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Verbruggen AER, Dieltjens M, Wouters K, De Volder I, Van de Heyning PH, Braem MJ, Vanderveken OM. Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing. Sleep Med 2013; 15:269-72. [PMID: 24424099 DOI: 10.1016/j.sleep.2013.11.781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/04/2013] [Accepted: 11/01/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oral appliance therapy with a mandibular advancement device (OAm) can yield to complete therapeutic response (apnea-hypopnea index [AHI]<5 events/h), though some patients show little or no improvement in daytime sleepiness. The prevalence of residual excessive sleepiness (RES) despite effective treatment with OAm therapy is unknown. We aimed to determine the prevalence of RES in patients treated with a titratable custom-made duobloc OAm. METHODS A prevalence study was performed, collecting data from 185 patients with an established diagnosis of sleep-disordered breathing (SDB) under OAm therapy with a titratable custom-made duobloc device (baseline data were male:female ratio, 129:56; age, 48±9 years; body mass index [BMI], 27±4 kg/m2; Epworth Sleepiness Scale [ESS] score, 10±5; and AHI, 19±12 events/h). A full-night polysomnography was performed at baseline and after 3 months of OAm therapy. Daytime sleepiness was assessed using the ESS with RES defined as an ESS score of 11 or higher out of 24, despite complete therapeutic response. RESULTS Out of 185 patients, 84 patients (45%) showed a complete therapeutic response with an AHI of <5 events per hour after 3 months of OAm therapy. Despite this normalization of AHI, 27 out of these 84 patients (32%) showed RES and had a significantly higher baseline ESS (15±4 vs. 9±4; P<.001) and were younger (43±9 vs. 47±9; P=.028) compared to patients without RES. CONCLUSION RES under OAm therapy showed a prevalence of up to 32% in SDB patients effectively treated with respect to AHI. Patients with RES were younger and had higher baseline daytime sleepiness.
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Ward AM, McLaren DG, Schultz AP, Chhatwal J, Boot BP, Hedden T, Sperling RA. Daytime sleepiness is associated with decreased default mode network connectivity in both young and cognitively intact elderly subjects. Sleep 2013; 36:1609-15. [PMID: 24179292 DOI: 10.5665/sleep.3108] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Sleep deprivation and daytime somnolence impair numerous aspects of physical, cognitive, and memory performance. However, most studies examining the effect of somnolence on brain function focus on acute sleep restriction in young adults. We examine the relationship between chronic daytime somnolence and connectivity in six brain networks in both young and elderly subjects using stimulus-free resting-state functional magnetic resonance imaging. DESIGN Cross-sectional. SETTING Outpatient research at the Massachusetts General Hospital. PARTICIPANTS Young (n = 27) and elderly (n = 84) healthy, cognitively normal volunteers. INTERVENTIONS None. MEASUREMENTS AND RESULTS Compared with young subjects, cognitively normal elderly adults report less daytime somnolence on the Epworth Sleepiness Scale (ESS) (P = 0.019) and display reduced default mode network (DMN) connectivity (P = 0.004). Across all subjects, increasing daytime sleepiness was associated with decreasing functional connectivity in the DMN (P = 0.003, partial r of ESS = -0.29). There was no difference in the slope of this relationship between young adults and elderly subjects. No other cortical networks were correlated with daytime sleepiness. Daytime sleepiness and DMN connectivity were not related to sex, brain structure, or body mass index. CONCLUSIONS These findings suggest that daytime sleepiness is associated with impaired connectivity of the DMN in a manner that is distinct from the effects of aging. This association is important to consider in any study using DMN connectivity as a biomarker. Additionally, these results may help identify those subjects at risk for future memory decline.
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Maestri M, Giorgi FS, Pizzanelli C, Fabbrini M, Di Coscio E, Carnicelli L, Iacopini E, Manconi M, Iudice A, Galli R, Bonanni E. Daytime sleepiness in de novo untreated patients with epilepsy. Epilepsy Behav 2013; 29:344-8. [PMID: 24011397 DOI: 10.1016/j.yebeh.2013.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/16/2013] [Accepted: 07/30/2013] [Indexed: 01/17/2023]
Abstract
The aims of our study were to evaluate excessive daytime sleepiness in a group of de novo untreated people with epilepsy using a comprehensive and standardized approach, including subjective evaluation and neurophysiological and performance tests, and to compare these results with those obtained in a control group. Forty-seven patients with epilepsy (17 affected by primary generalized epilepsy and 30 by partial epilepsy), with a new epilepsy diagnosis and never treated, and 44 controls underwent Multiple Sleep Latency Test (preceded by nocturnal polysomnography), simple/complex visual reaction times, and Epworth Sleepiness Scale evaluation. Newly diagnosed and drug-free patients with epilepsy did not differ from controls in any of the tests performed to evaluate daytime sleepiness. In clinical practice, daytime sleepiness is a well-known and frequent complaint of patients with epilepsy, but different mechanisms and causes, such as associated psychiatric or sleep disorders, nocturnal seizures, sleep fragmentation, and antiepileptic drugs, must be taken into account. Excessive daytime sleepiness should not be considered an unavoidable consequence of epilepsy. Thus, a complete diagnostic work-up in patients with epilepsy and sleepiness should be undertaken whenever possible.
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Rashmikant US, Chand P, Singh SV, Singh RD, Arya D, Kant S, Agarwal SP. Cephalometric evaluation of mandibular advancement at different horizontal jaw positions in obstructive sleep apnoea patients: a pilot study. Aust Dent J 2013; 58:293-300. [PMID: 23981209 DOI: 10.1111/adj.12079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/21/2012] [Accepted: 10/24/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to comparatively evaluate the efficacy of the mandibular advancement device (MAD) at 50% (P2) and 75% (P3) of maximum mandibular advancement, relative to maximum intercuspation (P1) subjectively and objectively. METHODS Eighteen subjects previously diagnosed with obstructive sleep apnoea (OSA) were selected for the study. ESS score, VAS score, soft palate angle, MP-H distance, S-H distance, a C4 -H distance, a Pu -p Pu distance and total pharyngeal area were calculated at P1, P2 and P3 positions with the help of an adjustable MAD. The results were statistically analysed. RESULTS ESS score, VAS score, soft palate angle, MP-H distance, S-H distance and radius of curvature of airway at P2 and P3 were significantly lower compared to P1, but there was no significant difference between P2 and P3. CONCLUSIONS The MAD produced significant improvement in objective signs and subjective symptoms at both 50% and 75% of the maximum mandibular protrusion positions at comparable comfort levels. Therefore, MAD may be given at 50% of maximum advancement in order to reduce dental or temporomandibular joint disturbances.
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Inoue Y, Takasaki Y, Yamashiro Y. Efficacy and safety of adjunctive modafinil treatment on residual excessive daytime sleepiness among nasal continuous positive airway pressure-treated japanese patients with obstructive sleep apnea syndrome: a double-blind placebo-controlled study. J Clin Sleep Med 2013; 9:751-7. [PMID: 23946704 PMCID: PMC3716665 DOI: 10.5664/jcsm.2912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES This double-blind study evaluated the efficacy and safety of modafinil for treating excessive daytime sleepiness in Japanese patients with obstructive sleep apnea syndrome (OSAS). METHODS Patients with residual excessive sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11) on optimal nasal continuous positive airway pressure (nCPAP) therapy (apnea-hypopnea index ≤ 10) were randomized to either 200 mg modafinil (n = 52) or placebo (n = 62) once daily for 4 weeks. Outcomes included baseline-week 4 changes in ESS total score, sleep latency on maintenance of wakefulness test (SL-MWT), nocturnal polysomnography, Pittsburgh Sleep Quality Index (PSQI), and safety. RESULTS All 114 randomized patients completed the study. Mean change in ESS total score (-6.6 vs -2.4, p < 0.001) and SL-MWT (+2.8 vs -0.4 minutes, p = 0.009) were significantly greater with modafinil than with placebo. ESS total score decreased from > 11 to < 11 at the final assessment in 69.2% of modafinil-treated patients and 30.6% of placebo-treated patients (p < 0.001). Corresponding rates at week 1 were 57.7% and 33.9% (p = 0.014). Changes in nocturnal polysomnography, PSQI, and apnea-hypopnea index from baseline to the final assessment were similar in both groups. Adverse drug reactions occurred in 36.5% and 22.6% of patients in the modafinil and placebo groups, respectively (p = 0.146). CONCLUSIONS Once-daily modafinil was effective and well tolerated for managing residual daytime sleepiness in Japanese OSAS patients with residual excessive daytime sleepiness on optimal nCPAP therapy.
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Hayley AC, Williams LJ, Berk M, Kennedy GA, Jacka FN, Pasco JA. The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women. Aust N Z J Psychiatry 2013; 47:772-8. [PMID: 23677847 DOI: 10.1177/0004867413490036] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Excessive daytime sleepiness (EDS) is a common clinical symptom that affects women more than men. However, the association of excessive sleepiness with depressive and anxiety disorders in the broader population is unclear. The aim of this study was, therefore, to examine the association between excessive daytime sleepiness as measured by the Epworth Sleepiness Scale, and depressive and anxiety disorders in a population-based sample of women. METHODS Using the Structured Clinical Interview for DSM-IV Disorders (Non-Patient) (SCID-I/NP), 944 women aged 20-97 years (median 49 years, IQR 33-65 years) were assessed for depressive and anxiety disorders as part of the Geelong Osteoporosis Study. EDS was assessed using the Epworth Sleepiness Scale (ESS, cut-off > 10). Lifestyle factors were documented by self-report, height and weight were measured, and socioeconomic status categorised according to the Index of Relative Socio-Economic Advantage and Disadvantage. RESULTS Overall, 125 (13.2%) of the women were identified with EDS. EDS was associated with an increased likelihood for both current (OR = 2.11, 95% CI 1.10-4.06) and lifetime history (OR = 1.95, 95% CI 1.28-2.97) of depressive disorders, but not anxiety disorders, independent of age and alcohol consumption. These findings were not explained by antidepressant or sedative use, body mass index, physical activity, smoking, or socioeconomic status. CONCLUSIONS These results suggest that excessive daytime sleepiness is associated with current and lifetime depressive, but not anxiety disorders. Clinically, this highlights the need to take into account the possible bidirectional relationship between depressive disorders and excessive sleepiness when assessing mental health issues in patients with EDS.
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van Huisstede A, Castro Cabezas M, van de Geijn GJM, Mannaerts GH, Njo TL, Taube C, Hiemstra PS, Braunstahl GJ. Underdiagnosis and overdiagnosis of asthma in the morbidly obese. Respir Med 2013; 107:1356-64. [PMID: 23764128 DOI: 10.1016/j.rmed.2013.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/05/2013] [Accepted: 05/06/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of obesity and asthma has increased concurrently over the last decades, suggesting a link between obesity and asthma. However, asthma might not be adequately diagnosed in this population. AIM To investigate whether not only overdiagnosis but also underdiagnosis of asthma is present in an obese population. METHODS Morbidly obese subjects with or without physician-diagnosed asthma were recruited from a pre-operative screening programme for bariatric surgery, and were characterized using an extensive diagnostic algorithm. RESULTS 473 subjects were screened; 220 met inclusion criteria, and 86 agreed to participate. Among the 32 participating subjects who had a physician diagnosis of asthma, reversible airway obstruction and/or bronchial hyperresponsiveness could only be detected in 19 patients (59%, 95% CI [0.41-0.76]), whereas in 13 patients (41%, 95% CI [0.24-0.50]) the diagnosis of asthma could not be confirmed (overdiagnosis). In contrast, in the remaining 54 patients, 17 (31%, 95% CI [0.20-0.46]) were newly diagnosed with asthma (underdiagnosis). CONCLUSION Besides overdiagnosis, there is also substantial underdiagnosis of asthma in the morbidly obese. Symptoms could be incorrectly ascribed to either obesity or asthma, and therefore also in the morbidly obese the diagnosis of asthma should also be based on pulmonary function testing.
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Salepci B, Caglayan B, Kiral N, Parmaksiz ET, Comert SS, Sarac G, Fidan A, Gungor GA. CPAP adherence of patients with obstructive sleep apnea. Respir Care 2013; 58:1467-73. [PMID: 23431305 DOI: 10.4187/respcare.02139] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. OBJECTIVE We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. METHODS Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. RESULTS Six-hundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Four-hundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred forty-eight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). CONCLUSIONS Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CONCLUSIONS CPAP/BPAP adherence should be followed with objective monitoring.
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Mondal P, Gjevre JA, Taylor-Gjevre RM, Lim HJ. Relationship between the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in a sleep laboratory referral population. Nat Sci Sleep 2013; 5:15-21. [PMID: 23620689 PMCID: PMC3630984 DOI: 10.2147/nss.s40608] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sleep health questionnaires are often employed as a first assessment step for sleep pathology. The Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) are two commonly employed questionnaire instruments. Aspects of sleep health may be measured differently depending on choice of instrument. OBJECTIVES In a patient population at high risk for sleep disorders, referred for polysomnography (PSG), we evaluated the level of association between results from these two instruments. Questionnaire results were also compared with measured PSG parameters. METHODS Records of patients undergoing overnight PSG in the sleep laboratory between February-June 2011 were retrospectively reviewed for eligibility. Inclusion criteria were met by 236 patients. PSQI and ESS scores, demographic information, and PSG data were extracted from each record for analysis. Four subgroups based on normal/abnormal values for ESS and PSQI were evaluated for between-group differences. RESULTS Of 236 adult participants, 72.5% were male, the mean age was 52.9 years (13.9), mean body mass index (BMI) 34.4 kg/m(2) (8.3), mean ESS 9.0 (4.8; range: 0-22), PSQI mean 8.6 (4.2; range: 2-19). The Pearson correlation coefficient was r = 0.13 (P = 0.05) for association between ESS and PSQI. Participants with an abnormal ESS were more likely to have an abnormal PSQI score (odds ratio 1.9 [1.1-3.6]; P = 0.03). Those with an abnormal ESS had higher BMI (P = 0.008) and higher apnea-hypopnea indexes (AHI) (P = 0.05). Differences between the four subgroups were observed for BMI and sex proportions, but not for AHI. CONCLUSIONS We observed limited association between these two commonly used questionnaire instruments, the ESS and the PSQI. These two questionnaires appear to evaluate different aspects of sleep. In terms of clinical application, for global assessment of patients with sleep problems, care should be taken to include instruments measuring different facets of sleep health.
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Taher YA, Samud AM, Ratimy AH, Seabe AM. Sleep complaints and daytime sleepiness among pharmaceutical students in Tripoli. Libyan J Med 2012; 7:18930. [PMID: 23118811 PMCID: PMC3485400 DOI: 10.3402/ljm.v7i0.18930] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/27/2012] [Indexed: 11/14/2022] Open
Abstract
Background The effect of sleep difficulties has achieved a great deal of attention recently, with university students considered as a homogenized population, particularly affected by sleep habits. Aim The objective of this study was to investigate whether Libyan college students experience sleep disturbance during their academic programmes. Methods A cross-sectional survey was conducted in the college of Pharmacy, Tripoli University, during February 2010. A total of 201 students, including 179 females (89.05%) and 22 males (10.95%), were recruited from different academic levels. Data were collected using a structured questionnaire and included a number of life-style variables. Epworth Sleepiness Scale (ESS) was used for the assessment of daytime sleepiness. Results This study showed that the total sleep time (TST) on a weeknight was 6.40 h and 67 students reported napping during daytime. The TST plus naps totalled 7.39 h. Out of eight possible dozing situations, we found that the mean score for ESS was 8.78. In addition, 79 students showed an ESS score of >10. Furthermore, our results showed that the majority of students (>92%) reported poor sleep satisfaction with quality and duration of sleep hours. Thinking about difficulty of study but not increasing education programs or tea/coffee consumption is associated with sleep difficulties reported. Moreover, 77.6% of students reported an irregular sleep–wake schedule. Conclusion These findings indicate that students experienced excessive daytime sleepiness. The TST of pharmaceutical students in Libya, as in other developing countries, is less than those reported by Western students. Students experienced various environmental demands during their college years and, their quality of sleep was negatively affected.
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Su CS, Liu KT, Panjapornpon K, Andrews N, Foldvary-Schaefer N. Functional outcomes in patients with REM-related obstructive sleep apnea treated with positive airway pressure therapy. J Clin Sleep Med 2012; 8:243-7. [PMID: 22701379 DOI: 10.5664/jcsm.1902] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES To evaluate functional outcomes in adults with REM-related obstructive sleep apnea (OSA) treated with positive airway pressure (PAP) therapy. DESIGN Retrospective observational study. SETTING Outpatient sleep clinic. PATIENTS 330 adults (171 males) with OSA receiving PAP therapy, including 130 with REM OSA and 200 with OSA not restricted to REM. MEASUREMENTS AND RESULTS REM OSA was defined as a REM apnea-hypopnea index (AHI) / NREM AHI > 2 and NREM AHI < 15. Patients had baseline and post-PAP functional outcomes, including Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Patient Health Questionnaire-9 (PHQ-9), and Functional Outcomes Sleep Questionnaire (FOSQ) scores. We compared functional outcomes, demographic, clinical and polysomnographic features, and PAP adherence in patients with REM OSA and OSA not restricted to REM. Female gender was significantly more common in REM OSA. Age, BMI, neck girth, and baseline ESS, FSS, PHQ-9, and FOSQ were similar between groups. Smoking history and comorbid disorders were also similar except for a higher prevalence of depression and cardiovascular disease in OSA not restricted to REM. All functional outcomes improved significantly after PAP therapy in both groups. Change from baseline to post treatment was similar for all functional outcomes between groups. CONCLUSIONS The study is the first addressing clinical outcomes in REM OSA using validated measures. Functional outcomes in patients with REM OSA improve after treatment with PAP therapy comparable to that observed in patients with OSA not restricted to REM. COMMENTARY A commentary on this article appears in this issue on page 249.
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Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med 2012; 7:467-72. [PMID: 22003341 DOI: 10.5664/jcsm.1308] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE The Epworth Sleepiness Scale (ESS) has been used to detect patients with potential sleep disordered breathing (SDB). Recently, a 4-Variable screening tool was proposed to identify patients with SDB, in addition to the STOP and STOP-Bang questionnaires. This study evaluated the abilities of the 4-Variable screening tool, STOP, STOP-Bang, and ESS questionnaires in identifying subjects at risk for SDB. METHODS A total of 4,770 participants who completed polysomnograms in the baseline evaluation of the Sleep Heart Health Study (SHHS) were included. Subjects with RDIs ≥ 15 and ≥ 30 were considered to have moderate-to-severe or severe SDB, respectively. Variables were constructed to approximate those in the questionnaires. The risk of SDB was calculated by the 4-Variable screening tool according to Takegami et al. The STOP and STOP-Bang questionnaires were evaluated including variables for snoring, tiredness/sleepiness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender. Sleepiness was evaluated using the ESS questionnaire and scores were dichotomized into < 11 and ≥ 11. RESULTS The STOP-Bang questionnaire had higher sensitivity to predict moderate-to-severe (87.0%) and severe (70.4%) SDB, while the 4-Variable screening tool had higher specificity to predict moderate-to-severe and severe SDB (93.2% for both). CONCLUSIONS In community populations such as the SHHS, high specificities may be more useful in excluding low-risk patients, while avoiding false positives. However, sleep clinicians may prefer to use screening tools with high sensitivities, like the STOP-Bang, in order to avoid missing cases that may lead to adverse health consequences and increased healthcare costs.
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Aurora RN, Caffo B, Crainiceanu C, Punjabi NM. Correlating subjective and objective sleepiness: revisiting the association using survival analysis. Sleep 2011; 34:1707-14. [PMID: 22131609 PMCID: PMC3208849 DOI: 10.5665/sleep.1442] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The Epworth Sleepiness Scale (ESS) and multiple sleep latency test (MSLT) are the most commonly used measures of subjective and objective sleepiness, respectively. The strength of the association between these measures as well as the optimal ESS threshold that indicates objective sleepiness remains a topic of significant interest in the clinical and research arenas. The current investigation sought to: (a) examine the association between the ESS and the average sleep latency from the MSLT using the techniques of survival analysis; (b) determine whether specific patient factors influence the association; (c) examine the utility of each ESS question; and (d) identify the optimal ESS threshold that indicates objective sleepiness. DESIGN Cross-sectional study. PATIENTS AND SETTINGS Patients (N = 675) referred for polysomnography and MSLT. MEASUREMENTS AND RESULTS Using techniques of survival analysis, a significant association was noted between the ESS score and the average sleep latency. The adjusted hazard ratios for sleep onset during the MSLT for the ESS quartiles were 1.00 (ESS < 9), 1.32 (ESS: 10-13), 1.85 (ESS: 14-17), and 2.53 (ESS ≥ 18), respectively. The association was independent of several patient factors and was distinct for the 4 naps. Furthermore, most of the ESS questions were individually predictive of the average sleep latency except the tendency to doze off when lying down to rest in the afternoon, which was only predictive in patients with less than a college education. Finally, an ESS score ≥ 13 optimally predicted an average sleep latency < 8 minutes. CONCLUSIONS In contrast to previous reports, the association between the ESS and the average sleep latency is clearly apparent when the data are analyzed by survival analysis, and most of the ESS questions are predictive of objective sleepiness. An ESS score ≥ 13 most effectively predicts objective sleepiness, which is higher than what has typically been used in clinical practice. Given the ease of administering the ESS, it represents a relatively simple and cost-effective method for identifying individuals at risk for daytime sleepiness.
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Abstract
BACKGROUND Excessive daytime sleepiness (EDS) has been reported among depressed patients in many populations. Many depressed patients seek medical attention partly to deal with EDS, but this sleep disorder is often overlooked in clinical practice. OBJECTIVES The objectives of this study were to determine the prevalence of EDS among depressed patients and determine its relationship with the severity of depression. METHODS Sixty-seven patients diagnosed with depressive episode took part in the study. The severity of depression was rated using the 17-item Hamilton Depression Rating Scale (HDRS). EDS was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS The mean ESS score was 9.2 (SD = 2.8). EDS, defined as an ESS score ≥ 10, was present in 44.8% of the depressed patients. The mean score on the HDRS was 14.8 (SD = 3.6), representing the mild-moderate depression range. ESS scores correlated highly and positively (r=0.69, p=0.000) with scores on the HDRS. CONCLUSION In the light of the high prevalence of EDS among depressed patients and its undesirable consequences, it is suggested that daytime sleepiness be evaluated in depressed patients.
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Mume CO. Excessive daytime sleepiness among depressed patients. Libyan J Med 2010; 5:10.4176/091024. [PMID: 21483548 PMCID: PMC3066783 DOI: 10.4176/091024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 08/04/2009] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) has been reported among depressed patients in many populations. Many depressed patients seek medical attention partly to deal with EDS, but this sleep disorder is often overlooked in clinical practice. OBJECTIVES The objectives of this study were to determine the prevalence of EDS among depressed patients and determine its relationship with the severity of depression. METHODS Sixty-seven patients diagnosed with depressive episode took part in the study. The severity of depression was rated using the 17-item Hamilton Depression Rating Scale (HDRS). EDS was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS The mean ESS score was 9.2 (SD=2.8). EDS, defined as an ESS score≥10, was present in 44.8% of the depressed patients. The mean score on the HDRS was 14.8 (SD=3.6), representing the mild-moderate depression range. ESS scores correlated highly and positively (r=0.69, p=0.000) with scores on the HDRS. CONCLUSION In the light of the high prevalence of EDS among depressed patients and its undesirable consequences, it is suggested that daytime sleepiness be evaluated in depressed patients.
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