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Páez-Moya S, Parejo-Gallardo KJ. Cuadro clínico del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El pilar para el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es el cuadro clínico obtenido mediante una historia clínica detallada. Los síntomas son referidos por el paciente o su compañero de cama y se pueden dar durante el sueño o la vigilia; estos últimos se presentan como consecuencia del trastorno del sueño. Los síntomas son consecuencia de la obstrucción de la vía aérea superior, de la hipoxia intermitente o de la fragmentación repetida del sueño.Para el diagnóstico de SAHOS, se deben tener en cuenta los factores agravantes, las comorbilidades, los antecedentes familiares, el examen físico, la obtención de medidas antropométricas, los signos vitales y los hallazgos anatómicos estructurales asociados con este síndrome o con alteraciones congénitas que lo predispongan. Tener conocimiento de estos aspectos clínicos es fundamental para alcanzar una buena aproximación a su diagnóstico.
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Abstract
This article describes clinical approaches to assessing sleepiness. Subjective sleep scales are used in clinical settings but have significant limitations. Likewise, objective tools may have prohibitive expense, and practical administration considerations may prohibit regular use. Gold standard tests include the multiple sleep latency test and maintenance of wakefulness test. These studies are criticized for a variety of reasons but are useful in appropriate clinical context. New tools suggest novel ways to assess sleepiness and will likely be more prominent in clinical assessments over time. This article outlines subjective scales and objective tools and suggests situations where particular instruments may be appropriate.
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Affiliation(s)
- Brian James Murray
- Neurology and Sleep Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room M1-600, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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Abstract
Relationships between symptoms of hypersomnolence, psychiatric disorders, and hypersomnia disorders (i.e., narcolepsy and idiopathic hypersomnia) are complex and multidirectional. Hypersomnolence is a common complaint across mood disorders; however, patients suffering from mood disorders and hypersomnolence rarely have objective daytime sleepiness, as assessed by the current gold standard test, the Multiple Sleep Latency Test. An iatrogenic origin of symptoms of hypersomnolence, and sleep apnea syndrome must be considered in a population of psychiatric patients, often overweight and treated with sedative drugs. On the other hand, psychiatric comorbidities, especially depression symptoms, are often reported in patients with hypersomnia disorders, and an endogenous origin cannot be ruled out. A great challenge for sleep specialists and psychiatrists is to differentiate psychiatric hypersomnolence and a central hypersomnia disorder with comorbid psychiatric symptoms. The current diagnostic tools seem to be limited in that condition, and further research in that field is warranted.
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Affiliation(s)
- Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.,National Reference Network for Narcolepsy, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Régis Lopez
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.,National Reference Network for Narcolepsy, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Jean Arthur Micoulaud Franchi
- Services d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, 33076, Bordeaux, France.,University Bordeaux, SANPSY, USR 3413, 33000, Bordeaux, France.,CNRS, SANPSY, USR 3413, 33000, Bordeaux, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France. .,National Reference Network for Narcolepsy, Montpellier, France. .,Inserm U1061, Montpellier, France.
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Easow Mathew M, Biswas T, Fahad S, Patnaik M. Modafinil for excessive daytime sleepiness. Hippokratia 2017. [DOI: 10.1002/14651858.cd010843.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Manu Easow Mathew
- Christian Medical College; South Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
| | | | - Shabin Fahad
- Kasturba Medical College; Department of General Surgery; Light House Hill Road Mangalore Karnataka India 575001
| | - Mitali Patnaik
- Drexel University, College of Medicine, Hahnemann University Hospital; Department of Psychiatry; 230 North Broad Street Philadelphia Pennsylvania USA 19130
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Lapid MI, Kuntz KM, Mason SS, Aakre JA, Lundt ES, Kremers W, Allen LA, Drubach DA, Boeve BF. Efficacy, Safety, and Tolerability of Armodafinil Therapy for Hypersomnia Associated with Dementia with Lewy Bodies: A Pilot Study. Dement Geriatr Cogn Disord 2017; 43:269-280. [PMID: 28448998 PMCID: PMC5503747 DOI: 10.1159/000471507] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Hypersomnia is common in dementia with Lewy bodies (DLB). We assessed the efficacy, safety, and tolerability of armodafinil for hypersomnia associated with DLB. METHODS We performed a 12-week pilot trial of armodafinil therapy (125-250 mg orally daily) in DLB outpatients with hypersomnia. The patients underwent neurologic examinations, a neuropsychological battery, laboratory testing, electrocardiography, and polysomnography. Efficacy was assessed at 2, 4, 8, and 12 weeks. Safety assessment included laboratory examinations, QTc interval, and heart rate. Tolerability was assessed by analysis of adverse events. Data were analyzed using the last-observation-carried-forward method. RESULTS Of 20 participants, 17 completed the protocol. The median age was 72 years, most of the participants were men (80%), and most had spouses as caregivers. The Epworth Sleepiness Scale (p < 0.001), Maintenance of Wakefulness Test (p = 0.003), and Clinical Global Impression of Change (p < 0.001) scores improved at week 12. The Neuropsychiatric Inventory total score (p = 0.003), visual hallucinations (p = 0.003), and agitation (p = 0.02) improved at week 4. Caregiver overall quality of life improved at week 12 (p = 0.004). No adverse events occurred. CONCLUSION These pilot data suggest improvements in hypersomnia and wakefulness and reasonable safety and tolerability of armodafinil therapy in hypersomnolent patients with DLB. Our findings inform the use of pharmacologic strategies for managing hypersomnolence in these patients.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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56
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Findings of the Maintenance of Wakefulness Test and its relationship with response to modafinil therapy for residual excessive daytime sleepiness in obstructive sleep apnea patients adequately treated with nasal continuous positive airway pressure. Sleep Med 2016; 27-28:45-48. [PMID: 27938918 DOI: 10.1016/j.sleep.2016.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between subjective and objective sleepiness in obstructive sleep apnea syndrome (OSAS) patients with residual sleepiness, and to determine whether baseline objective sleepiness severity predicts the response to modafinil therapy. METHODS Data were obtained from a randomized, placebo-controlled modafinil (200 mg/day) study in Japanese OSAS patients with residual sleepiness receiving nasal continuous positive pressure (n-CPAP) treatment. We analyzed 50 participants whose subjective (Epworth Sleepiness Scale [ESS] total score) and objective (Maintenance of Wakefulness Test [MWT] sleep latency) sleepiness were evaluated before and after treatment. Subjects were dichotomized into two subgroups according to the mean baseline MWT sleep latency. ESS total score and MWT sleep latency changes after treatment were compared between the placebo and modafinil groups in both subgroups. RESULTS The mean baseline ESS total score and MWT sleep latency were 14.1 ± 2.8 and 14.2 ± 4.9 min, respectively; there was no significant correlation between these two variables. Patient characteristics were similar between the two subgroups (MWT sleep latency: <14 min, n = 23; ≥14 min, n = 27). In the <14-min subgroup, changes in ESS total score and MWT sleep latency after treatment were significantly greater in the modafinil group than in the placebo group (p = 0.005). In the ≥14-min subgroup, changes in these parameters did not differ between the treatment groups. CONCLUSION In OSAS patients with residual sleepiness, the objective sleepiness level was not as high as expected, despite increased subjective sleepiness. Improvements in subjective and objective sleepiness seemed difficult to achieve with modafinil treatment among subjects with less objective sleepiness.
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Dauvilliers Y, Lopez R, Lecendreux M. French consensus. Hypersomnolence: Evaluation and diagnosis. Rev Neurol (Paris) 2016; 173:19-24. [PMID: 27838094 DOI: 10.1016/j.neurol.2016.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Sleepiness is one of the most frequently reported complaints in adults and children during specialised sleep consultations. It is responsible for an alteration that can be severe in quality of life, a lowering of academic or professional performance, and domestic or work accidents. Hypersomnolence is the first cause of road accidents on the highway, responsible for a third of fatal accidents. Furthermore its presence is associated with an increased risk of morbi-mortality related to cardiovascular and neurodegenerative pathologies. Hence, its represents a real public health issue. Recent revisions in international classifications have clarified confusing terminology, and the complaint of hypersomnia has now been replaced by the terms hypersomnolence or excessive sleepiness. It is clinically defined as an excessive quantity of sleep over 24hours, and/or by an alteration in the quality of arousal defined as incapacity to maintain a satisfactory level of vigilance during the day or in the morning on awakening (defined as sleep inertia). The evaluation of sleepiness requires a rigorous clinical approach, completed by subjective and objective measurements. The Epworth Sleep Scale, Multiple Sleep Latency Tests and the Maintenance of Wakefulness Test are the most studied and used in clinical practice. However, to date, no gold standard measurement of excessive sleepiness exists, and there are no quantifiable biological markers. It is therefore important to optimise our evaluation tools, improve our pathophysiological understanding of sleepiness, and define genetic and environmental risk factors.
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Affiliation(s)
- Y Dauvilliers
- Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; Unité des troubles du sommeil et de l'éveil, hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1061, 34295 Montpellier, France.
| | - R Lopez
- Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; Unité des troubles du sommeil et de l'éveil, hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1061, 34295 Montpellier, France
| | - M Lecendreux
- Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; AP-HP, centre du sommeil pédiatrique, CHU Robert-Debré, 75019 Paris, France
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van Schie MKM, Werth E, Lammers GJ, Overeem S, Baumann CR, Fronczek R. Improved vigilance after sodium oxybate treatment in narcolepsy: a comparison between in-field and in-laboratory measurements. J Sleep Res 2016; 25:486-96. [DOI: 10.1111/jsr.12386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe; Heeze The Netherlands
- University of Technology; Eindhoven The Netherlands
| | | | - Rolf Fronczek
- Leiden University Medical Centre; Leiden The Netherlands
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Valencia-Flores M, Mokhlesi B, Santiago-Ayala V, Reséndiz-García M, Castaño-Meneses A, Meza-Vargas MS, Mendoza A, Orea-Tejeda A, García-Ramos G, Aguilar-Salinas C, Bliwise DL. Intermittent hypoxemia and sleep fragmentation: associations with daytime alertness in obese sleep apnea patients living at moderate altitude. Sleep Med 2016; 20:103-9. [PMID: 27318233 DOI: 10.1016/j.sleep.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/17/2015] [Accepted: 01/08/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although obstructive sleep apnea (OSA) has long been associated with daytime sleepiness, far less is known about its association with the ability to remain awake. The aim of this study was to examine the relative importance of inter-correlated measures of OSA severity (eg, various indices of oxygen saturation and sleep fragmentation) in the ability to stay alert as measured objectively by the Maintenance of Wakefulness Test (MWT), defined by a mean sleep latency of ≥12 min. METHODS Seventy-eight obese women and men of similar age and body mass index living at altitude (Mexico City) underwent standard polysomnography, MWT, and completed validated sleep-related questionnaires. RESULTS Men had more severe sleep apnea than women (p = 0.002) and were also less alert on MWT (p = 0.022). Logistic regression models indicated that measures of desaturation consistently predicted MWT-defined alertness, whereas varied measures of sleep fragmentation did not. Nearly a third of the variance (r(2) = 0.304) in MWT-defined alertness was accounted for by the number of desaturations per hour of sleep (p = 0.003), which is considerably higher than other studies have reported in different populations. CONCLUSION The ability to remain awake in obese patients is best accounted for by hypoxemia rather than sleep fragmentation. Whether the size of this effect reflects differences in the population under study (eg, extent of obesity, racial background, residence at moderate altitude) and/or is a function of the measurement of alertness with the MWT remains uncertain.
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Affiliation(s)
- Matilde Valencia-Flores
- Clinica de Trastornos del Dormir, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNCSZ), Mexico; División de Investigación y Estudios de Posgrado, UNAM, Mexico.
| | - Babak Mokhlesi
- Section of Pulmonary and Critical Care, Sleep Disorders Center, University of Chicago, IL, USA
| | - Victoria Santiago-Ayala
- Clinica de Trastornos del Dormir, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNCSZ), Mexico
| | - Montserrat Reséndiz-García
- Clinica de Trastornos del Dormir, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNCSZ), Mexico
| | - Alejandra Castaño-Meneses
- Clinica de Trastornos del Dormir, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNCSZ), Mexico
| | | | - Alejandro Mendoza
- Clinica de Trastornos del Dormir, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNCSZ), Mexico
| | | | | | | | - Donald L Bliwise
- Sleep Program, School of Medicine, Emory University, Atlanta, GA, USA
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Abstract
Sleep and circadian rhythms significantly impact almost all aspects of human behavior and are therefore relevant to occupational sleep medicine, which is focused predominantly around workplace productivity, safety, and health. In this article, 5 main factors that influence occupational functioning are reviewed: (1) sleep deprivation, (2) disordered sleep, (3) circadian rhythms, (4) common medical illnesses that affect sleep and sleepiness, and (5) medications that affect sleep and sleepiness. Consequences of disturbed sleep and sleepiness are also reviewed, including cognitive, emotional, and psychomotor functioning and drowsy driving.
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Affiliation(s)
- Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher Drake
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA.
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61
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Valent F, Sincig E, Gigli GL, Dolso P. Maintenance of Wakefulness and Occupational Injuries among Workers of an Italian Teaching Hospital. Saf Health Work 2015; 7:120-3. [PMID: 27340598 PMCID: PMC4909841 DOI: 10.1016/j.shaw.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 10/06/2015] [Accepted: 10/11/2015] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND To assess in a laboratory setting the ability to stay awake in a sample of workers of an Italian hospital and to investigate the association between that ability and the risk of occupational injury. METHODS Nine workers at the University Hospital of Udine who reported an occupational injury in the study period (cases), and seven noninjured workers (controls) underwent a polysomnography and four 40-minute maintenance of wakefulness tests (MWT). Differences in sleep characteristics and in wakefulness maintenance were assessed using Wilcoxon's rank sums tests and Fisher's exact tests. RESULTS Controls had greater sleep latency, lower total sleep time, fewer leg movements, and a higher percentage ratio of cycling alternating pattern, were more likely not to fall asleep during the MWT and were less likely to have two or more sleep onsets. Although not all the differences reached statistical significance, cases had lower sleep onset times in Trials 1-3. CONCLUSION In the literature, the evidence of an association between MWT results and real life risk of accidents is weak. Our results suggest a relationship between the MWT results and the risk of injury among hospital workers.
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Affiliation(s)
- Francesca Valent
- Epidemiologic Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy; Unit of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Elisa Sincig
- Neurology Clinic, University Hospital of Udine, Udine, Italy
| | | | - Pierluigi Dolso
- Neurology Clinic, University Hospital of Udine, Udine, Italy
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63
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Guaita M, Melia U, Vallverdú M, Caminal P, Vilaseca I, Montserrat JM, Gaig C, Salamero M, Santamaria J. Regularity of cardiac rhythm as a marker of sleepiness in sleep disordered breathing. PLoS One 2015; 10:e0122645. [PMID: 25860587 PMCID: PMC4393025 DOI: 10.1371/journal.pone.0122645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/23/2015] [Indexed: 11/18/2022] Open
Abstract
Aim The present study aimed to analyse the autonomic nervous system activity using heart rate variability (HRV) to detect sleep disordered breathing (SDB) patients with and without excessive daytime sleepiness (EDS) before sleep onset. Methods Two groups of 20 patients with different levels of daytime sleepiness -sleepy group, SG; alert group, AG- were selected consecutively from a Maintenance of Wakefulness Test (MWT) and Multiple Sleep Latency Test (MSLT) research protocol. The first waking 3-min window of RR signal at the beginning of each nap test was considered for the analysis. HRV was measured with traditional linear measures and with time-frequency representations. Non-linear measures -correntropy, CORR; auto-mutual-information function, AMIF- were used to describe the regularity of the RR rhythm. Statistical analysis was performed with non-parametric tests. Results Non-linear dynamic of the RR rhythm was more regular in the SG than in the AG during the first wakefulness period of MSLT, but not during MWT. AMIF (in high-frequency and in Total band) and CORR (in Total band) yielded sensitivity > 70%, specificity >75% and an area under ROC curve > 0.80 in classifying SG and AG patients. Conclusion The regularity of the RR rhythm measured at the beginning of the MSLT could be used to detect SDB patients with and without EDS before the appearance of sleep onset.
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Affiliation(s)
- Marc Guaita
- Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- * E-mail: (MG); (JS)
| | - Umberto Melia
- Dept. ESAII, Centre for Biomedical Engineering Research, BarcelonaTech, CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Montserrat Vallverdú
- Dept. ESAII, Centre for Biomedical Engineering Research, BarcelonaTech, CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Pere Caminal
- Dept. ESAII, Centre for Biomedical Engineering Research, BarcelonaTech, CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Isabel Vilaseca
- Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain
- Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain
- Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Medical School, University of Barcelona, Barcelona, Spain
| | - Josep M. Montserrat
- Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain
- Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Medical School, University of Barcelona, Barcelona, Spain
- Department of Pneumology, Hospital Clinic, Barcelona, Spain
| | - Carles Gaig
- Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain
- Department of Neurology, Hospital Clinic, Barcelona, Spain
- Ciber Enfermedades Neurológicas (CIBERNED), Barcelona, Spain
| | - Manel Salamero
- Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Medical School, University of Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Clinic, Barcelona, Spain
| | - Joan Santamaria
- Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Medical School, University of Barcelona, Barcelona, Spain
- Department of Neurology, Hospital Clinic, Barcelona, Spain
- Ciber Enfermedades Neurológicas (CIBERNED), Barcelona, Spain
- * E-mail: (MG); (JS)
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Melia U, Guaita M, Vallverdú M, Embid C, Vilaseca I, Salamero M, Santamaria J. Mutual information measures applied to EEG signals for sleepiness characterization. Med Eng Phys 2015; 37:297-308. [PMID: 25638417 DOI: 10.1016/j.medengphy.2015.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 12/23/2014] [Accepted: 01/12/2015] [Indexed: 11/20/2022]
Abstract
Excessive daytime sleepiness (EDS) is one of the main symptoms of several sleep related disorders with a great impact on the patient lives. While many studies have been carried out in order to assess daytime sleepiness, the automatic EDS detection still remains an open problem. In this work, a novel approach to this issue based on non-linear dynamical analysis of EEG signal was proposed. Multichannel EEG signals were recorded during five maintenance of wakefulness (MWT) and multiple sleep latency (MSLT) tests alternated throughout the day from patients suffering from sleep disordered breathing. A group of 20 patients with excessive daytime sleepiness (EDS) was compared with a group of 20 patients without daytime sleepiness (WDS), by analyzing 60-s EEG windows in waking state. Measures obtained from cross-mutual information function (CMIF) and auto-mutual-information function (AMIF) were calculated in the EEG. These functions permitted a quantification of the complexity properties of the EEG signal and the non-linear couplings between different zones of the scalp. Statistical differences between EDS and WDS groups were found in β band during MSLT events (p-value < 0.0001). WDS group presented more complexity than EDS in the occipital zone, while a stronger nonlinear coupling between occipital and frontal zones was detected in EDS patients than in WDS. The AMIF and CMIF measures yielded sensitivity and specificity above 80% and AUC of ROC above 0.85 in classifying EDS and WDS patients.
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Affiliation(s)
- Umberto Melia
- Department of ESAII, Centre for Biomedical Engineering Research, Universitat Politècnica de Catalunya, CIBER-BBN, Barcelona, Spain.
| | - Marc Guaita
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d' Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Vallverdú
- Department of ESAII, Centre for Biomedical Engineering Research, Universitat Politècnica de Catalunya, CIBER-BBN, Barcelona, Spain
| | - Cristina Embid
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Department of Pneumology, Hospital Clinic, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain; Medical School, University of Barcelona, Spain
| | - Isabel Vilaseca
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain; Medical School, University of Barcelona, Spain
| | - Manel Salamero
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Department of Psychiatry, Hospital Clinic, Barcelona, Spain; Institut d' Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Medical School, University of Barcelona, Spain
| | - Joan Santamaria
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Department of Neurology, Hospital Clinic, Barcelona, Spain; Institut d' Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Ciber Enfermedades Neurológicas (CIBERNED), Barcelona, Spain; Medical School, University of Barcelona, Spain
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A generalized estimating equation approach to analysis of maintenance of wakefulness testing in a study of lisdexamfetamine dimesylate, armodafinil, and placebo in sleep-deprived adults. J Clin Psychopharmacol 2014; 34:642-4. [PMID: 25180798 DOI: 10.1097/jcp.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In a study of acute sleep deprivation in healthy male volunteers randomized to double-blind treatment with lisdexamfetamine dimesylate (20, 50, or 70 mg), placebo control, or an active control (armodafinil 250 mg), Maintenance of Wakefulness Test data were compared using a generalized estimating equation analysis to eliminate the need for unequivocal sleep latency imputation. Compared with placebo across all Maintenance of Wakefulness Tests, all active treatments were associated with lower risk of falling asleep (risk ratio [95% confidence interval]): 0.45 (0.27-0.76; P = 0.0026), 0.10 (0.05-0.20; P < 0.0001), and 0.05 (0.02-0.14; P < 0.0001) for 20, 50, and 70 mg lisdexamfetamine dimesylate, respectively, and 0.11 (0.06-0.21; P < 0.0001) for the active control. Sleep-risk ratios were similar for lisdexamfetamine dimesylate 50 or 70 mg and for the active control, but lisdexamfetamine 20 mg was associated with a greater risk of falling asleep compared with the active control (4.13 [1.97-8.67]; P = 0.0002). Generalized estimating equation analysis detected wake-promoting effects of active treatments and eliminating data imputation, suggesting model utility in future studies.
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66
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Mayer G, Benes H, Young P, Bitterlich M, Rodenbeck A. Modafinil in the treatment of idiopathic hypersomnia without long sleep time-a randomized, double-blind, placebo-controlled study. J Sleep Res 2014; 24:74-81. [DOI: 10.1111/jsr.12201] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Geert Mayer
- Hephata Klinik; Schwalmstadt-Treysa Germany
- Department of Neurology; Philipps-Universität Marburg; Marburg Germany
| | - Heike Benes
- Department of Neurology; University of Rostock; Rostock Germany
| | - Peter Young
- Department for Sleep Medicine and Neuromuscular Disorders; University of Münster; Münster Germany
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The effect of intranasal orexin-A (hypocretin-1) on sleep, wakefulness and attention in narcolepsy with cataplexy. Behav Brain Res 2014; 262:8-13. [PMID: 24406723 DOI: 10.1016/j.bbr.2013.12.045] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/13/2013] [Accepted: 12/20/2013] [Indexed: 01/17/2023]
Abstract
Narcolepsy with cataplexy is a sleep dysregulation disorder with alterations of REM sleep, i.e., sleep onset REM periods and REM sleep instability. Deficient orexin-A (hypocretin-1) signaling is assumed to be a major cause of narcolepsy with cataplexy. In this study we investigated fourteen subjects with narcolepsy with cataplexy in a within-subject, random-order crossover, placebo-controlled design. Patients received double-blinded intranasal orexin-A (435 nmol) or sterile water (placebo) in the morning. Administration was preceded by an adaptation night and followed by a modified maintenance of wakefulness test, attention testing and a second full night of polysomnographic recording. We found comparable sleep behavior during the adaptation nights between both conditions. After orexin-A administration patients had less wake-REM sleep transitions and a decreased REM sleep duration. In the subsequent night, patients showed an increased N2 duration. In the test of divided attention, patients had fewer false reactions after orexin-A administration. Our results support orexin-A to be a REM sleep stabilizing factor and provide functional signs for effects of orexin-A on sleep alterations and attention in narcolepsy with cataplexy.
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68
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Veauthier C, Paul F. Sleep disorders in multiple sclerosis and their relationship to fatigue. Sleep Med 2014; 15:5-14. [DOI: 10.1016/j.sleep.2013.08.791] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/14/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
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69
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Bliwise DL, Scullin MK, Trotti LM. Fluctuations in cognition and alertness vary independently in dementia with Lewy bodies. Mov Disord 2013; 29:83-9. [PMID: 24151106 DOI: 10.1002/mds.25707] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/22/2013] [Accepted: 09/01/2013] [Indexed: 11/06/2022] Open
Abstract
Fluctuations in mental status are 1 of the core diagnostic criteria for dementia with Lewy bodies (DLB) and are thought to reflect variability in daytime alertness. Previous attempts to study fluctuations have been limited to caregiver reports, observer rating scales, short segments of electroencephalography, or motor-dependent, reaction time tests. Concordance among such measures is often poor, and fluctuations remain difficult to quantify. We compared fluctuations in cognition and alertness in patients with DLB (n = 13) and idiopathic Parkinson's disease (PD) (n = 64), a condition associated with deficits in daytime alertness. We systematically and repeatedly collected cognitive and physiologic measures during a 48-hour inpatient protocol in a sound-attenuated sleep laboratory in a geriatric hospital. Cognitive fluctuations were analyzed using coefficients of variation (COVs) derived from performance on a bedside examination familiar to clinicians (digit span). Alertness fluctuations were assessed objectively using COVs from the polysomnographically-based Maintenance of Wakefulness Test. Despite predictably lower mean digit span performances, DLB patients demonstrated significantly greater cognitive fluctuations than PD patients (P < 0.001), even when groups were matched on general cognitive impairment. There were no group differences in alertness fluctuations, although DLB patients were less alert than PD patients not receiving dopaminergics. The prevailing assumption that fluctuations in cognition in DLB are reflected in fluctuations in daytime alertness was not supported by objective, physiological measurements. Fluctuating mental status in DLB patients can be detected with repeated administration of a simple bedside exam that can be adapted to a clinic setting.
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Affiliation(s)
- Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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70
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Herring WJ, Liu K, Hutzelmann J, Snavely D, Snyder E, Ceesay P, Lines C, Michelson D, Roth T. Alertness and psychomotor performance effects of the histamine-3 inverse agonist MK-0249 in obstructive sleep apnea patients on continuous positive airway pressure therapy with excessive daytime sleepiness: a randomized adaptive crossover study. Sleep Med 2013; 14:955-63. [DOI: 10.1016/j.sleep.2013.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/20/2013] [Accepted: 04/11/2013] [Indexed: 11/15/2022]
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Wiseman-Hakes C, Murray B, Moineddin R, Rochon E, Cullen N, Gargaro J, Colantonio A. Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI. Brain Inj 2013; 27:1364-76. [PMID: 24070180 PMCID: PMC3809926 DOI: 10.3109/02699052.2013.823663] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/28/2013] [Accepted: 07/07/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To longitudinally examine objective and self-reported outcomes for recovery of cognition, communication, mood and participation in adults with traumatic brain injury (TBI) and co-morbid post-traumatic sleep/wake disorders. DESIGN Prospective, longitudinal, single blind outcome study. SETTING Community-based. PARTICIPANTS Ten adults with moderate-severe TBI and two adults with mild TBI and persistent symptoms aged 18-58 years. Six males and six females, who were 1-22 years post-injury and presented with self-reported sleep/wake disturbances with onset post-injury. INTERVENTIONS Individualized treatments for sleep/wake disorders that included sleep hygiene recommendations, pharmacological interventions and/or treatments for sleep apnea with follow-up. MAIN OUTCOME MEASURES Insomnia Severity Index, Beck Depression and Anxiety Inventories, Latrobe Communication Questionnaire, Speed and Capacity of Language Processing, Test of Everyday Attention, Repeatable Battery for the Assessment of Neuropsychological Status, Daily Cognitive-Communication and Sleep Profile. RESULTS Group analysis revealed positive trends in change for each measure and across sub-tests of all measures. Statistically significant changes were noted in insomnia severity, p = 0.0003; depression severity, p = 0.03; language, p = 0.01; speed of language processing, p = 0.007. CONCLUSIONS These results add to a small but growing body of evidence that sleep/wake disorders associated with TBI exacerbate trauma-related cognitive, communication and mood impairments. Treatment for sleep/wake disorders may optimize recovery and outcomes.
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Affiliation(s)
- Catherine Wiseman-Hakes
- Department of Rehabilitation Science, University of TorontoToronto, ONCanada
- Toronto Rehabilitation InstituteToronto, ONCanada
| | - Brian Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of TorontoToronto, ONCanada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
| | - Elizabeth Rochon
- Toronto Rehabilitation InstituteToronto, ONCanada
- Department of Speech Language Pathology, University of TorontoToronto, ONCanada
| | - Nora Cullen
- Toronto Rehabilitation InstituteToronto, ONCanada
- West Park Health Care CentreToronto, ONCanada
| | | | - Angela Colantonio
- Toronto Rehabilitation InstituteToronto, ONCanada
- Department of Occupational Therapy and Occupational Science, University of TorontoToronto, ONCanada
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Zandieh S, Ramgopal S, Khatwa U, Sangiuliano M, Gunnuscio M, Zarowski M, Kothare SV. The maintenance of wakefulness test in pediatric narcolepsy. Pediatr Neurol 2013; 48:443-6. [PMID: 23668868 DOI: 10.1016/j.pediatrneurol.2013.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 10/26/2022]
Abstract
Objective tools are needed to assess the response to treatment in pediatric narcolepsy. This article presents a single-center experience documenting the use of the maintenance of wakefulness test (MWT) in a pediatric series. This study reviewed the charts of children with narcolepsy who had an MWT performed between January 2008 and June 2012. A cutoff was used for mean sleep latency: <8 minutes for inadequate control of hypersomnia, and >20 minutes to indicate adequate control on medications. Thirteen tests were performed on 10 children (median age 15.8 years, range 8.7-20.3 years) with narcolepsy, of which six had cataplexy and three were boys. Comorbid conditions included Prader-Willi syndrome, bipolar affective disorder, and epilepsy (n = 1 each). The median mean sleep latency for all studies was 16 minutes (range 5.8-40 minutes). Sleep-onset rapid eye movement sleep events were seen in three of 13 studies. In seven patients, findings from the MWT resulted in changes in management. These data suggest that the MWT may be a useful and feasible test for assessing response to treatment in children with narcolepsy. Future research is needed to obtain normative MWT data on children with and without narcolepsy.
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Affiliation(s)
- Stephanie Zandieh
- Center for Pediatric Sleep Disorders, Boston Children's Hospital, Boston, Massachusetts 02115, USA
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73
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Philip P, Chaufton C, Taillard J, Sagaspe P, Léger D, Raimondi M, Vakulin A, Capelli A. Maintenance of Wakefulness Test scores and driving performance in sleep disorder patients and controls. Int J Psychophysiol 2013; 89:195-202. [PMID: 23727627 DOI: 10.1016/j.ijpsycho.2013.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Sleepiness at the wheel is a risk factor for traffic accidents. Past studies have demonstrated the validity of the Maintenance of Wakefulness Test (MWT) scores as a predictor of driving impairment in untreated patients with obstructive sleep apnea syndrome (OSAS), but there is limited information on the validity of the maintenance of wakefulness test by MWT in predicting driving impairment in patients with hypersomnias of central origin (narcolepsy or idiopathic hypersomnia). The aim of this study was to compare the MWT scores with driving performance in sleep disorder patients and controls. METHODS 19 patients suffering from hypersomnias of central origin (9 narcoleptics and 10 idiopathic hypersomnia), 17 OSAS patients and 14 healthy controls performed a MWT (4×40-minute trials) and a 40-minute driving session on a real car driving simulator. Participants were divided into 4 groups defined by their MWT sleep latency scores. The groups were pathological (sleep latency 0-19 min), intermediate (20-33 min), alert (34-40 min) and control (>34 min). The main driving performance outcome was the number of inappropriate line crossings (ILCs) during the 40 minute drive test. RESULTS Patients with pathological MWT sleep latency scores (0-19 min) displayed statistically significantly more ILC than patients from the intermediate, alert and control groups (F (3, 46)=7.47, p<0.001). INTERPRETATION Pathological sleep latencies on the MWT predicted driving impairment in patients suffering from hypersomnias of central origin as well as in OSAS patients. MWT is an objective measure of daytime sleepiness that appears to be useful in estimating the driving performance in sleepy patients.
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Affiliation(s)
- Pierre Philip
- Univ. de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, F-33000 Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000 Bordeaux, France; CHU Pellegrin, F-33076 Bordeaux, France
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Dauvilliers Y, Lopez R, Ohayon M, Bayard S. Hypersomnia and depressive symptoms: methodological and clinical aspects. BMC Med 2013; 11:78. [PMID: 23514569 PMCID: PMC3621400 DOI: 10.1186/1741-7015-11-78] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/27/2013] [Indexed: 11/28/2022] Open
Abstract
The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies have used objective tools such as polysomnography to directly measure both daytime and nighttime sleep propensity in depression with normal mean sleep latency and sleep duration. Hypersomnia in mood disorders, rather than a medical condition per se, is more a subjective sleep complaint than an objective finding. Mood symptoms have also been frequently reported in hypersomnia disorders of central origin, especially in narcolepsy. Hypocretin deficiency could be a contributing factor in this condition. Further interventional studies are needed to explore whether management of sleep complaints improves mood symptoms in hypersomnia disorders and, conversely, whether management of mood complaints improves sleep symptoms in mood disorders.
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Affiliation(s)
- Yves Dauvilliers
- Centre de référence national sur les maladies rares (narcolepsie, hypersomnie idiopathique, syndrome de Kleine-Levin), Service de Neurologie, Unité des troubles du sommeil, Hôpital Gui-de-Chauliac, 80 avenue Augustin Fliche, Montpellier cedex 5 34295, France.
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75
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Sangal RB. Evaluating sleepiness-related daytime function by querying wakefulness inability and fatigue: Sleepiness-Wakefulness Inability and Fatigue Test (SWIFT). J Clin Sleep Med 2012; 8:701-11. [PMID: 23243405 DOI: 10.5664/jcsm.2270] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Routine assessment of daytime function in Sleep Medicine has focused on "tendency to fall asleep" in soporific circumstances, to the exclusion of "wakefulness inability" or inability to maintain wakefulness, and fatigue/tiredness/lack of energy. The objective was to establish reliability and discriminant validity of a test for wakefulness inability and fatigue, and to test its superiority against the criterion standard for evaluation of sleepiness-the Epworth Sleepiness Scale (ESS). METHODS A 12-item self-administered instrument, the Sleepiness-Wakefulness Inability and Fatigue Test (SWIFT), was developed and administered, with ESS, to 256 adults ≥ 18 years of age (44 retook the tests a month later); consecutive patients with symptoms of sleep disorders including 286 with obstructive sleep apnea ([OSA], apnea-hypopnea index ≥ 5/h sleep on polysomnography [PSG]), 49 evaluated with PSG and multiple sleep latency test for narcolepsy and 137 OSA patients treated with continuous positive airway pressure (CPAP). RESULTS SWIFT had internal consistency 0.87 and retest intraclass coefficient 0.82. Factor analysis revealed 2 factors-general wakefulness inability and fatigue (GWIF) and driving wakefulness inability and fatigue (DWIF). Normal subjects differed from patients in ESS, SWIFT, GWIF, and DWIF. SWIFT and GWIF (but not DWIF) had higher area under ROC curve, Youden's index, and better positive and negative likelihood ratios than ESS. ESS, SWIFT, GWIF, and DWIF improved with CPAP. Improvements in SWIFT, GWIF, and DWIF (but not ESS) were significantly correlated with CPAP compliance. CONCLUSIONS SWIFT is reliable and valid. SWIFT and its factor GWIF have a discriminant ability superior to that of the ESS.
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Affiliation(s)
- R Bart Sangal
- Sleep Disorders Institute, Sterling Heights, MI 48314, USA.
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76
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Baumgartel KL, Terhorst L, Conley YP, Roberts JM. Psychometric evaluation of the Epworth sleepiness scale in an obstetric population. Sleep Med 2012; 14:116-21. [PMID: 23218535 DOI: 10.1016/j.sleep.2012.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Epworth Sleepiness Scale (ESS) was initially developed to measure daytime sleep propensity in patients affected by a variety of sleep disorders. Obstetrical research has measured sleepiness in pregnant women with the ESS, although psychometric analyses and dimensionality evaluations have never been conducted with this population. OBJECTIVE The objective was to perform a psychometric evaluation of the ESS in an obstetric population. The design was a secondary data analysis of the subjects enrolled in the Prenatal Exposures and Preeclampsia Prevention III (PEPP) study. The setting for the subjects who received prenatal care was at Magee-Women's Hospital UPMC in Pittsburgh, Pennsylvania and included 337 pregnant women in their first trimester that completed the ESS. METHODS Principal components analysis and confirmatory factor analysis were performed using SPSS and M-Plus. Additionally, reliability was assessed and construct validity was measured using the Life Orientation Test (LOT). Lastly, a relationship between daytime sleepiness and snoring was investigated using item 5e from the Pittsburgh Sleep Quality Index (PSQI). RESULTS PCA with varimax rotation yielded two factors that explained approximately 50% of the variance and CFA results verified this two-factor solution. An overall Cronbach's alpha (0.751) revealed moderate reliability (Factor 1α=.754; Factor 2α=.524). Both convergent and discriminant validity were established. CONCLUSION The ESS is appropriate for use in an obstetric population to measure daytime sleepiness. Future work should include additional evaluations of the ESS in a diverse group of pregnant women.
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Affiliation(s)
- Kelley L Baumgartel
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15261,United States.
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Kushida CA, Nichols DA, Holmes TH, Quan SF, Walsh JK, Gottlieb DJ, Simon RD, Guilleminault C, White DP, Goodwin JL, Schweitzer PK, Leary EB, Hyde PR, Hirshkowitz M, Green S, McEvoy LK, Chan C, Gevins A, Kay GG, Bloch DA, Crabtree T, Dement WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 2012. [PMID: 23204602 DOI: 10.5665/sleep.2226] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA). DESIGN, SETTING, AND PARTICIPANTS The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures. INTERVENTION Active or sham CPAP MEASUREMENTS: THREE NEUROCOGNITIVE VARIABLES, EACH REPRESENTING A NEUROCOGNITIVE DOMAIN: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F]) RESULTS The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test. CONCLUSIONS CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship. CLINICAL TRIAL INFORMATION Registered at clinicaltrials.gov. Identifier: NCT00051363. CITATION Kushida CA; Nichols DA; Holmes TH; Quan SF; Walsh JK; Gottlieb DJ; Simon RD; Guilleminault C; White DP; Goodwin JL; Schweitzer PK; Leary EB; Hyde PR; Hirshkowitz M; Green S; McEvoy LK; Chan C; Gevins A; Kay GG; Bloch DA; Crabtree T; Demen WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2012;35(12):1593-1602.
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Abad VC, Guilleminault C. Diagnosis and treatment of sleep disorders: a brief review for clinicians. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033666 PMCID: PMC3181779 DOI: 10.31887/dcns.2003.5.4/vabad] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep disorders encompass a wide spectrum of diseases with significant individual health consequences and high economic costs to society. To facilitate the diagnosis and treatment of sleep disorders, this review provides a framework using the International Classification of Sleep Disorders, Primary and secondary insomnia are differentiated, and pharmacological and nonpharmacological treatments are discussed. Common circadian rhythm disorders are described in conjunction with interventions, including chronotherapy and light therapy. The diagnosis and treatment of restless legs syndrome/periodic limb movement disorder is addressed. Attention is focused on obstructive sleep apnea and upper airway resistance syndrome, and their treatment. The constellation of symptoms and findings in narcolepsy are reviewed together with diagnostic testing and therapy, Parasomnias, including sleep terrors, somnambulism, and rapid eye movement (REM) behavior sleep disorders are described, together with associated laboratory testing results and treatment.
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Affiliation(s)
- Vivien C Abad
- Stanford University Sleep Disorders Clinic and Research Center, Stanford University, School of Medicine, Stanford, Calif, USA
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Bliwise DL, Trotti LM, Wilson AG, Greer SA, Wood-Siverio C, Juncos JJ, Factor SA, Freeman A, Rye DB. Daytime alertness in Parkinson's disease: potentially dose-dependent, divergent effects by drug class. Mov Disord 2012; 27:1118-24. [PMID: 22753297 PMCID: PMC3589103 DOI: 10.1002/mds.25082] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 05/03/2012] [Accepted: 05/14/2012] [Indexed: 11/08/2022] Open
Abstract
Many patients with idiopathic Parkinson's disease experience difficulties maintaining daytime alertness. Controversy exists regarding whether this reflects effects of antiparkinsonian medications, the disease itself, or other factors such as nocturnal sleep disturbances. In this study we examined the phenomenon by evaluating medicated and unmedicated Parkinson's patients with objective polysomnographic measurements of nocturnal sleep and daytime alertness. Patients (n = 63) underwent a 48-hour laboratory-based study incorporating 2 consecutive nights of overnight polysomnography and 2 days of Maintenance of Wakefulness Testing. We examined correlates of individual differences in alertness, including demographics, clinical features, nocturnal sleep variables, and class and dosage of anti-Parkinson's medications. Results indicated that, first, relative to unmediated patients, all classes of dopaminergic medications were associated with reduced daytime alertness, and this effect was not mediated by disease duration or disease severity. Second, the results showed that increasing dosages of dopamine agonists were associated with less daytime alertness, whereas higher levels of levodopa were associated with higher levels of alertness. Variables unrelated to the Maintenance of Wakefulness Test defined daytime alertness including age, sex, years with diagnosis, motor impairment score, and most nocturnal sleep variables. Deficits in objectively assessed daytime alertness in Parkinson's disease appear to be a function of both the disease and the medications and their doses used. The apparent divergent dose-dependent effects of drug class in Parkinson's disease are anticipated by basic science studies of the sleep/wake cycle under different pharmacological agents.
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Affiliation(s)
- Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
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Evaluation Instruments for Sleep Disorders: A Brief History of Polysomnography and Sleep Medicine. INTRODUCTION TO MODERN SLEEP TECHNOLOGY 2012. [DOI: 10.1007/978-94-007-5470-6_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Cochen De Cock V, Dauvilliers Y. Current and future therapeutic approaches in narcolepsy. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.11.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Narcolepsy with cataplexy (NC) is a disabling orphan sleep disorder characterized by excessive daytime sleepiness, cataplexy and other dissociated manifestations of rapid eye movement sleep (hypnagogic hallucinations and sleep paralysis), as well as frequent movement and awakening during night-time sleep. In this article, we will describe the main symptoms and the current and future treatments of NC. Pathophysiological studies have shown that NC is caused by the early loss of neurons in the hypothalamus that produce hypocretin/orexin, a wakefulness-associated neurotransmitter present in cerebrospinal fluid. The cause of neural loss could be autoimmune since most patients have the human leukocyte antigen DQB1*0602 allele that predisposes individuals to NC. The treatment of narcolepsy has evolved over the past few years with the widespread use of modafinil for daytime sleepiness, antidepressants for cataplexy and γ-hydroxybutyrate (sodium oxybate) for both symptoms. Potential development of new wake-promoting drugs, anticataplectic medications, slow-wave sleep-enhancing treatments, hypocretin-replacement therapy and immunotherapy at early stages of the disease needs to be evaluated in the near future.
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Affiliation(s)
- Valérie Cochen De Cock
- National Reference Network for Narcolepsy, Sleep-Disorders Center, Department of Neurology, Hôpital Gui de Chauliac, INSERM U1061, UM1, Montpellier, France
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Gast H, Schindler K, Rummel C, Herrmann US, Roth C, Hess CW, Mathis J. EEG correlation and power during maintenance of wakefulness test after sleep-deprivation. Clin Neurophysiol 2011; 122:2025-31. [DOI: 10.1016/j.clinph.2011.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/28/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
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Wiseman-Hakes C, Victor JC, Brandys C, Murray BJ. Impact of post-traumatic hypersomnia on functional recovery of cognition and communication. Brain Inj 2011; 25:1256-65. [DOI: 10.3109/02699052.2011.608215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Sleep science has been a vigorously evolving field over the past 60 years, and the practice of sleep medicine has become increasingly complex with a growing number of tests and treatments. This article briefly traces the history of the field of sleep science over the past three millennia. The foundations of sleep medicine can be traced back to ancient civilizations around the globe. Many philosophers, scientists, and researchers have espoused theories about the causes of sleep throughout the centuries, theories that have become more intricate as our understanding of medicine and neurobiology has continued to advance.
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87
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Veauthier C, Radbruch H, Gaede G, Pfueller CF, Dörr J, Bellmann-Strobl J, Wernecke KD, Zipp F, Paul F, Sieb JP. Fatigue in multiple sclerosis is closely related to sleep disorders: a polysomnographic cross-sectional study. Mult Scler 2011; 17:613-22. [PMID: 21278050 DOI: 10.1177/1352458510393772] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sleep disorders can cause tiredness. The relationship between sleep disorders and fatigue in patients with multiple sclerosis (MS) has not yet been investigated systematically. OBJECTIVE To investigate the relationship between fatigue and sleep disorders in patients with MS. METHODS Some 66 MS patients 20 to 66 years old were studied by overnight polysomnography. Using a cut-off point of 45 in the Modified Fatigue Impact Scale (MFIS), the entire cohort was stratified into a fatigued MS subgroup (n=26) and a non-fatigued MS subgroup (n=40). RESULTS Of the fatigued MS patients, 96% (n=25) were suffering from a relevant sleep disorder, along with 60% of the non-fatigued MS patients (n=24) (p=0.001). Sleep-related breathing disorders were more frequent in the fatigued MS patients (27%) than in the non-fatigued MS patients (2.5%). Significantly higher MFIS values were detected in all (fatigued and non-fatigued) patients with relevant sleep disorders (mean MFIS 42.8; SD 18.3) than in patients without relevant sleep disorders (mean MFIS 20.5; SD 17.0) (p<0.001). Suffering from a sleep disorder was associated with an increased risk of fatigue in MS (odds ratio: 18.5; 95% CI 1.6-208; p=0.018). CONCLUSION Our results demonstrate a clear and significant relationship between fatigue and sleep disorders.
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Affiliation(s)
- C Veauthier
- Hanse-Klinikum, Department of Neurology, Stralsund, Germany.
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88
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89
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Der Multiple Wachbleibetest (MWT). SOMNOLOGIE 2010. [DOI: 10.1007/s11818-010-0454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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90
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Sleepiness is not always perceived before falling asleep in healthy, sleep-deprived subjects. Sleep Med 2010; 11:747-51. [DOI: 10.1016/j.sleep.2010.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/23/2010] [Accepted: 03/24/2010] [Indexed: 11/22/2022]
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91
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Banks S, Van Dongen HPA, Maislin G, Dinges DF. Neurobehavioral dynamics following chronic sleep restriction: dose-response effects of one night for recovery. Sleep 2010; 33:1013-26. [PMID: 20815182 PMCID: PMC2910531 DOI: 10.1093/sleep/33.8.1013] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Establish the dose-response relationship between increasing sleep durations in a single night and recovery of neurobehavioral functions following chronic sleep restriction. DESIGN Intent-to-treat design in which subjects were randomized to 1 of 6 recovery sleep doses (0, 2, 4, 6, 8, or 10 h TIB) for 1 night following 5 nights of sleep restriction to 4 h TIB. SETTING Twelve consecutive days in a controlled laboratory environment. PARTICIPANTS N = 159 healthy adults (aged 22-45 y), median = 29 y). INTERVENTIONS Following a week of home monitoring with actigraphy and 2 baseline nights of 10 h TIB, subjects were randomized to either sleep restriction to 4 h TIB per night for 5 nights followed by randomization to 1 of 6 nocturnal acute recovery sleep conditions (N = 142), or to a control condition involving 10 h TIB on all nights (N = 17). MEASUREMENTS AND RESULTS Primary neurobehavioral outcomes included lapses on the Psychomotor Vigilance Test (PVT), subjective sleepiness from the Karolinska Sleepiness Scale (KSS), and physiological sleepiness from a modified Maintenance of Wakefulness Test (MWT). Secondary outcomes included psychomotor and cognitive speed as measured by PVT fastest RTs and number correct on the Digit Symbol Substitution Task (DSST), respectively, and subjective fatigue from the Profile of Mood States (POMS). The dynamics of neurobehavioral outcomes following acute recovery sleep were statistically modeled across the 0 h-10 h recovery sleep doses. While TST, stage 2, REM sleep and NREM slow wave energy (SWE) increased linearly across recovery sleep doses, best-fitting neurobehavioral recovery functions were exponential across recovery sleep doses for PVT and KSS outcomes, and linear for the MWT. Analyses based on return to baseline and on estimated intersection with control condition means revealed recovery was incomplete at the 10 h TIB (8.96 h TST) for PVT performance, KSS sleepiness, and POMS fatigue. Both TST and SWE were elevated above baseline at the maximum recovery dose of 10 h TIB. CONCLUSIONS Neurobehavioral deficits induced by 5 nights of sleep restricted to 4 h improved monotonically as acute recovery sleep dose increased, but some deficits remained after 10 h TIB for recovery. Complete recovery from such sleep restriction may require a longer sleep period during 1 night, and/or multiple nights of recovery sleep. It appears that acute recovery from chronic sleep restriction occurs as a result of elevated sleep pressure evident in both increased SWE and TST.
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Affiliation(s)
- Siobhan Banks
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, Australia
| | | | - Greg Maislin
- Biomedical Statistical Consulting, Wynnewood, PA
| | - David F. Dinges
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA
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92
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Shahid A, Shen J, Shapiro CM. Measurements of sleepiness and fatigue. J Psychosom Res 2010; 69:81-9. [PMID: 20630266 DOI: 10.1016/j.jpsychores.2010.04.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 11/25/2022]
Abstract
Sleepiness and fatigue are terms commonly used in clinical practice and research. At times sleepiness and fatigue are used interchangeably; however, each of them has distinct implications for diagnosis and treatment. The objective of this article is to review the psychometric properties of the measurements of sleepiness and fatigue. Although there are objective and subject measures to evaluate sleepiness, only rating scales are available to assess fatigue. Further research should be directed toward exploring the potential mechanisms underlying the measurements of sleepiness and fatigue. Establishing objective assessing instruments to evaluate fatigue and clarifying the relationship between objective and subjective assessments of sleepiness are crucially needed.
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Affiliation(s)
- Azmeh Shahid
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada.
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93
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Why do we yawn? Neurosci Biobehav Rev 2010; 34:1267-76. [DOI: 10.1016/j.neubiorev.2010.03.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 11/23/2022]
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94
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Alóe F, Alves RC, Araújo JF, Azevedo A, Bacelar A, Bezerra M, Bittencourt LRA, Bustamante G, Cardoso TAMDO, Eckeli AL, Fernandes RMF, Goulart L, Pradella-Hallinan M, Hasan R, Sander HH, Pinto LR, Lopes MC, Minhoto GR, Moraes W, Moreira GA, Pachito D, Pedrazolli M, Poyares D, Prado L, Rizzo G, Rodrigues RN, Roitman I, Silva AB, Tavares SMA. [Brazilian guidelines for the diagnosis of narcolepsy]. ACTA ACUST UNITED AC 2010; 32:294-304. [PMID: 20585744 DOI: 10.1590/s1516-44462010005000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
Abstract
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period -free narcolepsy.
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Affiliation(s)
- Flávio Alóe
- Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
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Bakker J, Campbell A, Neill A. Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep 2010; 33:523-9. [PMID: 20394322 DOI: 10.1093/sleep/33.4.523] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) can be limited by suboptimal compliance. C-Flex technology (Philips Respironics, PA, USA) reduces pressure during expiration, aiming to improve comfort and therefore compliance. This may be of particular relevance to patients requiring high pressures. Many studies thus far have suffered from design limitations and small sample sizes. This study aimed to compare compliance with C-Flex and CPAP, as well as analyzing objective and subjective sleepiness and vigilance. DESIGN Three-month, double-blinded, parallel-arm randomized controlled trial. SETTING A university-based sleep laboratory. PATIENTS 76 consecutive patients with severe OSA (mean +/- SD AHI 60.2 +/- 32.9 events/hour, ESS 13.6 +/- 4.5/24, BMI 35.6 +/- 7.8 kg/m2), without significant cardiac, respiratory, psychiatric, or sleep comorbidities. INTERVENTIONS Patients were randomized to C-Flex (dip level 2) or CPAP. MEASUREMENTS AND RESULTS Patients underwent titration with C-Flex/CPAP (mean pressure 11.6 cm H2O). Modified maintenance of wakefulness tests (mod-MWT), psychomotor vigilance tasks (PVT) and questionnaires were administered at baseline and after one and 3 months. Median compliance was 5.51 and 5.89 h/night in the C-Flex and CPAP groups respectively (P = 0.82). There were no significant differences between groups in terms of PVT reaction time, subjective sleepiness, sleep quality, health-related quality of life, or treatment comfort. There was no significant difference between the groups regarding the change in mod-MWT sleep latency values. CONCLUSIONS In patients with severe OSA both CPAP and C-Flex resulted in substantial improvements in sleepiness, vigilance, and quality of life. The use of C-Flex did not result in greater compliance, and neither treatment appeared superior.
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Affiliation(s)
- Jessie Bakker
- WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand.
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96
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Fabbri M, Pizza F, Magosso E, Ursino M, Contardi S, Cirignotta F, Provini F, Montagna P. Automatic slow eye movement (SEM) detection of sleep onset in patients with obstructive sleep apnea syndrome (OSAS): comparison between multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT). Sleep Med 2010; 11:253-7. [PMID: 20163984 DOI: 10.1016/j.sleep.2009.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 05/13/2009] [Accepted: 05/18/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether automatic slow eye movement (SEM) analysis performs comparably to standard sleep onset criteria at the multiple sleep latency test (MSLT) and at the maintenance of wakefulness test (MWT) in patients with obstructive sleep apnea syndrome (OSAS). METHODS We compared sleep latencies obtained upon standard analysis of MSLT and MWT recordings with automatically detected SEM latencies in a population of 20 severe OSAS patients that randomly underwent the two tests 1 week apart. RESULTS Eight of 20 OSAS patients had EDS as answered by the Epworth Sleepiness Scale (ESS). Mean SEM latency performed comparably to standard sleep onset in both the MSLT (6.4+/-5.5 min versus 7.4+/-5.1 min, p=0.25) and the MWT (25.2+/-14.5 min versus 24.4+/-14.0 min, p=0.45) settings. Mean SEM latency significantly correlated with the sleep latency at the MSLT (r=0.52, p<0.05) and at the MWT (r=0.74, p<0.001). Finally, the Epworth Sleepiness Scale score correlated with SEM latency at the MWT (r=-0.62, p<0.01), but not at the MSLT. CONCLUSIONS Automatic SEM detection performed comparably to standard polysomnographic assessment of sleep onset, thus providing a simplified technical requirement for the MSLT and the MWT. Further studies are warranted to evaluate SEM detection of sleep onset in other sleep disorders with excessive daytime sleepiness.
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Affiliation(s)
- Margherita Fabbri
- Department of Neurological Sciences, University of Bologna, Via Ugo Foscolo 7, 40132 Bologna, Italy
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Edgar CJ, Pace-Schott EF, Wesnes KA. Approaches to measuring the effects of wake-promoting drugs: a focus on cognitive function. Hum Psychopharmacol 2009; 24:371-89. [PMID: 19565524 PMCID: PMC2747813 DOI: 10.1002/hup.1034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES In clinical drug development, wakefulness and wake-promotion may be assessed by a large number of scales and questionnaires. Objective assessment of wakefulness is most commonly made using sleep latency/maintenance of wakefulness tests, polysomnography and/or behavioral measures. The purpose of the present review is to highlight the degree of overlap in the assessment of wakefulness and cognition, with consideration of assessment techniques and the underlying neurobiology of both concepts. DESIGN Reviews of four key areas were conducted: commonly used techniques in the assessment of wakefulness; neurobiology of sleep/wake and cognition; targets of wake promoting and/or cognition enhancing drugs; and ongoing clinical trials investigating wake promoting effects. RESULTS There is clear overlap between the assessment of wakefulness and cognition. There are common techniques which may be used to assess both concepts; aspects of the neurobiology of both concepts may be closely related; and wake-promoting drugs may have nootropic properties (and vice versa). Clinical trials of wake-promoting drugs often, though not routinely, assess aspects of cognition. CONCLUSIONS Routine and broad assessment of cognition in the development of wake-promoting drugs may reveal important nootropic effects, which are not secondary to alertness/wakefulness, whilst existing cognitive enhancers may have underexplored or unknown wake promoting properties.
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Affiliation(s)
| | - Edward F. Pace-Schott
- Department of Psychiatry, Center for Sleep and Cognition, Harvard Medical School, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA
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99
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Pizza F, Contardi S, Mondini S, Trentin L, Cirignotta F. Daytime sleepiness and driving performance in patients with obstructive sleep apnea: comparison of the MSLT, the MWT, and a simulated driving task. Sleep 2009; 32:382-91. [PMID: 19294958 DOI: 10.1093/sleep/32.3.382] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To test the reliability of a driving-simulation test for the objective measurement of daytime alertness compared with the Multiple Sleep Latency Test (MSLT) and with the Maintenance of Wakefulness Test (MWT), and to test the ability to drive safely, in comparison with on-road history, in the clinical setting of untreated severe obstructive sleep apnea. DESIGN N/A. SETTING Sleep laboratory. PATIENTS OR PARTICIPANTS Twenty-four patients with severe obstructive sleep apnea and reported daytime sleepiness varying in severity (as measured by the Epworth Sleepiness Scale). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Patients underwent MSLT and MWT coupled with 4 sessions of driving-simulation test on 2 different days randomly distributed 1 week apart. Simulated-driving performance (in terms of lane-position variability and crash occurrence) was correlated with sleep latency on the MSLT and more significantly on the MWT, showing a predictive validity toward the detection of sleepy versus alert patients with obstructive sleep apnea. In addition, patients reporting excessive daytime sleepiness or a history of car crashes showed poorer performances on the driving simulator. CONCLUSIONS A simulated driving test is a suitable tool for objective measurement of daytime alertness in patients with obstructive sleep apnea. Further studies are needed to clarify the association between simulated-driving performance and on-road crash risk of patients with sleep disordered breathing.
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Affiliation(s)
- Fabio Pizza
- Unit of Neurology, S. Orsola-Malpighi Hospital, Bologna, Italy
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100
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Powers CR, Frey WC. Maintenance of wakefulness test in military personnel with upper airway resistance syndrome and mild to moderate obstructive sleep apnea. Sleep Breath 2009; 13:253-8. [PMID: 19229578 DOI: 10.1007/s11325-009-0245-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 01/12/2009] [Accepted: 01/19/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) and the associated symptom of excessive daytime sleepiness (EDS) in military personnel has influential consequences in both the garrison and the deployed environments. The maintenance of wakefulness test (MWT) is a daytime study used to evaluate the tendency to stay awake. We evaluated consecutive patients diagnosed with mild to moderate obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) to provide an objective measure of their EDS using the MWT. MATERIALS AND METHODS All military personnel referred between February 2004 and March 2005 with a clinical evaluation suspicious for SDB were evaluated with an overnight polysomnography (PSG). After overnight PSG, military personnel with mild to moderate OSA and UARS were evaluated with a 40-min protocol MWT. Abnormal MWT was defined as sleep onset latency mean below 19.4 min (<2 SD below the mean). RESULTS Sixty-two military personnel met entry criteria. Fifty-nine were men. Nineteen patients (32%) were diagnosed with UARS with a mean respiratory disturbance index of 11/h (5-20/h). Forty-one (68%) of the military personnel had OSA with a mean apnea-hypopnea index of 12/h (5-29/h). As a collective group, the mean Epworth Sleepiness Scale was elevated at 13/24 (1-24). This subjective excessive sleepiness was assessed with the MWT test, which resulted in a group mean MWT sleep onset latency of 27 min (5-40 min). Eighteen soldiers (30% of the total patients) had abnormal MWTs [six patients (33.3%) with UARS and 12 (67%) with OSA]. CONCLUSION Military personnel with mild to moderate OSA and UARS often have abnormal MWTs and therefore have a pathological tendency to fall asleep. This EDS could pose a safety hazard in those personnel, military or civilian, who operate dangerous vehicles, machinery, or carry a firearm. Military personnel with untreated SDB are also at risk for the consequences of decreased mental alertness and decreased cognitive functioning due to daytime sleepiness.
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Affiliation(s)
- Christopher R Powers
- Pulmonary, Critical Care and Sleep Medicine Service, William Beaumont Army Medical Center, El Paso, TX 79920, USA.
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