhto
- Almazov National Medical Research Centre, Saint Petersburg, Russia
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Younes A, Point C, Wacquier B, Lanquart JP, Hein M. Excessive Daytime Sleepiness in Hypertensive Patients: The Role of Major Depressive Disorder. Diagnostics (Basel) 2024; 14:1854. [PMID: 39272639 PMCID: PMC11394253 DOI: 10.3390/diagnostics14171854] [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: 07/30/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024] Open
Abstract
There is a special relationship between major depressive disorder and excessive daytime sleepiness. However, given the negative impact of excessive daytime sleepiness on life quality and cardiovascular outcome in hypertensive patients, the objective of this study was to investigate the potential role played by major depressive disorder in the occurrence of this complaint for this particular subpopulation. Data from 1404 hypertensive patients recruited from the Sleep Unit's polysomnographic recordings database were analyzed. A score >10 on the Epworth Sleepiness Scale was used to define excessive daytime sleepiness in this study. Logistic regression analyses were performed to investigate the risk of excessive daytime sleepiness associated with major depressive disorder in hypertensive patients. Excessive daytime sleepiness was frequent (40.0%) in our sample of hypertensive patients. After adjustments for major confounding factors, multivariate logistic regression analyses demonstrated that unlike remitted major depressive disorder, only current major depressive disorder was associated with a higher risk of excessive daytime sleepiness in hypertensive patients. Given this potential implication of current major depressive disorder in the occurrence of excessive daytime sleepiness for hypertensive patients, it is therefore essential to achieve the complete remission of this psychiatric disorder to avoid negative consequences associated with this complaint in this particular subpopulation.
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Affiliation(s)
- Alexandre Younes
- Faculté de Médecine, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Camille Point
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Jean-Pol Lanquart
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles, ULB, 1020 Bruxelles, Belgium
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Kawada T. Obstructive sleep apnea and mortality: a risk assessment. Sleep Breath 2024; 28:1857-1858. [PMID: 38743324 DOI: 10.1007/s11325-024-03060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/12/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
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17
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Webster LA, Ali T, Sharninghausen J, Hajduk AM, Gill TM, Miner B. Insomnia Severity and Daytime Sleepiness in Caregivers of Advanced Age. FRONTIERS IN SLEEP 2024; 3:1404684. [PMID: 39544482 PMCID: PMC11563192 DOI: 10.3389/frsle.2024.1404684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2024]
Abstract
OBJECTIVE Aging-related changes and caregiver burden may increase the risk for sleep disturbances among older caregivers, yet few studies have examined the prevalence of insomnia and daytime sleepiness in this group. We examined the relationship of caregiver status with insomnia and daytime sleepiness among persons of advanced age (>75 years of age). DESIGN Cross-sectional. SETTING Community. PARTICIPANTS Yale Precipitating Events Project participants (n=383, mean age 84.4 years, 67% female, 12% African American, 25% caregivers). MEASUREMENTS Caregivers were persons who reported caring for another person in the past week or caring for/helping a friend or relative >4 times in the past month. We examined the correlates of caregiver status, including demographic (age, sex, race/ethnicity, education, marital status), psychosocial (living alone, Medicaid eligibility, depressive symptoms, social support, hours volunteered), and physical (obesity, chronic conditions, medication use, self-rated health status, physical activity, functional disability, cognitive impairment) factors. We used the Insomnia Severity Index (ISI) to establish insomnia severity (ISI score 0-28) or clinically significant insomnia symptoms (ISI ≥8). We used the Epworth Sleepiness Scale to establish daytime sleepiness (ESS score 0-24) or hypersomnia (ESS ≥10). In nonparametric multivariable regression analyses, we examined the relationship of caregiver status with insomnia or daytime sleepiness. RESULTS Compared to non-caregivers, caregivers were younger, more educated, less likely to be Medicaid eligible and had lower rates of depression, obesity, poor self-rated health, low physical activity, functional disability, and cognitive impairment. Mean ISI and ESS scores were in the normal range and similar among non-caregivers and caregivers (ISI scores of 6.9±5.6 and 6.9±5.4, and ESS scores of 6.4±4.7 and 6.1±4.3, in non-caregivers and caregivers, respectively). Multivariable-adjusted models demonstrated no significant differences in ISI and ESS scores between non-caregivers and caregivers (regression coefficients for ISI and ESS scores of -0.01 [95% CI= -1.58, 1.21] and -0.10 [-1.05, 1.21], respectively). CONCLUSION When compared to older non-caregivers, older caregivers had more advantageous demographic, psychosocial, and physical profiles and had similar levels of insomnia and daytime sleepiness on standardized questionnaires. Future research is needed to elucidate contextual factors (e.g., caregiving intensity and care partner disease) that may increase the risk of sleep disturbances among caregivers of advanced age.
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Affiliation(s)
- Lucy A. Webster
- Division of Psychiatry, UCL, London, United Kingdom
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Talha Ali
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Thomas M. Gill
- Yale University School of Medicine, New Haven, Connecticut
| | - Brienne Miner
- Yale University School of Medicine, New Haven, Connecticut
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18
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Ren J, Liu R, Zhao T, Lu J, Liu C, Hou T, Wang Y, Cong L, Du Y, Tang S, Qiu C. Prevalence and associated factors of excessive daytime sleepiness in rural older adults: a population-based study. Sleep Breath 2024; 28:1459-1464. [PMID: 38374476 PMCID: PMC11196351 DOI: 10.1007/s11325-024-03004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To investigate the prevalence and associated factors of excessive daytime sleepiness (EDS) among rural-dwelling Chinese older adults. METHODS We collected data on demographic, epidemiological, and clinical factors via in-person interviews and clinical examinations following a structured questionnaire. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, the Berlin questionnaire (BQ) to assess obstructive sleep apnea (OSA) risk; and the Epworth Sleepiness Scale (ESS) to assess sleep characteristics. EDS was defined as the total ESS score > 10. RESULTS This population-based study engaged 4845 participants (age ≥ 65 years, 57.3% female) in the 2018 examination of the Multimodal Interventions to Delay Dementia and Disability in Rural China. The prevalence of EDS was 9.3% in the total sample, 8.3% in females, and 10.6% in males, and the prevalence decreased with advanced age. Logistic regression analysis revealed that EDS was significantly associated with age (multivariable-adjusted odds ratio [OR] = 0.97; 95% confidence interval [CI] 0.95-0.99), female sex (0.53; 0.36-0.77), hypertension (0.68; 0.54-0.85), depressive symptoms (2.68; 2.07-3.46), high OSA risk (2.11; 1.69-2.63), and poor sleep quality (2.12; 1.60-2.82). CONCLUSION EDS affects nearly one-tenth of rural older adults in China. Older age, female sex, and hypertension were associated with a decreased likelihood of EDS, while depressive symptoms, high OSA risk, and poor sleep quality were correlated with an elevated likelihood of EDS.
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Affiliation(s)
- Juan Ren
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Rui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Tong Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Jie Lu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Cuicui Liu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China.
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China.
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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Tankéré P, Taillard J, Armeni MA, Petitjean T, Berthomier C, Strauss M, Peter-Derex L. Revisiting the maintenance of wakefulness test: from intra-/inter-scorer agreement to normative values in patients treated for obstructive sleep apnea. J Sleep Res 2024; 33:e13961. [PMID: 37287324 DOI: 10.1111/jsr.13961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/06/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
The Maintenance of Wakefulness Test is widely used to objectively assess sleepiness and make safety-related decisions, but its interpretation is subjective and normative values remain debated. Our work aimed to determine normative thresholds in non-subjectively sleepy patients with well-treated obstructive sleep apnea, and to assess intra- and inter-scorer variability. We included maintenance of wakefulness tests of 141 consecutive patients with treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean (SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset latencies were independently scored by two experts. Discordant scorings were reviewed to reach a consensus and half of the cohort was double-scored by each scorer. Intra- and inter-scorer variability was assessed using Cohen's kappa for 40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep latencies were compared between four groups according to subjective sleepiness (Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index (< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit [mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer agreement on mean sleep latency was high but inter-scorer was only fair (Cohen's kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in changes in latency category in 4%-12% of patients. A higher sleepiness score but not the residual apnea-hypopnea index was significantly associated with a lower mean sleep latency. Our findings suggest a higher than usually accepted normative threshold (30 min) in this context and emphasise the need for more reproducible scoring approaches.
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Affiliation(s)
- Pierre Tankéré
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit, Dijon University Hospital, Dijon, France
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques Taillard
- Sommeil, Addiction et Neuropsychiatrie, Université de Bordeaux, SANPSY, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Marc-Antoine Armeni
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Petitjean
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Mélanie Strauss
- Hôpital Universitaire de Bruxelles, Site Erasme, Services de Neurologie, Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, Brussels, Belgium
- Neuropsychology and Functional Imaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences and ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France
- Claude Bernard Lyon 1 University, Lyon, France
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Fernandes GL, da Silva Vallim JR, D'Almeida V, Tufik S, Andersen ML. The effects of social jetlag and sleep variability on sleepiness in a population-based study: The mediating role of sleep debt. J Sleep Res 2024; 33:e14043. [PMID: 37691450 DOI: 10.1111/jsr.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
Sleepiness is a multicausal condition, and previous research has highlighted associations between this symptom and the circadian timing system, specifically concerning social jetlag and sleep variability. Recent inquiries have shown that the effects of social jetlag on sleepiness can be confounded with the consequences of sleep debt. In light of the current evidence, we aimed to assess the effects of social jetlag and sleep variability on sleepiness and the potential mediating role of sleep debt. We used data from the EPISONO study, a cross-sectional population-based study with a sample size of 1042 participants, representative of the city of Sao Paulo, Brazil. Participants completed the UNIFESP Sleep Questionnaire (self-reported bedtime and get-up time) and the Epworth Sleepiness Scale (subjective daytime sleepiness). Subsequently, sleep-corrected mid-sleep time (chronotype), total sleep time, social jetlag (absolute difference between the mid-sleep time on workdays and mid-sleep time on free days), sleep variability (standard deviation of mid-sleep time), and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalised linear models were used to test whether social jetlag and sleep variability affected sleepiness. Mediation models were used to determine if any observed significant effects were mediated by sleep debt. The prevalence of social jetlag was 23% for >1 h and 12% for >2 h. The mean sleep variability was 41 ± 30 min. Social jetlag had a significant effect on the Epworth Sleepiness Scale scores. This association was no longer statistically significant after controlling for age, sex, body mass index, work schedule, and chronotype. A significant indirect effect of social jetlag on sleep debt and subsequently on the Epworth Sleepiness Scale scores was found. No effect of sleep variability on sleepiness could be identified. In conclusion, the association between social jetlag and sleepiness was mediated by sleep debt but was not independent of demographic, work, and chronotype variables. This study provides new evidence on the importance of circadian misalignment and sleep debt for sleep health on a population level.
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Affiliation(s)
| | | | - Vânia D'Almeida
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Fernandes GL, Tufik S, Andersen ML. Emergence of different dimensions of sleepiness in a general population sample: An EPISONO study. Sleep Med 2023; 112:46-52. [PMID: 37806035 DOI: 10.1016/j.sleep.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Recent evidence supports the idea that sleepiness has several dimensions, comprising psychophysiological phenomena, such as sleep propensity and sleepiness perception. The Epworth Sleepiness Scale (ESS) is among one of the most used sleepiness assessment tools, but recent data suggest that it might not detect problematic impairments in sleep health. More research is warranted investigating sleepiness dimensions with large sample sizes, using both objective and subjective methods of analyzing sleep. METHODS We used data from the Epidemiological Sleep Study (EPISONO), a major study carried out in Brazil using a representative sample of 1042 participants of the general population of Sao Paulo city, who completed questionnaires and underwent type I polysomnography. Sleepiness was measured by the ESS (sleep propensity) and the UNIFESP Sleep Questionnaire, which asked about the frequency of feeling sleepy during the day (sleepiness perception). The participants were distributed into 4 groups in respect of excessive daytime sleepiness (EDS) according to the following criteria: 1) having an ESS score >10 (ESS group). 2) feeling sleepy ≥3 times per week (Frequent EDS group). 3) the combined criteria (Combined EDS group). 4) having no evidence of EDS (no EDS group). The UNIFESP Sleep Questionnaire was used to obtain self-reported sleep duration, sleep debt, and sleep duration variability. Participants also completed the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and a pre-polysomnography sleep questionnaire. RESULTS After removing participants with missing data, there were 620 participants with no EDS, 255 individuals in the ESS group, 68 in the Frequent EDS group, and 73 in the Combined EDS group. Compared to the no EDS group, the ESS and Combined EDS groups had significantly increased sleep efficiency, diminished sleep latency, wake after sleep onset, and self-reported weekly sleep duration. The Frequent and Combined EDS groups had significantly higher scores in the Insomnia Severity Index and Pittsburgh Sleep Quality Index. All EDS groups had an increased likelihood of nonrestorative sleep. EDS frequency and the ESS scores were significantly correlated. CONCLUSIONS Participants with a high sleep propensity had a profile suggesting prior sleep deprivation, while high sleepiness perception was associated with impaired sleep quality. These findings indicated that, in the general population, these instruments evaluated separate sleepiness dimensions with different associations, highlighting that screening using a combination of instruments might be more effective in detecting impairments in sleep health.
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Affiliation(s)
- Guilherme Luiz Fernandes
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, 04024-002, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, 04024-002, Brazil; Sleep Institute, São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, São Paulo, 04024-002, Brazil; Sleep Institute, São Paulo, Brazil.
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22
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Chen S, Li H, Wen D. Social Support and Daytime Sleepiness Among Chinese Medical Students: Mediating Roles of Loneliness and Problematic Smartphone Use. Psychol Res Behav Manag 2023; 16:4083-4093. [PMID: 37817912 PMCID: PMC10561758 DOI: 10.2147/prbm.s432400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
Background Sleep problems have become a serious threat to public health worldwide. Daytime sleepiness is an important indicator of many sleep problems, which have a significant impact on academic performance, physical and mental health, and wellbeing among medical students. We aimed to explore the factors associated with daytime sleepiness among medical students. Methods We conducted a cross-sectional survey of 466 medical students recruited via convenience sampling. Self-rated psychometric scales, including the Social Support Rate Scale, the Epworth Sleepiness Scale, the Chinese version of the UCLA loneliness scale, and the Mobile Phone Addiction Index (MPAI), were utilized to evaluate social support, daytime sleepiness, loneliness, and problematic smartphone use. A sequential mediation model was constructed with daytime sleepiness as the dependent variable, social support as the independent variable, and loneliness and problematic smartphone use as mediating variables. Age, gender, and grade were taken as covariates. Results Social support among medical students was negatively associated with loneliness, problematic smartphone use, and daytime sleepiness (p < 0.01). A sequential mediation analysis showed that loneliness (the first mediator) and problematic smartphone use (the second mediator) sequentially mediated the path from social support to daytime sleepiness among medical students (β = -0.008; 95% CI = -0.016, -0.002). Moreover, there were also significant mediating roles observed in the relationship between social support and daytime sleepiness via loneliness only (β = -0.037; 95% CI = -0.062, -0.015) and problematic smartphone use only (β = -0.022; 95% CI = -0.041, -0.008). Conclusion Social support, loneliness, and problematic smartphone use among medical students influenced their daytime sleepiness. Interventions targeting medical student loneliness and problematic smartphone use behaviors might attenuate the effects from low levels of social support and further improve daytime sleepiness.
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Affiliation(s)
- Sijian Chen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, People’s Republic of China
- School of Nursing, China Medical University, Shenyang, People’s Republic of China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, People’s Republic of China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, People’s Republic of China
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23
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Peter-Derex L, Micoulaud-Franchi JA, Lopez R, Barateau L. Evaluation of hypersomnolence: From symptoms to diagnosis, a multidimensional approach. Rev Neurol (Paris) 2023; 179:715-726. [PMID: 37563022 DOI: 10.1016/j.neurol.2023.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy socio-economic burden. The positive and aetiological diagnosis is crucial, as it determines the therapeutic strategy. It must consider the following aspects: i) hypersomnolence is a complex concept referring to symptoms as varied as excessive daytime sleepiness, excessive need for sleep, sleep inertia, or drowsiness, all of which warrant specific dedicated investigations; ii) the boundary between physiological and abnormal hypersomnolence is blurred, since most symptoms can be encountered in the general population to varying degrees without being considered as pathological, meaning that their severity, frequency, context of occurrence and related impairment need to be carefully assessed; iii) investigation of hypersomnolence relies on scales/questionnaires as well as behavioural and neurophysiological tests, which measure one or more dimensions, keeping in mind the possible discrepancy between objective and subjective assessment; iv) aetiological reasoning is driven by knowledge of the main sleep regulation mechanisms, epidemiology, and associated symptoms. The need to assess hypersomnolence is growing, both for its management, and for assessing the efficacy of treatments. The landscape of tools available for investigating hypersomnolence is constantly evolving, in parallel with research into sleep physiology and technical advances. These investigations face the challenges of reconciling subjective perception and objective data, making tools accessible to as many people as possible and predicting the risk of accidents.
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Affiliation(s)
- L Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Centre, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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24
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Zawadka-Kunikowska M, Rzepiński Ł, Cieślicka M, Klawe JJ, Tafil-Klawe M. Association between Daytime Sleepiness, Fatigue and Autonomic Responses during Head-Up Tilt Test in Multiple Sclerosis Patients. Brain Sci 2023; 13:1342. [PMID: 37759943 PMCID: PMC10526123 DOI: 10.3390/brainsci13091342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
We aimed to assess dynamic changes in hemodynamic and autonomic function in response to the head-up tilt test (HUTT) in patients with multiple sclerosis (MS) compared to healthy controls (HCs) and evaluate its relationship with the patients' reported daytime sleepiness and fatigue symptoms. A total of 58 MS patients and 30 HCs were included in the analysis. Fatigue and sleepiness were evaluated using the Chalder Fatigue Scale (CFQ) and the Epworth Sleepiness Scale (ESS), respectively. Hemodynamic response, baroreflex sensitivity, heart rate variability, and systolic and diastolic blood pressure (BP) variability (SBPV, DBPV) parameters were calculated at rest, and in response to the HUTT. The MS patients displayed attenuated BP responses coupled with a more pronounced decrease in cardiac index as well as a reduced increase in the low frequency (LFnu) of DBPV (p = 0.021) and the sympathovagal ratio (p = 0.031) in the latter-phase orthostatic challenge compared to HCs. In MS patients, the ESS score showed no correlation with CFQ or clinical disease outcomes, but exhibited a moderate correlation with LFnu of BPVrest. Fatigue and disease variants predicted blood pressure response to HUTT. These findings underscore the importance of subjective daytime sleepiness and fatigue symptoms and their role in blood pressure regulation in MS patients.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
| | - Łukasz Rzepiński
- Sanitas–Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland;
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland;
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
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25
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Lyall LM, Sangha N, Zhu X, Lyall DM, Ward J, Strawbridge RJ, Cullen B, Smith DJ. Subjective and objective sleep and circadian parameters as predictors of depression-related outcomes: A machine learning approach in UK Biobank. J Affect Disord 2023; 335:83-94. [PMID: 37156273 DOI: 10.1016/j.jad.2023.04.138] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/25/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Sleep and circadian disruption are associated with depression onset and severity, but it is unclear which features (e.g., sleep duration, chronotype) are important and whether they can identify individuals showing poorer outcomes. METHODS Within a subset of the UK Biobank with actigraphy and mental health data (n = 64,353), penalised regression identified the most useful of 51 sleep/rest-activity predictors of depression-related outcomes; including case-control (Major Depression (MD) vs. controls; postnatal depression vs. controls) and within-case comparisons (severe vs. moderate MD; early vs. later onset, atypical vs. typical symptoms; comorbid anxiety; suicidality). Best models (of lasso, ridge, and elastic net) were selected based on Area Under the Curve (AUC). RESULTS For MD vs. controls (n(MD) = 24,229; n(control) = 40,124), lasso AUC was 0.68, 95 % confidence interval (CI) 0.67-0.69. Discrimination was reasonable for atypical vs. typical symptoms (n(atypical) = 958; n(typical) = 18,722; ridge: AUC 0.74, 95 % CI 0.71-0.77) but poor for remaining models (AUCs 0.59-0.67). Key predictors across most models included: difficulty getting up, insomnia symptoms, snoring, actigraphy-measured daytime inactivity and lower morning activity (~8 am). In a distinct subset (n = 310,718), the number of these factors shown was associated with all depression outcomes. LIMITATIONS Analyses were cross-sectional and in middle-/older aged adults: comparison with longitudinal investigations and younger cohorts is necessary. DISCUSSION Sleep and circadian measures alone provided poor to moderate discrimination of depression outcomes, but several characteristics were identified that may be clinically useful. Future work should assess these features alongside broader sociodemographic, lifestyle and genetic features.
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Affiliation(s)
- Laura M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Natasha Sangha
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Xingxing Zhu
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joey Ward
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rona J Strawbridge
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Health Data Research, UK; Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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26
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Hwang H, Kim KM, Yun CH, Yang KI, Chu MK, Kim WJ. Sleep state of the elderly population in Korea: Nationwide cross-sectional population-based study. Front Neurol 2023; 13:1095404. [PMID: 36698878 PMCID: PMC9868806 DOI: 10.3389/fneur.2022.1095404] [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: 11/11/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Interest in sleep disorders among the elderly, especially those in Korea, has increased. We aimed to describe the overall sleep status of the elderly population in Korea using survey data and to determine the risk factors concerning different aspects of sleep status. Methods We conducted a cross-sectional survey on 271 respondents aged 65-86 years old. We performed multistage clustered random sampling according to the population and socioeconomic distribution of all Korean territories. The survey questionnaire was used to perform a structural assessment of sociodemographic characteristics; medical comorbidities; psychiatric comorbidities; and sleep status, including sleep duration, sleep quality, presence of insomnia, excessive daytime sleepiness, sleep apnea, and restless legs syndrome. Results Approximately 12.5, 22.%, and 51.3% of the elderly population had poor sleep quality, excessive daytime sleepiness, and insomnia, respectively. Hypertension, dyslipidemia, insomnia, anxiety, and depression predicted poor sleep quality. Female sex, insomnia, and sleep apnea predicted excessive daytime sleepiness. Poor sleep quality and depression predicted insomnia. Conclusion A substantial proportion of the elderly Korean population have sleep problems, including poor sleep quality, excessive daytime sleepiness, and insomnia. Sleep status is influenced by various factors, including age, sex, and metabolic and psychiatric comorbidities.
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Affiliation(s)
- Heewon Hwang
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea,Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Ho Yun
- Department of Neurology, Bundang Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea,*Correspondence: Won-Joo Kim ✉
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27
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Marchi NA, Pizzarotti B, Solelhac G, Berger M, Haba‐Rubio J, Preisig M, Vollenweider P, Marques‐Vidal P, Lutti A, Kherif F, Heinzer R, Draganski B. Abnormal brain iron accumulation in obstructive sleep apnea: A quantitative MRI study in the HypnoLaus cohort. J Sleep Res 2022; 31:e13698. [PMID: 35830960 PMCID: PMC9787990 DOI: 10.1111/jsr.13698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea syndrome (OSA) may be a risk factor for Alzheimer's disease. One of the hallmarks of Alzheimer's disease is disturbed iron homeostasis leading to abnormal iron deposition in brain tissue. To date, there is no empirical evidence to support the hypothesis of altered brain iron homeostasis in patients with obstructive sleep apnea as well. Data were analysed from 773 participants in the HypnoLaus study (mean age 55.9 ± 10.3 years) who underwent polysomnography and brain MRI. Cross-sectional associations were tested between OSA parameters and the MRI effective transverse relaxation rate (R2*) - indicative of iron content - in 68 grey matter regions, after adjustment for confounders. The group with severe OSA (apnea-hypopnea index ≥30/h) had higher iron levels in the left superior frontal gyrus (F3,760 = 4.79, p = 0.003), left orbital gyri (F3,760 = 5.13, p = 0.002), right and left middle temporal gyrus (F3,760 = 4.41, p = 0.004 and F3,760 = 13.08, p < 0.001, respectively), left angular gyrus (F3,760 = 6.29, p = 0.001), left supramarginal gyrus (F3,760 = 4.98, p = 0.003), and right cuneus (F3,760 = 7.09, p < 0.001). The parameters of nocturnal hypoxaemia were all consistently associated with higher iron levels. Measures of sleep fragmentation had less consistent associations with iron content. This study provides the first evidence of increased brain iron levels in obstructive sleep apnea. The observed iron changes could reflect underlying neuropathological processes that appear to be driven primarily by hypoxaemic mechanisms.
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Affiliation(s)
- Nicola Andrea Marchi
- Centre for Investigation and Research on Sleep, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
- Laboratory for Research in Neuroimaging, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Beatrice Pizzarotti
- Laboratory for Research in Neuroimaging, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Geoffroy Solelhac
- Centre for Investigation and Research on Sleep, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Mathieu Berger
- Centre for Investigation and Research on Sleep, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - José Haba‐Rubio
- Centre for Investigation and Research on Sleep, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Martin Preisig
- Centre for Research in Psychiatric Epidemiology and Psychopathology, Department of PsychiatryLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Peter Vollenweider
- Service of Internal Medicine, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Pedro Marques‐Vidal
- Service of Internal Medicine, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Antoine Lutti
- Laboratory for Research in Neuroimaging, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Ferath Kherif
- Laboratory for Research in Neuroimaging, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Raphael Heinzer
- Centre for Investigation and Research on Sleep, Department of MedicineLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging, Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
- Max Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
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28
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Polat F, Karasu F. Effect of sleep hygiene training given to elderly individuals on daytime sleepiness and fatigue: A randomized controlled trial. Perspect Psychiatr Care 2022; 58:2161-2169. [PMID: 35124807 DOI: 10.1111/ppc.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study was conducted to determine the effect of sleep hygiene training given to elderly individuals on daytime sleepiness and fatigue. DESIGN AND METHODS The sample size was calculated by G. Power and determined as 134 elderly individuals. The experimental group was trained in sleep, two sessions a week for a total of 2 weeks. FINDINGS The difference between Epworth Sleepiness Scale and Fatigue Severity Scale posttest mean scores of the elderly individuals in the experimental and control groups were found to be statistically significant (p < 0.05). PRACTICE IMPLICATIONS Sleep hygiene training reduced daytime sleepiness and fatigue in older adults.
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Affiliation(s)
- Filiz Polat
- Department of Midwifery, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey
| | - Fatma Karasu
- Department of Nursing, Yusuf Şerefoğlu Faculty of Health Sciences, Kilis 7 Aralık University, Kilis, Turkey
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29
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Pérez-Carbonell L, Mignot E, Leschziner G, Dauvilliers Y. Understanding and approaching excessive daytime sleepiness. Lancet 2022; 400:1033-1046. [PMID: 36115367 DOI: 10.1016/s0140-6736(22)01018-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 10/14/2022]
Abstract
Excessive daytime sleepiness (EDS) is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported. Variations in the definition of EDS and limitations in clinical assessment lead to difficulties in its epidemiological study, but the relevance of this symptom from a socioeconomic perspective is inarguable. EDS might be a consequence of several behavioural issues leading to insufficient or disrupted sleep, as well as a consequence of sleep disorders including sleep apnoea syndrome, circadian disorders, central hypersomnolence disorders (narcolepsy and idiopathic hypersomnia), other medical or psychiatric conditions, or medications. Furthermore, EDS can have implications for health as it is thought to act as a risk factor for other conditions, such as cardiovascular and neurodegenerative disorders. Because of the heterogeneous causes of EDS and the complexity of its pathophysiology, management will largely depend on the cause, with the final aim of making treatment specific to the individual using precision medicine and personalised medicine.
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Affiliation(s)
| | - Emmanuel Mignot
- Center for Narcolepsy, Stanford University, Palo Alto, CA, USA
| | - Guy Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Département de Neurologie, Hôpital Gui-de-Chauliac, Inserm INM, Université Montpellier, Montpellier, France
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30
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Scharf MT, Zhang P, Walker NA, Mirza M, Jobanputra AM, Aurora RN, Sunderram J, Lu SE. Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure. J Clin Sleep Med 2022; 18:2273-2279. [PMID: 35499278 PMCID: PMC9435344 DOI: 10.5664/jcsm.10048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) improves sleepiness in patients with obstructive sleep apnea, but some patients remain sleepy. The objective of this study was to identify determinants that are associated with improvements in self-reported sleepiness in patients with obstructive sleep apnea on CPAP therapy. METHODS A retrospective cohort study was performed in a clinic-based population to determine which variables contributed to the improvement in the Epworth Sleepiness Scale (ESS) in patients on CPAP therapy for OSA, stratified by baseline ESS score (< 11 or ≥ 11). Variables associated with ESS scores normalizing with CPAP were also assessed. RESULTS Patients with a baseline high ESS score showed greater improvements in the ESS with CPAP. When looking at interactions between baseline ESS classification and changes in ESS, we found that a higher apnea-hypopnea index was only associated with improvement in the ESS among patients with a high baseline ESS. Other assessed factors or covariates were not significantly different. When looking at ESS normalization, we found that female sex and lower body mass index were associated with a lower likelihood of ESS normalization. The difference in the rate of ESS normalization between females and males was higher with more days on CPAP. CONCLUSIONS Of all the assessed factors and covariates, only the apnea-hypopnea index was associated with the change in the ESS differently in patients with a high or normal baseline ESS score. ESS normalization rates were lower in females than in males, and this disparity was amplified by more days on CPAP. CITATION Scharf MT, Zhang P, Walker NA, et al. Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure. J Clin Sleep Med. 2022;18(9):2273-2279.
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Affiliation(s)
- Matthew T. Scharf
- Department of Neurology, Rutgers/Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers/Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Peng Zhang
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Nathan A. Walker
- Sleep Center, Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Mariam Mirza
- School of Arts and Science, Rutgers University, New Brunswick, New Jersey
| | - Aesha M. Jobanputra
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers/Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - R. Nisha Aurora
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers/Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jag Sunderram
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers/Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shou-En Lu
- School of Public Health, Rutgers University, Piscataway, New Jersey
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31
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Redeker NS, Conley S, Hwang Y. Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer. Clin Chest Med 2022; 43:217-228. [PMID: 35659020 PMCID: PMC9178708 DOI: 10.1016/j.ccm.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.
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Affiliation(s)
- Nancy S Redeker
- UCONN School of Nursing, Yale University, University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, USA.
| | - Samantha Conley
- Nursing Research Division, Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Youri Hwang
- Yale School of Nursing, PO Box 27399, West Haven, CT 06516-0972, USA
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32
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Ma Z, Tao Y, Chen H, Zhang Y, Pan Y, Meng D, Fan F. An Exploration of Self-Reported Sleep Inertia Symptoms Using Network Analysis. Nat Sci Sleep 2022; 14:661-674. [PMID: 35450224 PMCID: PMC9018210 DOI: 10.2147/nss.s347419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Sleep inertia (SI) is the transitional state accompanied by compromised cognitive and physical performance and sleepiness. Network analysis offers a potential new framework to conceptualize a complex network of symptom-symptom interactions, and the network structure is analyzed to reveal the core characteristics. However, no previous study examined the network structure of SI symptoms. Thus, this study aimed to elucidate characteristics and compare sex differences of SI symptom networks in the general population. MATERIALS AND METHODS A total of 1491 participants from China were recruited from 30 May to 17 June, 2021. SI symptoms were assessed by using the Sleep Inertia Questionnaire (SIQ). The network structures were estimated and compared using network analytic methods in the R version 4.1.1. RESULTS Centrality properties analysis of the expected influence suggested that symptoms of "Feel sleepy", "Groggy, fuzzy or hazy mind", and "Dread starting your day" exerted greatest influences. The weighted adjacency matrix revealed that the "Dread starting your day" and "Anxious about the upcoming day" edge showed the strongest connection (edge weight value = 0.70). The network comparison test found no significant difference in network global strength (p=0.928), distribution of edge weights (p=0.194) and individual edge weights (all p values >0.05 after Holm-Bonferroni corrections) between males and females. CONCLUSION Symptoms of "Feel sleepy", "Groggy, fuzzy or hazy mind", and "Dread starting your day" were central in the SI symptom network. Intervention, such as the artificial dawn and change in body temperature, for symptoms of "Feel sleepy", "Groggy, fuzzy or hazy mind", and "Dread starting your day" might be crucial to hasten the dissipation of SI in the general population who may need to perform tasks upon waking.
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Affiliation(s)
- Zijuan Ma
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Yanqiang Tao
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, People's Republic of China
| | - Huilin Chen
- Department of Psychology, University of Bath, Bath, UK
| | - Yifan Zhang
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Ye Pan
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Dongjing Meng
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
| | - Fang Fan
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, People's Republic of China
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Scharf MT. Reliability and Efficacy of the Epworth Sleepiness Scale: Is There Still a Place for It? Nat Sci Sleep 2022; 14:2151-2156. [PMID: 36536636 PMCID: PMC9759004 DOI: 10.2147/nss.s340950] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
The Epworth sleepiness scale (ESS) is a commonly used questionnaire to evaluate patients for excessive daytime sleepiness (EDS). The ESS has been validated as a measure of EDS, but a number of studies have shown more test-retest variability in clinical settings compared to the original validation study. This observation of higher-than-expected test-retest variability has called into question the utility of the ESS as a clinical tool to assess EDS. The purpose of this review article is to summarize how studies of test-retest variability in clinical populations compare to the original validation study of Johns and to highlight where they differ. Furthermore, use of the ESS as a continuous variable (with no specified cutoff value) versus a categorical variable (normal versus high) is described. These observations are put into a clinical context by comparing the test-retest variability observed on the ESS with that of the multiple sleep latency test (MSLT). Finally, how contributors to ESS scores differ within certain subpopulations is described. The ESS remains an important tool to measure EDS in patient populations, but an awareness of its limitations needs to be considered.
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Affiliation(s)
- Matthew T Scharf
- Sleep Center, Division of Pulmonary and Critical Care, Department of Medicine and Department of Neurology, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Akter R, Larose TL, Sandvik J, Fonne V, Meland A, Wagstaff AS. Excessive Daytime Sleepiness and Associated Factors in Military Search and Rescue Personnel. Aerosp Med Hum Perform 2021; 92:975-979. [PMID: 34986937 DOI: 10.3357/amhp.5946.2021] [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: 11/24/2022]
Abstract
BACKGROUND: Abnormal excessive daytime sleepiness (EDS) has been reported worldwide, but too little is known about EDS and its determinants in Search and Rescue (SAR) populations. We aimed to determine the prevalence of abnormal EDS and contributing factors among Royal Norwegian Air Force (RNoAF) SAR helicopter personnel.METHODS: In this cross-sectional study, a total of N = 175 RNoAF SAR personnel completed an electronic survey including socio-demographic and lifestyle questions. The Epworth Sleepiness Scale (ESS) was used as both a continuous and categorical outcome variable to measure EDS.RESULTS: Abnormal EDS defined by ESS was found in 41% of the participants in this study. We observed no associations between socio-demographic and lifestyle factors and abnormal EDS in this study. DISCUSSION: There is a high prevalence of abnormal EDS in the current RNoAF SAR population. Despite this elevated level of fatigue, we did not find that the socio-demographic and lifestyle factors assessed in this study were associated with abnormal EDS in RNoAF SAR helicopter personnel. Also unusually, the study cohort did not demonstrate higher scores in factors found to change ESS scores in similar study populations (e.g., caffeine use, tobacco use, exercise level). Further research is required to investigate other factors (organizational, operational) that may be associated with abnormal EDS in this and other SAR populations.Akter R, Larose TL, Sandvik J, Fonne V, Meland A, Wagstaff AS. Excessive daytime sleepiness and associated factors in military search and rescue personnel. Aerosp Med Hum Perform. 2021; 92(12):975-979.
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Riemann D. From basic sleep research to miscellaneous aspects of sleep medicine. J Sleep Res 2021; 30:e13336. [PMID: 33764647 DOI: 10.1111/jsr.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Zhang D, Zhang Z, Li H, Ding K. Excessive Daytime Sleepiness in Depression and Obstructive Sleep Apnea: More Than Just an Overlapping Symptom. Front Psychiatry 2021; 12:710435. [PMID: 34566713 PMCID: PMC8458762 DOI: 10.3389/fpsyt.2021.710435] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a significant public health concern, with obstructive sleep apnea (OSA) being a common cause, and a particular relationship exists with the severity of depression. A literature search on OSA, depression, and EDS was performed in PubMed. The chosen evidence was limited to human studies. Available evidence was systematically reviewed to ascertain the association of EDS with depression and OSA according to the general population and some specific population subgroups. In addition, effectiveness of continuous positive airway pressure (CPAP) was analyzed as a standard therapy for improving EDS and depression in patients with OSA. In the general population, patients with OSA, and some other subpopulations, the review contributed to: (1) delineating the prevalence of EDS; (2) substantiating the relationship of EDS and depression; (3) presenting the relationship between EDS and OSA; and (4) revealing that the duration of CPAP is crucial for its therapeutic effects in improving EDS and depressive symptoms in patients with OSA.
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Affiliation(s)
- Danwei Zhang
- Department of Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Zhen Zhang
- Department of Psychiatry, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Huihua Li
- Department of Psychiatry, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Kaimo Ding
- Department of Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
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Use of Wake-Promoting Agents in OSA: When Patients Do Not Achieve a Minimum of 6 Hours of PAP Usage per Night? CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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