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Lee PL, Wu YW, Cheng HM, Wang CY, Chuang LP, Lin CH, Hang LW, Yu CC, Hung CL, Liu CL, Chou KT, Su MC, Cheng KH, Huang CY, Hou CJY, Chiu KL. Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of sleep Medicine/Taiwan Society of pulmonary and Critical Care Medicine joint consensus statement. J Formos Med Assoc 2024; 123:159-178. [PMID: 37714768 DOI: 10.1016/j.jfma.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.
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Affiliation(s)
- Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan; PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Pang Chuang
- Sleep Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Tauyan, Taiwan
| | - Chou-Han Lin
- Division of Respirology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chieh Yu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, Taipei, Taiwan
| | - Ching-Lung Liu
- Division of Chest, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kai-Hung Cheng
- Kao-Ho Hospital, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
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Alakörkkö I, Törmälehto S, Leppänen T, McNicholas WT, Arnardottir ES, Sund R. The economic cost of obstructive sleep apnea: A systematic review. Sleep Med Rev 2023; 72:101854. [PMID: 37939650 DOI: 10.1016/j.smrv.2023.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023]
Abstract
Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA. Two bibliographic databases, PubMed and Scopus, were used to identify articles on the costs of OSA. The systematic literature review identified 5,938 publications, of which 31 met the inclusion criteria. According to the results, adjusted for inflation and converted to euros, the annual cost per patient ranged from €236 (the incremental cost of OSA) for New Zealand to €28,267 for the United States. The total annual cost per patient in Europe ranged from €1,669 to €5,186. OSA causes a significant burden on society, and OSA-related costs increase many years before the diagnosis and remain elevated for a long time after the diagnosis. Despite some well-conducted studies, the cost estimates for OSA are uncertain and specific to the context in which the study was conducted.
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Affiliation(s)
- Ida Alakörkkö
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Soili Törmälehto
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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An J, Glick HA, Sawyer AM, Arguelles J, Bae CJ, Keenan BT, Kuna ST, Maislin G, Mazzotti DR, Pack AI, Shi JM, Watach AJ, Hwang D. Association Between Positive Airway Pressure Adherence and Health Care Costs Among Individuals With OSA. Chest 2023; 163:1543-1554. [PMID: 36706909 DOI: 10.1016/j.chest.2023.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The impact of positive airway pressure (PAP) therapy for OSA on health care costs is uncertain. RESEARCH QUESTION Are 3-year health care costs associated with PAP adherence in participants from the Tele-OSA clinical trial? STUDY DESIGN AND METHODS Participants with OSA and prescribed PAP in the Tele-OSA study were stratified into three PAP adherence groups based on usage patterns over 3 years: (1) high (consistently ≥ 4 h/night), (2) moderate (2-3.9 h/night or inconsistently ≥ 4 h/night), and (3) low (< 2 h/night). Using data from 3 months of the Tele-OSA trial and 33 months of posttrial follow up, average health care costs (2020 US dollars) in 6-month intervals were derived from electronic health records and analyzed using multivariable generalized linear models. RESULTS Of 543 participants, 25% were categorized as having high adherence, 22% were categorized as having moderate adherence, and 52% were categorized as having low adherence to PAP therapy. Average PAP use mean ± SD was 6.5 ± 1.0 h, 3.7 ± 1.2 h, and 0.5 ± 0.5 h for the high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average covariate-adjusted 6-month health care costs ± SE ($3,207 ± $251) compared with the moderate ($3,638 ± $363) and low ($4,040 ± $304) adherence groups. Significant cost differences were observed between the high and low adherence groups ($832; 95% CI, $127 to $1,538); differences between moderate and low adherence were nonsignificant ($401; 95% CI, -$441 to $1,243). INTERPRETATION In participants with OSA, better PAP adherence was associated with significantly lower health care costs over 3 years. Findings support the importance of strategies to enhance long-term PAP adherence.
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Affiliation(s)
- Jaejin An
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Henry A Glick
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Amy M Sawyer
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | | | - Charles J Bae
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samuel T Kuna
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Greg Maislin
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jiaxiao M Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alexa J Watach
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Dennis Hwang
- Sleep Medicine, Southern California Medical Group, Fontana, CA.
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Li Y, Wang J, Ji L, Cheng C, Su T, Wu S, Han F, Cox DJ, Wang E, Chen R. Cortical thinning in male obstructive sleep apnoea patients with excessive daytime sleepiness. Front Neurol 2023; 14:1019457. [PMID: 37034093 PMCID: PMC10076663 DOI: 10.3389/fneur.2023.1019457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Background and purpose Obstructive sleep apnoea is associated with excessive daytime sleepiness due to sleep fragmentation and hypoxemia, both of which can lead to abnormal brain morphology. However, the pattern of brain structural changes associated with excessive daytime sleepiness is still unclear. This study aims to investigate the effects of excessive daytime sleepiness on cortical thickness in patients with obstructive sleep apnoea. Materials and methods 61 male patients with newly diagnosed obstructive sleep apnoea were included in the present study. Polysomnography and structural MRI were performed for each participant. Subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale score. Surface-based morphometric analysis was performed using Statistical Parametric Mapping 12 and Computational Anatomy 12 toolboxes to extract cortical thickness. Results Using the median Epworth Sleepiness Scale score, patients were divided into the non-sleepiness group and the sleepiness group. The cortical thickness was markedly thinner in the sleepiness group in the left temporal, frontal, and parietal lobe and bilateral pre- and postcentral gyri (pFWE < 0.05). There was a significant negative correlation between the cortical thickness and the Epworth Sleepiness Scale score. After adjusting for age, body mass index, and obstructive sleep apnoea severity, the Epworth Sleepiness Scale score remained an independent factor affecting the cortical thickness of the left middle temporal lobe, transverse temporal and temporal pole. Conclusion Subjective daytime sleepiness is associated with decreased cortical thickness, and the Epworth Sleepiness Scale score may be of utility as a clinical marker of brain injury in patients with obstructive sleep apnoea.
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Affiliation(s)
- Yezhou Li
- School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Jing Wang
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lirong Ji
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chaohong Cheng
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tong Su
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuqing Wu
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei Han
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Daniel J. Cox
- Division of Psychology, Communication, and Human Neuroscience, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Erlei Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Erlei Wang,
| | - Rui Chen
- Department of Respiratory and Critical Care, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Sleep Centre, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Rui Chen,
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Cambron-Mellott MJ, Mettam S, Li VW, Rowland JC, Castro JC. Examining the impact of excessive daytime sleepiness on utility scores in patients with obstructive sleep apnoea and/or narcolepsy in five European countries. BMC Neurol 2022; 22:317. [PMID: 36008792 PMCID: PMC9404621 DOI: 10.1186/s12883-022-02827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Excessive daytime sleepiness (EDS) is a cardinal symptom of narcolepsy and affects many patients with obstructive sleep apnoea (OSA). EDS is associated with reduced quality of life, increased accident risk, and poor workplace performance. Given the impact of EDS, the ability to predict health-related utility from sleepiness is valuable for examining the cost effectiveness of novel treatments. The aim of this study was to examine the association between EDS and EQ-5D in patients with OSA and/or narcolepsy by modelling EQ-5D utility scores from Epworth Sleepiness Scale (ESS) scores. Methods Data were obtained from the Europe 2016/2017 National Health and Wellness Survey, an online, general population survey, designed to represent the age and gender composition of each country’s adult population. Analyses included 2,348 patients self-reporting symptomatic and diagnosed OSA (n = 2,277), narcolepsy (n = 48), or both (n = 23). Multivariable models were used to examine ESS as a predictor of EQ-5D utility while adjusting for covariates of interest. Results were validated following the National Institute for Health and Care Excellence Decision Support Unit guidelines for predictive modelling. Results Utility decreased as EDS severity increased (no EDS: 0.711 ± 0.251, mild: 0.685 ± 0.261, moderate: 0.643 ± 0.268, severe: 0.559 ± 0.323). Whereas participants with only OSA or only narcolepsy did not differ in utility, those with both conditions had lower scores (0.685 ± 0.266 and 0.627 ± 0.325 vs. 0.439 ± 0.340, respectively). Piecewise linear regression identified a single breakpoint at ESS score of 11.29. In the final model, for each point increase in ESS score, the corresponding decrease in EQ-5D utility was larger among patients with ESS scores ≥ 12 compared to patients with ESS scores ≤ 11 (model slopes: -0.0131 vs. -0.0026, respectively). Findings from the validation sample confirmed these results. Conclusions This study demonstrates the impact of sleepiness on quality of life (QoL) and its negative impact irrespective of sleep condition (OSA or narcolepsy). The breakpoint identified is relatively consistent with the established ESS cutoff score ≥ 11, which demarcates pathological sleepiness. Furthermore, as EDS severity worsens (increases) on the ESS, the impact on QoL is greater. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02827-7.
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Olivares MJ, Toledo C, Ortolani D, Ortiz FC, Díaz HS, Iturriaga R, Del Río R. Sleep dysregulation in sympathetic-mediated diseases: implications for disease progression. Sleep 2022; 45:6649852. [DOI: 10.1093/sleep/zsac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/18/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The autonomic nervous system (ANS) plays an important role in the coordination of several physiological functions including sleep/wake process. Significant changes in ANS activity occur during wake-to-sleep transition maintaining the adequate cardiorespiratory regulation and brain activity. Since sleep is a complex homeostatic function, partly regulated by the ANS, it is not surprising that sleep disruption trigger and/or evidence symptoms of ANS impairment. Indeed, several studies suggest a bidirectional relationship between impaired ANS function (i.e. enhanced sympathetic drive), and the emergence/development of sleep disorders. Furthermore, several epidemiological studies described a strong association between sympathetic-mediated diseases and the development and maintenance of sleep disorders resulting in a vicious cycle with adverse outcomes and increased mortality risk. However, which and how the sleep/wake control and ANS circuitry becomes affected during the progression of ANS-related diseases remains poorly understood. Thus, understanding the physiological mechanisms underpinning sleep/wake-dependent sympathetic modulation could provide insights into diseases involving autonomic dysfunction. The purpose of this review is to explore potential neural mechanisms involved in both the onset/maintenance of sympathetic-mediated diseases (Rett syndrome, congenital central hypoventilation syndrome, obstructive sleep apnoea, type 2 diabetes, obesity, heart failure, hypertension, and neurodegenerative diseases) and their plausible contribution to the generation of sleep disorders in order to review evidence that may serve to establish a causal link between sleep disorders and heightened sympathetic activity.
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Affiliation(s)
- María José Olivares
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Camilo Toledo
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
| | - Domiziana Ortolani
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Fernando C Ortiz
- Mechanisms of Myelin Formation and Repair Laboratory, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile , Santiago , Chile
| | - Hugo S Díaz
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
| | - Rodrigo Iturriaga
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
| | - Rodrigo Del Río
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile , Santiago , Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes , Punta Arenas , Chile
- Centro de Envejecimiento y Regeneración (CARE), Pontificia Universidad Católica de Chile , Santiago , Chile
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El-Mekkawy L, El Salmawy D, Basheer MA, Maher E, Nada MM. Screening of non-restorative sleep by quantitative EEG. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Non-restorative sleep is the major cause of excessive daytime sleepiness and causes injures of the central nervous system. The most common cause of Excessive day sleepiness in a clinical setting is obstructive sleep apnea. Sleepiness scales can assess multiple aspects of the sleep and include subjective and objective measures. The present study aim to disclose the capability of quantitative electroencephalography to screen, as well as to know the pathogenesis of non-restorative sleep in patients with excessive day time sleepiness.
Results
Twenty obstructive sleep apnea patients and 20 healthy control subjects were recruited. All patients were subjected to Epworth sleepiness scale and polysomnography. Quantitative electroencephalography and Karolinska sleepiness scale were done before and after sleep for patients as well as controls. The patients group revealed a significant power reduction in delta and alpha bands, comparing before and after sleep records. Interestingly, there was a significant change in delta power in the temporal delta waves power. Yet, the changes were opposite among cases (significant decrease) versus controls (significant increase). In addition, there were significant correlations between sleepiness scales; Epworth sleepiness scale and Karolinska Sleepiness Scale scores, and alpha band results in quantitative electroencephalography.
Conclusion
Quantitative electroencephalography with further research, could provide us with clues to the pathogenesis of EDS and non-restorative sleep accompanying OSA and an objective screening tool.
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Ronnebaum S, Bron M, Patel D, Menno D, Bujanover S, Kratochvil D, Lucas E, Stepnowsky C. Indirect treatment comparison of solriamfetol, modafinil, and armodafinil for excessive daytime sleepiness in obstructive sleep apnea. J Clin Sleep Med 2021; 17:2543-2555. [PMID: 34402784 DOI: 10.5664/jcsm.9610] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness associated with obstructive sleep apnea affects 9%-22% of continuous positive airway pressure-treated patients. An indirect treatment comparison meta-analysis was performed to compare efficacy and safety of medications (solriamfetol, modafinil, and armodafinil) approved to treat excessive daytime sleepiness associated with obstructive sleep apnea. METHODS Efficacy and safety measures assessed in this indirect treatment comparison included Epworth Sleepiness Scale (ESS), 20-minute Maintenance of Wakefulness Test (MWT20), Clinical Global Impression of Change (CGI-C), Functional Outcomes of Sleep Questionnaire (FOSQ), and incidence of treatment-emergent adverse events (any, serious, or leading to discontinuation). RESULTS A systematic literature review identified 6 parallel-arm, placebo-controlled randomized controlled trials that randomized 1,714 total participants to placebo, solriamfetol, modafinil, or armodafinil. In this indirect treatment comparison, all comparators were associated with greater improvements than placebo on the ESS, MWT20, and CGI-C after 4, 8, and 12 weeks of treatment. Relative to comparators and placebo at 12 weeks, solriamfetol at 150 mg or 300 mg had the highest probabilities of improvement in the ESS, MWT20, and CGI-C. Modafinil (200 or 400 mg) and solriamfetol (150 or 300 mg) were associated with greater improvement on the FOSQ than placebo at 12 weeks. Less than 2% of patients using placebo or comparators experienced serious or discontinuation-related treatment-emergent adverse events. CONCLUSIONS The results of this indirect treatment comparison show 12 weeks of treatment with solriamfetol, modafinil, and armodafinil resulted in varying levels of improvement on the ESS, MWT20, and CGI-C and similar safety risks in participants with excessive daytime sleepiness associated with obstructive sleep apnea. CITATION Ronnebaum S, Bron M, Patel D, et al. Indirect treatment comparison of solriamfetol, modafinil, and armodafinil for excessive daytime sleepiness in obstructive sleep apnea. J Clin Sleep Med. 2021;17(12):2543-2555.
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Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes. Neurol Ther 2021; 10:651-672. [PMID: 34658002 PMCID: PMC8520824 DOI: 10.1007/s40120-021-00289-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 02/04/2023] Open
Abstract
Although excessive daytime sleepiness (EDS) attributable to obstructive sleep apnea (OSA) can be resolved by consistent usage of and effective treatment (often with the use of continuous positive airway pressure therapy), 12–58% of patients report residual EDS (REDS). While REDS is difficult to treat, a proportion of cases are possibly due to reversible issues, and wake-promoting medications can prove useful for the remaining cases. Given the challenges associated with effective management of REDS and its relationship to multiple comorbidities, multidisciplinary management of patients with REDS is often recommended. Here we aim to bridge the knowledge gap on the burden, risk factors, prevalence, and potential pathophysiologic mechanisms of REDS in patients with OSA after first-line treatment. The roles of primary care physicians and sleep specialists, as well as the importance of the use of objective assessment tools for the evaluation of REDS and the effective management of comorbidities, are discussed. An update of approved treatments and emerging candidate treatments is also presented.
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Soreca I. The role of circadian rhythms in Obstructive Sleep Apnea symptoms and novel targets for treatment. Chronobiol Int 2021; 38:1274-1282. [PMID: 34027758 DOI: 10.1080/07420528.2021.1929281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/09/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a common disorder that is associated with disability, premature mortality and lost quality of life. Excessive daytime sleepiness and depressive symptoms confer a great portion of the disability and lost quality of life associated with the disorder. While showing robust rates of response and symptoms resolutions, current treatments aimed at correcting the respiratory disturbances are not universally successful and a non-negligible proportion of patients who are correctly using available therapies do not experience symptomatic relief, suggesting that mechanisms beyond the respiratory disturbances may be involved in the pathogenesis of symptoms. A growing body of literature concerning animal and human models suggests that the sleep and respiratory disturbances commonly seen in OSA, namely sleep fragmentation, partial sleep deprivation, intermittent hypoxia, can promote shifts in circadian rhythms ultimately leading to misalignment between sleep-wake rhythms and the internal clock, as well as desynchrony amongst peripheral clocks and peripheral and central clock. This manuscript reviews the current evidence in support of a circadian disturbance underlying OSA symptomatology and proposes new applications for existing chronotherapeutic interventions with the potential for improving symptoms and quality of life for those patients that do not find symptomatic relief with currently available treatments.
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Affiliation(s)
- Isabella Soreca
- Department of Sleep Medicine, Mental Illness Research, Clinical, Education Centers of Excellence (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Celik Y, Yapici-Eser H, Balcan B, Peker Y. Association of Excessive Daytime Sleepiness with the Zung Self-Rated Depression Subscales in Adults with Coronary Artery Disease and Obstructive Sleep Apnea. Diagnostics (Basel) 2021; 11:1176. [PMID: 34203553 PMCID: PMC8308057 DOI: 10.3390/diagnostics11071176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/09/2023] Open
Abstract
Excessive daytime sleepiness (EDS) is a factor associated with both obstructive sleep apnea (OSA) and depressive symptoms. Continuous positive airway pressure (CPAP) treatment may decrease EDS in adults with OSA; however, the modulatory role of depressive symptoms on the improvement of EDS is not known. We aimed to explore the association between subscales of the Zung Self-rated Depression Scale (SDS) and Epworth Sleepiness Scale (ESS) over a 2-year period in coronary artery disease (CAD) patients with OSA. This was a post-hoc analysis of the RICCADSA cohort, in which 399 adults with CAD (155 sleepy OSA [apnea-hypopnea index ≥ 15/h] and ESS score ≥ 10, who were offered CPAP; and 244 nonsleepy OSA [ESS < 10]), randomized to CPAP [n = 122] or no-CPAP [n = 122]) were included. Three factors were extracted from the Zung SDS, based on the principal component analysis: F1, cognitive symptoms and anhedonia; F2, negative mood; and F3, appetite. In a mixed model, the ESS score decreased by 3.4 points (p < 0.001) among the sleepy OSA phenotype, which was predicted by the decline in the F2, but not in the F1 and F3 scores. The fixed effects of time were not significant in the nonsleepy OSA groups, and thus, further analyses were not applicable. Additional within-group analyses showed a significant decrease in all subscales over time both in the sleepy and nonsleepy OSA patients on CPAP whereas there was a significant increase in the nonsleepy OSA group randomized to no-CPAP. We conclude that the improvement in negative mood symptoms of depression, but not changes in cognitive symptoms and anhedonia as well as appetite, was a significant predictor of decline in the ESS scores over a 2-year period in this CAD cohort with sleepy OSA on CPAP treatment.
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Affiliation(s)
- Yeliz Celik
- School of Medicine, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul 34450, Turkey; (H.Y.-E.); (Y.P.)
- Graduate School of Health Sciences, Koç University, Istanbul 34450, Turkey
| | - Hale Yapici-Eser
- School of Medicine, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul 34450, Turkey; (H.Y.-E.); (Y.P.)
- Department of Psychiatry, School of Medicine, Koç University, Istanbul 34450, Turkey
| | - Baran Balcan
- Department of Pulmonary Medicine, School of Medicine, Marmara University, Istanbul 34722, Turkey;
| | - Yüksel Peker
- School of Medicine, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul 34450, Turkey; (H.Y.-E.); (Y.P.)
- Department of Clinical Sciences, Respiratory Medicine and Allergology, School of Medicine, Lund University, 22185 Lund, Sweden
- Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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12
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Streatfeild J, Smith J, Mansfield D, Pezzullo L, Hillman D. The Social And Economic Cost Of Sleep Disorders. Sleep 2021; 44:6279099. [PMID: 34015136 DOI: 10.1093/sleep/zsab132] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/14/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To estimate economic cost of common sleep disorders in Australia for 2019-2020. METHODS Costs were estimated for obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) using prevalence, financial, and nonfinancial data from national databases. These included: (1) financial costs associated with health care, informal care, productivity losses, non-medical accident costs, deadweight loss from taxation/welfare inefficiencies; and (2) nonfinancial costs associated with loss of well-being. They were expressed in US dollars ($). RESULTS Estimated overall cost of sleep disorders in Australia in 2019-2020 (population: 25.5 million) was $35.4 billion (OSA $13.1 billion; insomnia $13.3 billion, RLS $9.0 billion). Of this, the financial cost component was $10.0 billion, comprised of: health system costs $0.7 billion; productivity losses $7.7 billion; informal care $0.2 billion; other, mainly non-medical accident costs, $0.4 billion; and deadweight losses $1.0 billion. For moderate to severe OSA syndrome, insomnia unrelated to other conditions and RLS, financial costs represented $16,717, $21,982, and $16,624 per adult with the condition for the year, respectively. The nonfinancial cost was $25.4 billion. CONCLUSIONS The economic costs associated with sleep disorders are substantial. The financial component of $10.0 billion is equivalent to 0.73% of Australian gross domestic product. The nonfinancial cost of $25.4 billion represents 3.2% of total Australian burden of disease for the year. Health system costs of these disorders are low relative to those associated with their consequences, suggesting greater expenditure on detection, treatment and prevention is warranted.
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Affiliation(s)
- Jared Streatfeild
- Health Economics and Social Policy Team, Deloitte Access Economics, Canberra, Australia
| | - Jackson Smith
- Health Economics and Social Policy Team, Deloitte Access Economics, Canberra, Australia
| | - Darren Mansfield
- Monash Lung and Sleep Department, Monash Health, Melbourne, Australia
| | - Lynne Pezzullo
- Health Economics and Social Policy Team, Deloitte Access Economics, Canberra, Australia
| | - David Hillman
- Centre for Sleep Science, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
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13
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Jennum P, Coaquira Castro J, Mettam S, Kharkevitch T, Cambron-Mellott MJ. Socioeconomic and humanistic burden of illness of excessive daytime sleepiness severity associated with obstructive sleep apnoea in the European Union 5. Sleep Med 2021; 84:46-55. [PMID: 34102429 DOI: 10.1016/j.sleep.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/25/2021] [Accepted: 05/09/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND Evaluate the impact of excessive daytime sleepiness (EDS) severity on burden of illness among adults with obstructive sleep apnoea (OSA) in European Union 5 (EU5) countries (France, Germany, Italy, Spain, United Kingdom). PATIENTS/METHODS This retrospective observational study used data from the 2017 EU5 National Health and Wellness Survey, a self-administered, internet-based, non-screening survey. Respondents who self-reported both having experienced OSA in the last 12 months and having had their OSA diagnosed by a physician were considered to have OSA. Respondents completed the Epworth Sleepiness Scale (ESS) and were consequently categorised into 4 groups: OSA-with-EDS (ESS >10) subdivided by EDS severity (mild [ESS = 11-12], moderate [ESS = 13-15], severe [ESS = 16-24]), and OSA-without-EDS (ESS ≤10). Bivariate and multivariable analyses examined group differences in health-related quality of life (HRQoL), work productivity and activity impairment, and health care utilisation. RESULTS The analysis included 2008 respondents with OSA: n = 661 (32.9%) with EDS (29.5% mild, 34.5% moderate, 36.0% severe) and n = 1347 without EDS. Compared with the OSA-without-EDS group, the OSA-with-EDS subgroups generally had higher rates of obesity, depression, and other reported comorbidities. Greater severity of EDS was associated with worse self-reported HRQoL (all domains, P < 0.001) and work productivity and activity impairment (absenteeism, P = 0.031; presenteeism, overall work impairment, and non-work activity impairment, P < 0.001), as well as increased numbers of health care provider visits (P < 0.001). CONCLUSIONS Compared to patients with OSA but without EDS, those with EDS had substantially higher socioeconomic and humanistic burden of disease, which was more profound among those reporting greater EDS.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Copenhagen, Denmark.
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14
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Zhang D, Zhang Z, Li H, Ding K. Excessive Daytime Sleepiness in Depression and Obstructive Sleep Apnea: More Than Just an Overlapping Symptom. Front Psychiatry 2021; 12:710435. [PMID: 34566713 PMCID: PMC8458762 DOI: 10.3389/fpsyt.2021.710435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a significant public health concern, with obstructive sleep apnea (OSA) being a common cause, and a particular relationship exists with the severity of depression. A literature search on OSA, depression, and EDS was performed in PubMed. The chosen evidence was limited to human studies. Available evidence was systematically reviewed to ascertain the association of EDS with depression and OSA according to the general population and some specific population subgroups. In addition, effectiveness of continuous positive airway pressure (CPAP) was analyzed as a standard therapy for improving EDS and depression in patients with OSA. In the general population, patients with OSA, and some other subpopulations, the review contributed to: (1) delineating the prevalence of EDS; (2) substantiating the relationship of EDS and depression; (3) presenting the relationship between EDS and OSA; and (4) revealing that the duration of CPAP is crucial for its therapeutic effects in improving EDS and depressive symptoms in patients with OSA.
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Affiliation(s)
- Danwei Zhang
- Department of Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Zhen Zhang
- Department of Psychiatry, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Huihua Li
- Department of Psychiatry, Zhenjiang Mental Health Center, Zhenjiang, China
| | - Kaimo Ding
- Department of Psychology, Zhenjiang Mental Health Center, Zhenjiang, China
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15
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Weaver TE, Drake CL, Benes H, Stern T, Maynard J, Thein SG, Andry JM, Hudson JD, Chen D, Carter LP, Bron M, Lee L, Black J, Bogan RK. Effects of Solriamfetol on Quality-of-Life Measures from a 12-Week Phase 3 Randomized Controlled Trial. Ann Am Thorac Soc 2020; 17:998-1007. [PMID: 32353246 PMCID: PMC7393785 DOI: 10.1513/annalsats.202002-136oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/30/2020] [Indexed: 01/01/2023] Open
Abstract
Rationale: Excessive daytime sleepiness in patients with obstructive sleep apnea is associated with substantial burden of illness.Objectives: To assess treatment effects of solriamfetol, a dopamine/norepinephrine reuptake inhibitor, on daily functioning, health-related quality of life, and work productivity in participants with obstructive sleep apnea and excessive daytime sleepiness as additional outcomes in a 12-week phase 3 trial (www.clinicaltrials.gov identifier NCT02348606).Methods: Participants (N = 476) were randomized to solriamfetol 37.5, 75, 150, or 300 mg or to placebo. Outcome measures included the Functional Outcomes of Sleep Questionnaire short version, Work Productivity and Activity Impairment Questionnaire: Specific Health Problem, and 36-item Short Form Health Survey version 2. A mixed-effects model with repeated measures was used for comparisons with placebo.Results: Demographics, baseline disease characteristics, daily functioning, health-related quality of life, and work productivity were similar across groups. At Week 12, increased functioning and decreased impairment were observed with solriamfetol 150 and 300 mg (mean difference from placebo [95% confidence interval]) on the basis of Functional Outcomes of Sleep Questionnaire total score (1.22 [0.57 to 1.88] and 1.47 [0.80 to 2.13], respectively), overall work impairment (-11.67 [-19.66 to -3.69] and -11.75 [-19.93 to -3.57], respectively), activity impairment (-10.42 [-16.37 to -4.47] and -10.51 [-16.59 to -4.43], respectively), physical component summary (2.07 [0.42 to 3.72] and 1.91 [0.22 to 3.59], respectively), and mental component summary (150 mg only, 2.05 [0.14 to 3.96]). Common adverse events were headache, nausea, decreased appetite, and anxiety.Conclusions: Solriamfetol improved measures of functioning, quality of life, and work productivity in participants with obstructive sleep apnea and excessive daytime sleepiness. Safety was consistent with previous studies.Clinical trial registered with www.clinicaltrials.gov (NCT02348606).
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Affiliation(s)
- Terri E. Weaver
- University of Illinois at Chicago College of Nursing, Chicago, Illinois
| | | | - Heike Benes
- Somni Bene Institut für Medizinische Forschung und Schlafmedizin Schwerin GmbH, Schwerin, Germany
- Medical Center, University of Rostock, Rostock, Germany
| | - Thomas Stern
- Advanced Respiratory and Sleep Medicine, PLLC, Huntersville, North Carolina
| | | | - Stephen G. Thein
- Pacific Research Network, Evolution Research Group, LLC, San Diego, California
| | | | | | - Dan Chen
- Jazz Pharmaceuticals, Palo Alto, California
| | - Lawrence P. Carter
- Jazz Pharmaceuticals, Palo Alto, California
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Jed Black
- Jazz Pharmaceuticals, Palo Alto, California
- Stanford Center for Sleep Sciences and Medicine, Palo Alto, California
| | - Richard K. Bogan
- SleepMed, Inc., Columbia, South Carolina; and
- University of South Carolina School of Medicine, Columbia, South Carolina
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16
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The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea. Sleep Med Rev 2020; 51:101275. [PMID: 32169792 DOI: 10.1016/j.smrv.2020.101275] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 12/02/2019] [Accepted: 12/19/2019] [Indexed: 01/06/2023]
Abstract
Excessive daytime sleepiness (EDS) is common in patients with obstructive sleep apnea (OSA) and continues to persist in many patients despite adequate OSA treatment. EDS in OSA is associated with decreased quality of life (QOL) as well as increased societal burden, which may impact health care utilization and costs. However, economic burden is often not the primary focus in the treatment of EDS in OSA. This targeted literature review aimed to examine the published literature on the economic burden of EDS in OSA. This review identified available literature using a targeted PubMed search strategy using search terms related to EDS in OSA in adults. Results demonstrate that there are few studies that detailed the direct costs associated with EDS in OSA, though several studies indicated an association between EDS in OSA and indirect economic burdens, including motor vehicle accidents (MVAs), near misses, work productivity, mood, and QOL. Data from the literature confirmed that persistent EDS in OSA following continuous positive airway pressure persists in 12%-65% of patients. Future studies should further describe the direct costs of EDS in OSA, quantify the cost associated with MVAs and lost work productivity, and detail QOL and social impacts of the condition.
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17
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Gaisl T, Rejmer P, Thiel S, Haile SR, Osswald M, Roos M, Bloch KE, Stradling JR, Kohler M. Effects of suboptimal adherence of CPAP therapy on symptoms of obstructive sleep apnoea: a randomised, double-blind, controlled trial. Eur Respir J 2019; 55:13993003.01526-2019. [DOI: 10.1183/13993003.01526-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/04/2019] [Indexed: 11/05/2022]
Abstract
IntroductionContinuous positive airway pressure (CPAP) is currently the treatment of choice for sleepiness in patients with obstructive sleep apnoea (OSA); however, adherence is often thought to be suboptimal. We investigated the effects of suboptimal CPAP usage on objective and subjective sleepiness parameters in patients with OSA.Material and methodsIn this 2-week, parallel, double-blind, randomised controlled trial we enrolled moderate-to-severe OSA patients with excessive pre-treatment daytime sleepiness (Epworth sleepiness scale (ESS) score >10 points) who had suboptimal CPAP adherence over ≥12 months (mean nightly usage time 3–4 h). Patients were allocated through minimisation to either subtherapeutic CPAP (“sham CPAP”) or continuation of CPAP (“therapeutic CPAP”). A Bayesian analysis with historical priors calculated the posterior probability of superiority.ResultsBetween May, 2016 and November, 2018, 57 patients (aged 60±8 years, 79% male, 93% Caucasian) were allocated in total, and 52 who completed the study (50% in each arm) were included in the final analysis. The unadjusted ESS score increase was 2.4 points (95% CI 0.6–4.2, p=0.01) in the sham-CPAP group when compared to continuing therapeutic CPAP. The probability of superiority of therapeutic CPAP over sham CPAP was 90.4% for ESS, 90.1% for systolic blood pressure and 80.3% for diastolic blood pressure.ConclusionsPatients with moderate-to-severe OSA and daytime sleepiness are still getting a substantial benefit from suboptimal CPAP adherence, albeit not as much as they might get if they adhered more. Whether a similar statement can be made for even lower adherence levels remains to be established in future trials.
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18
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Stepnowsky C, Sarmiento KF, Bujanover S, Villa KF, Li VW, Flores NM. Comorbidities, Health-Related Quality of Life, and Work Productivity Among People With Obstructive Sleep Apnea With Excessive Sleepiness: Findings From the 2016 US National Health and Wellness Survey. J Clin Sleep Med 2019; 15:235-243. [PMID: 30736870 DOI: 10.5664/jcsm.7624] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Few population-based studies have explored how excessive sleepiness (ES) contributes to burden of illness among patients with obstructive sleep apnea (OSA). METHODS This study utilized data from the annual, cross-sectional 2016 US National Health and Wellness Survey. Respondents self-reporting an OSA diagnosis were categorized as having ES (Epworth Sleepiness Scale [ESS] score ≥ 11) or not having ES (ESS score < 11). Comorbidities, health-related quality of life (HRQoL), and productivity were examined in three groups: OSA with ES (n = 731), OSA without ES (n = 1,452), and non-OSA controls (n = 86,961). RESULTS The OSA with ES group had significantly higher proportions of respondents reporting depression (62.4% versus 48.0%), gastroesophageal reflux disease (39.0% versus 29.4%), asthma (26.3% versus 20.7%), and angina (7.8% versus 6.7%) compared to the OSA without ES group (P < .05). After controlling for covariates, the OSA with ES group had significantly lower (worse) scores for mental component score (41.81 versus 45.65 versus 47.81), physical component score (46.62 versus 48.68 versus 51.36), and SF-6D (0.65 versus 0.69 versus 0.73) compared with OSA without ES and non-OSA controls (all P < .001). The OSA with ES group had significantly higher (greater burden) mean rates of presenteeism (25.98% impairment versus 19.24% versus 14.75%), work impairment (29.41% versus 21.82% versus 16.85%), and activity impairment (31.09% versus 25.46% versus 19.93%) compared with OSA without ES and non-OSA controls (all P < .01) after controlling for covariates. CONCLUSIONS OSA with ES is associated with higher prevalence of comorbidities, reduced HRQoL, and greater impairment in productivity compared to OSA without ES and compared to non-OSA controls.
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Affiliation(s)
| | - Kathleen F Sarmiento
- San Francisco VA Health Care System, San Francisco, California.,University of California San Francisco, San Francisco, California
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19
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Steiropoulos P, Galbiati A, Ferini-Strambi L. Detection of mild cognitive impairment in middle-aged and older adults with obstructive sleep apnoea: does excessive daytime sleepiness play a role? Eur Respir J 2019; 53:53/1/1801917. [PMID: 30606763 DOI: 10.1183/13993003.01917-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Paschalis Steiropoulos
- Dept of Neurology OSR-Turro-Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy.,Sleep Unit, Dept of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andrea Galbiati
- Dept of Neurology OSR-Turro-Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Ferini-Strambi
- Dept of Neurology OSR-Turro-Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy
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20
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Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, Hedner J, Kohler M, Martinez-Garcia MA, Mihaicuta S, Montserrat J, Pepin JL, Pevernagie D, Pizza F, Polo O, Riha R, Ryan S, Verbraecken J, McNicholas WT. Challenges and perspectives in obstructive sleep apnoea. Eur Respir J 2018; 52:13993003.02616-2017. [DOI: 10.1183/13993003.02616-2017] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
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21
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Prasad B, Steffen AD, Van Dongen HPA, Pack FM, Strakovsky I, Staley B, Dinges DF, Maislin G, Pack AI, Weaver TE. Determinants of sleepiness in obstructive sleep apnea. Sleep 2018; 41:4850639. [PMID: 29444292 DOI: 10.1093/sleep/zsx199] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/18/2017] [Indexed: 01/15/2023] Open
Abstract
STUDY OBJECTIVES Significant interindividual variability in sleepiness is observed in clinical populations with obstructive sleep apnea (OSA). This phenomenon is only partially explained by the apnea-hypopnea index (AHI). Understanding factors that lead to sleepiness is critical to effective management of patients with OSA. We examined demographic and other factors associated with sleepiness in OSA. METHODS Prospective study of 283 patients with newly diagnosed OSA by polysomnography (AHI ≥ 5 per hour). Subjective sleepiness (Epworth Sleep Scale [ESS] ≥ 11) and objective sleepiness (psychomotor vigilance task [PVT] mean lapse ≥ 2) were assessed. RESULTS Participants were classified into four groups (1: sleepy by ESS and PVT, 2: sleepy by PVT only, 3: sleepy by ESS only, and 4: nonsleepy reference group) and compared by generalized logit model. Shorter daily sleep duration by actigraphy and less morningness were associated with higher risk of sleepiness (Odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.33-0.82 and OR = 0.89, CI 0.80-0.98, respectively). African-American race was associated with sleepiness (group 1, OR = 8.8, CI 2.8-27.3; group 2, OR = 16.6, CI 3.3-83.6; and group 3, OR = 3.3, CI 1.0-10.1). IL-6 level was higher in groups 1 and 3 (OR = 1.9, CI 1.0-3.4 and OR 2.0, CI 1.1-3.7, respectively). CONCLUSIONS African-American race, short sleep duration, chronotype, and increased proinflammatory cytokine IL-6 level were associated with sleepiness in OSA. These findings will inform future investigations determining mechanisms of sleepiness in OSA.
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Affiliation(s)
- Bharati Prasad
- Department of Medicine, Pulmonary, Critical Care, Sleep and Allergy, College of Medicine, University of Illinois at Chicago, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Alana D Steffen
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
| | - Francis M Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Inna Strakovsky
- Office of Clinical Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bethany Staley
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David F Dinges
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Greg Maislin
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Terri E Weaver
- Center for Narcolepsy, Sleep and Health Research, College of Nursing, University of Illinois at Chicago, Chicago, IL.,Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL
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22
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Soose RJ, Padhya TA, Gillespie MB, Froymovich O, Lin HS, Woodson BT. OSA treatment history in an upper airway stimulation trial cohort. World J Otorhinolaryngol Head Neck Surg 2017; 3:79-84. [PMID: 29204583 PMCID: PMC5683594 DOI: 10.1016/j.wjorl.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives Analyze the obstructive sleep apnea (OSA) treatment history in a group of participants who enrolled in a hypoglossal nerve stimulation trial. Methods Moderate-severe OSA patients with difficulty adhering to CPAP presented for enrollment in a multicenter trial. Self-reported history on prior OSA medical therapy was collected at enrollment, including OSA diagnosis date, CPAP start and stop dates, oral appliance trial, and reasons for discontinuation or non-adherence. Results The cohort consisted of 929 participants, 83% male, with a mean age (53.9 ± 10.5) years. Ninety percent (n = 835) had complete CPAP information including 47% (n = 435) who discontinued therapy prior to enrollment and 43% (n = 400) who were still attempting CPAP but had inadequate adherence. Abandonment rates were 60% at 1-year, 73% at 3-years, and 86% at 5-years. Oral appliance therapy was attempted by 171 patients for mean (1.8 ± 2.3) years, with 81% abandonment at 1 year, 89% at 3-years, and 94% at 5-years. Conclusions In this CPAP-refractory cohort, high rates of CPAP abandonment were reported in the first several years with approximately half of the participants not receiving any treatment despite being diagnosed for >5 years. Close clinical follow-up and consideration of alternative treatment options is indicated in all OSA patients in order to ensure adequate longitudinal care.
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Affiliation(s)
- Ryan J Soose
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tapan A Padhya
- University of South Florida College of Medicine, Tampa, FL, USA
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Soose RJ, Woodson BT, Gillespie MB, Maurer JT, de Vries N, Steward DL, Strohl KP, Baskin JZ, Padhya TA, Badr MS, Lin HS, Vanderveken OM, Mickelson S, Chasens E, Strollo PJ. Upper Airway Stimulation for Obstructive Sleep Apnea: Self-Reported Outcomes at 24 Months. J Clin Sleep Med 2017; 12:43-8. [PMID: 26235158 DOI: 10.5664/jcsm.5390] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 07/15/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the long-term (24-mo) effect of cranial nerve upper airway stimulation (UAS) therapy on patient-centered obstructive sleep apnea (OSA) outcome measures. METHODS Prospective, multicenter, cohort study of 126 patients with moderate to severe OSA who had difficulty adhering to positive pressure therapy and received the surgically implanted UAS system. Outcomes were measured at baseline and postoperatively at 12 mo and 24 mo, and included self- and bedpartner-report of snoring intensity, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ). Additional analysis included FOSQ subscales, FOSQ-10, and treatment effect size. RESULTS Significant improvement in mean FOSQ score was observed from baseline (14.3) to 12 mo (17.3), and the effect was maintained at 24 mo (17.2). Similar improvements and maintenance of effect were seen with all FOSQ subscales and FOSQ-10. Subjective daytime sleepiness, as measured by mean ESS, improved significantly from baseline (11.6) to 12 mo (7.0) and 24 mo (7.1). Self-reported snoring severity showed increased percentage of "no" or "soft" snoring from 22% at baseline to 88% at 12 mo and 91% at 24 mo. UAS demonstrated large effect size (> 0.8) at 12 and 24 mo for overall ESS and FOSQ measures, and the effect size compared favorably to previously published effect size with other sleep apnea treatments. CONCLUSIONS In a selected group of patients with moderate to severe OSA and body mass index ≤ 32 kg/m2, hypoglossal cranial nerve stimulation therapy can provide significant improvement in important sleep related quality-of-life outcome measures and the effect is maintained across a 2-y follow-up period.
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Affiliation(s)
- Ryan J Soose
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | - Nico de Vries
- Saint Lucas Andreas Hospital, Amsterdam, Netherlands
| | | | | | | | - Tapan A Padhya
- University of South Florida College of Medicine, Tampa, FL
| | | | | | | | | | - Eileen Chasens
- University of Pittsburgh School of Nursing, Pittsburgh, PA
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Laratta CR, Tsai WH, Wick J, Pendharkar SR, Johannson KA, Ronksley PE. Validity of administrative data for identification of obstructive sleep apnea. J Sleep Res 2016; 26:132-138. [DOI: 10.1111/jsr.12465] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/02/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Cheryl R. Laratta
- Division of Respirology, Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Willis H. Tsai
- Division of Respirology, Department of Medicine; University of Calgary; Calgary AB Canada
- Department of Community Health Sciences; University of Calgary; Calgary AB Canada
| | - James Wick
- Department of Medicine; University of Calgary; Calgary AB Canada
| | - Sachin R. Pendharkar
- Division of Respirology, Department of Medicine; University of Calgary; Calgary AB Canada
- Department of Community Health Sciences; University of Calgary; Calgary AB Canada
| | - Kerri A. Johannson
- Division of Respirology, Department of Medicine; University of Calgary; Calgary AB Canada
- Department of Community Health Sciences; University of Calgary; Calgary AB Canada
| | - Paul E. Ronksley
- Department of Community Health Sciences; University of Calgary; Calgary AB Canada
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Walia HK, Griffith SD, Thompson NR, Moul DE, Foldvary-Schaefer N, Mehra R. Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients. J Clin Sleep Med 2016; 12:1357-1364. [PMID: 27568910 DOI: 10.5664/jcsm.6188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVES We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN). METHODS Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation. PRO changes were estimated using multivariable linear mixed-effect models adjusted for baseline age, sex, race, body mass index, resistant hypertension (RHTN) status, cardiac and diabetes history, and correlation between repeated measurements. Age and race by PAP interaction terms (mean change, 95% CI) were examined. RESULTS 894 patients with HTN and SDB were examined. 130 (15%) had baseline RHTN (age 58 ± 12 y, 52.9 % male, BMI 36.2 ± 9.1 kg/m2). In multivariable models, a significant improvement in sleepiness ESS (-2.09, 95% CI: -2.37, -1.82), PHQ-9 (-1.91, 95% CI: -2.25, -1.56), and FSS scores (-4.06 95% CI: -4.89, -3.22) was observed. A significant race by PAP effect interaction was observed (p < 0.0001 for all PROs); Caucasians had greater improvements than non-Caucasians. The interaction term of effect of PAP and age was significant for ESS (p = 0.04) and PHQ-9 (p = 0.0003), indicating greater improvement in younger patients. CONCLUSIONS Consistent improvement of broad PRO domains in response to PAP in SDB was observed in this clinic-based hypertensive cohort; Caucasians and younger patients derived greater benefit.
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Affiliation(s)
- Harneet K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Sandra D Griffith
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Douglas E Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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26
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Povitz M, Tsai WH, Pendharkar SR, Hanly PJ, James MT. Healthcare Use in Individuals with Obesity and Chronic Hypoxemia Treated for Sleep Disordered Breathing. J Clin Sleep Med 2016; 12:543-8. [PMID: 26888590 DOI: 10.5664/jcsm.5686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/20/2015] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES To determine if treatment of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) among patients with chronic hypoxemia is associated with reduced healthcare utilization. METHODS We performed a retrospective cohort study of 129 obese, hypoxemic patients who underwent polysomnography and were prescribed positive airway pressure (PAP) therapy. During a 2-year follow-up period we examined the associations between adherence to PAP therapy and rates of hospitalization, emergency room (ER) visits, and outpatient visits. RESULTS Severe OSA and OHS were common, as were hypertension, cardiovascular, and pulmonary disease. Forty-nine percent of patients were adherent with PAP therapy. Compared to patients who were not adherent to PAP therapy, adherent patients had significantly lower rates of all-cause hospitalization (incident rate ratio [IRR]:0.55, 95% CI 0.33, 0.93) after adjustment for age, sex and hospitalisation rates prior to treatment. Adjustment for additional comorbidities attenuated this association (IRR: 0.61, 95% CI 0.35, 1.06). Adherence with PAP therapy was associated with lower odds of frequent hospitalization (odds ratio 0.23, 95% CI 0.07, 0.73). There were no significant differences in the rates of ER or outpatient visits between adherent and non-adherent patients. CONCLUSIONS Adherence with PAP treatment in patients with chronic hypoxemia and chronic medical disorders is associated with reduced rates of hospitalization, which has significant benefit both for patients and the healthcare system.
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Affiliation(s)
- Marcus Povitz
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Western University, London, Ontario, Canada
| | - Willis H Tsai
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R Pendharkar
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick J Hanly
- Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Li X, Lin L, Lv L, Pang X, Du S, Zhang W, Na G, Ma H, Zhang Q, Jiang S, Deng H, Han T, Sun C, Li Y. U-shaped relationships between sleep duration and metabolic syndrome and metabolic syndrome components in males: a prospective cohort study. Sleep Med 2015; 16:949-54. [DOI: 10.1016/j.sleep.2015.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/22/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022]
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Drakatos P, Ghiassi R, Jarrold I, Harris J, Abidi A, Douiri A, Hart N, Kosky C, Williams AJ, Partridge MR, Steier J. The use of an online pictorial Epworth Sleepiness Scale in the assessment of age and gender specific differences in excessive daytime sleepiness. J Thorac Dis 2015; 7:897-902. [PMID: 26101646 DOI: 10.3978/j.issn.2072-1439.2014.06.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/21/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a non-specific but highly prevalent cardinal symptom of sleep disorders. We hypothesized that with modern media and an online pictorial Epworth Sleepiness Scale (ESS) age and gender specific differences of EDS could be identified on a large scale. This could be helpful in the screening of patients with sleep disorders. PATIENTS AND METHODS In 8,098 subjects, age and gender were recorded in addition to an online pictorial ESS (range 0-24 points). The cut-off for EDS (ESS >10 points) was chosen in line with the traditional ESS. RESULTS The prevalence of EDS was slightly higher in male subjects (45% vs. 43%, P=0.033). When age was considered, female subjects tended to be sleepier in their 3(rd) and 4(th) lifetime decade (P=0.01 and P=0.003, respectively), whilst male subjects scored significantly higher in their 7(th) decade (P<0.0001); there was a trend to more daytime symptoms with higher age (P for trend <0.001). CONCLUSIONS The online pictorial ESS identifies gender differences in EDS and reveals increased levels of sleepiness associated with higher age. The use of modern media facilitates reaching out to the general population to raise awareness of conditions associated with EDS such as sleep apnoea.
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Affiliation(s)
- Panagis Drakatos
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ramesh Ghiassi
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ian Jarrold
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Judy Harris
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Athar Abidi
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Abdel Douiri
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nicholas Hart
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Christopher Kosky
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Adrian J Williams
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Martyn R Partridge
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joerg Steier
- 1 Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK ; 2 Imperial College London, South Kensington Campus, London SW7 2AZ, UK ; 3 British Lung Foundation, 73-75 Goswell Road, London EC1V 7ER, UK ; 4 King's College London, School of Medicine, Strand, London WC2R 2LS, London, UK ; 5 NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
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Use of electronic data and existing screening tools to identify clinically significant obstructive sleep apnea. Can Respir J 2015; 22:215-20. [PMID: 26083542 DOI: 10.1155/2015/581504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To assess the ability of electronic health data and existing screening tools to identify clinically significant obstructive sleep apnea (OSA), as defined by symptomatic or severe OSA. METHODS The present retrospective cohort study of 1041 patients referred for sleep diagnostic testing was undertaken at a tertiary sleep centre in Calgary, Alberta. A diagnosis of clinically significant OSA or an alternative sleep diagnosis was assigned to each patient through blinded independent chart review by two sleep physicians. Predictive variables were identified from online questionnaire data, and diagnostic algorithms were developed. The performance of electronically derived algorithms for identifying patients with clinically significant OSA was determined. Diagnostic performance of these algorithms was compared with versions of the STOP-Bang questionnaire and adjusted neck circumference score (ANC) derived from electronic data. RESULTS Electronic questionnaire data were highly sensitive (>95%) at identifying clinically significant OSA, but not specific. Sleep diagnostic testing-determined respiratory disturbance index was very specific (specificity ≥95%) for clinically relevant disease, but not sensitive (<35%). Derived algorithms had similar accuracy to the STOP-Bang or ANC, but required fewer questions and calculations. CONCLUSIONS These data suggest that a two-step process using a small number of clinical variables (maximizing sensitivity) and objective diagnostic testing (maximizing specificity) is required to identify clinically significant OSA. When used in an online setting, simple algorithms can identify clinically relevant OSA with similar performance to existing decision rules such as the STOP-Bang or ANC.
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30
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Torabi-Nami M, Mehrabi S, Borhani-Haghighi A, Derman S. Withstanding the obstructive sleep apnea syndrome at the expense of arousal instability, altered cerebral autoregulation and neurocognitive decline. J Integr Neurosci 2015; 14:169-93. [DOI: 10.1142/s0219635215500144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Pendharkar SR, Bischak DP, Rogers P, Flemons W, Noseworthy TW. Using patient flow simulation to improve access at a multidisciplinary sleep centre. J Sleep Res 2014; 24:320-7. [PMID: 25431022 DOI: 10.1111/jsr.12257] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 10/04/2014] [Indexed: 11/28/2022]
Abstract
The lack of timely access to diagnosis and treatment for sleep disorders is well described, but little attention has been paid to understanding how multiple system constraints contribute to long waiting times. The objectives of this study were to identify system constraints leading to long waiting times at a multidisciplinary sleep centre, and to use patient flow simulation modelling to test solutions that could improve access. Discrete-event simulation models of patient flow were constructed using historical data from 150 patients referred to the sleep centre, and used to both examine reasons for access delays and to test alternative system configurations that were predicted by administrators to reduce waiting times. Four possible solutions were modelled and compared with baseline, including addition of capacity to different areas at the sleep centre and elimination of prioritization by urgency. Within the model, adding physician capacity improved time from patient referral to initial physician appointment, but worsened time from polysomnography requisition to test completion, and had no effect on time from patient referral to treatment initiation. Adding respiratory therapist did not improve model performance compared with baseline. Eliminating triage prioritization worsened time to physician assessment and treatment initiation for urgent patients without improving waiting times overall. This study demonstrates that discrete-event simulation can identify multiple constraints in access-limited healthcare systems and allow suggested solutions to be tested before implementation. The model of this sleep centre predicted that investments in capacity expansion proposed by administrators would not reduce the time to a clinically meaningful patient outcome.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Diane P Bischak
- Haskayne School of Business, University of Calgary, Calgary, Canada
| | - Paul Rogers
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Canada
| | - Ward Flemons
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tom W Noseworthy
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Medeiros C, Bruin V, Férrer D, Paiva T, Montenegro Júnior R, Forti A, Bruin P. Excessive daytime sleepiness in type 2 diabetes. ACTA ACUST UNITED AC 2014; 57:425-30. [PMID: 24030181 DOI: 10.1590/s0004-27302013000600003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine excessive daytime sleepiness (EDS) in type 2 diabetes. SUBJECTS AND METHODS Patients (N = 110) were evaluated regarding Epworth Sleepiness Scale (EDS), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), Restless Legs Syndrome (RLS), risk of obstructive sleep apnea (OSA) (Berlin questionnaire), and comorbidity severity (Charlson Comorbidity Index). Patients were compared with individuals with arterial hypertension and without diabetes. RESULTS Diabetic patients had more EDS, depressive symptoms, and higher comorbidity severity than hypertensive patients (p < 0.005). In diabetic patients, poor quality sleep (53.3%), and high risk of OSA (40.9%) and RLS (14.5%) were found; EDS (55.5%) was associated with depressive symptoms present in 44.5% individuals (OR = 1.08; 95% CI: 1.01-1.15), and remained so after data were controlled for age, gender, body mass index, and glycated hemoglobin (OR = 2.27; 95% CI 1.03-5.03). CONCLUSIONS Sleep abnormalities are frequent. EDS affects most of the patients and is independently associated with depressive symptoms. Adequate antidepressant therapy should be tested for the effects on EDS.
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Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) has a substantial economic impact on healthcare systems. We reviewed parameters affecting healthcare costs (race, low education, and socioeconomic status) on OSA comorbidity, and costs and the effect of OSA treatment on medical costs. RECENT FINDINGS OSA is associated with increased cardiovascular disease (CVD) morbidity and substantially increased medical costs. Risk for OSA and resulting CVD are associated with obesity, tobacco smoking, black race, and low socioeconomic status; all these are associated with poor continuous positive airway pressure (CPAP) adherence. Healthcare costs are not normally distributed, that is, the costliest and the sickest upper third of patients consume 65-82% of all medical costs. Only a limited number of studies have explored the effect of CPAP on medical costs. SUMMARY Costs of untreated OSA may double the medical expenses mainly because of CVD. Identifying the costliest, sickest upper third of OSA patients will reduce expenses to healthcare systems. Studies exploring the effect of CPAP on medical costs are essential. In addition, tailoring intervention programs to reduce barriers to adherence have the potential to improve CPAP treatment, specially in at-risk populations that are sicker and consume more healthcare costs.
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Epworth sleepiness scale scores and adverse pregnancy outcomes. Sleep Breath 2013; 17:1179-86. [PMID: 23420179 DOI: 10.1007/s11325-013-0820-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/08/2012] [Accepted: 02/03/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE Snoring is associated with adverse pregnancy outcomes including gestational hypertensive disorders, gestational diabetes, and Cesarean deliveries. The purpose of this study was to assess whether excessive daytime sleepiness (EDS) assessed by Epworth Sleepiness Scale (ESS) increases the risk of these complications further. METHODS Following institutional review board approval and informed consent, English-speaking women in the immediate postpartum period were systematically selected and recruited. Women answered a survey that included questions regarding symptoms of sleep-disordered breathing (SDB) using the multivariable apnea prediction index and excessive daytime sleepiness using ESS. Pregnancy and fetal outcomes were collected by review of medical records. Standard statistical analysis with multivariable logistic regression was performed. ESS was evaluated both as a continuous variable and with various cutoffs given that pregnant women are likely more sleepy at baseline than the general population. RESULTS In patients who underwent planned Cesarean delivery, mean ESS was significantly higher than in those with uncomplicated vaginal delivery, even after adjusting for confounders (adjusted odds ratio (aOR), 1.08; 95 % CI, 1.01-1.15; p = 0.02). There was no significant association between EDS (defined as ESS of >10) and gestational diabetes or gestational hypertensive disorders in snorers or non snorers. However, a significant association with gestational diabetes was found in patients with an ESS of >16 compared to those with an ESS of ≤16, even after multiple adjustments (aOR, 6.82; 95 % CI, 1.19-39.27), but the number of subjects in an ESS of >16 category was small. CONCLUSIONS There is an increased association between women with higher ESS and planned Cesarean delivery. Severe EDS was associated with gestational diabetes in pregnant women in a small sample size. Future studies in larger samples need to confirm the association of severe EDS and gestational diabetes and elucidate potential mechanisms of the links with adverse outcomes.
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Excessive daytime sleepiness in late pregnancy may not always be normal: results from a cross-sectional study. Sleep Breath 2012; 17:735-40. [PMID: 22872283 DOI: 10.1007/s11325-012-0753-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/12/2012] [Accepted: 07/11/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE Many changes that normally occur during pregnancy disrupt sleep and may lead to excessive daytime sleepiness (EDS). However, given that pregnancy may also predispose to the development of sleep-disordered breathing (SDB), we sought to investigate whether EDS may be associated with snoring, gasping, or apneas, further suggesting SDB. METHODS A cross-sectional survey of women in the immediate postpartum period was conducted. Participants answered questions from the multivariable apnea prediction index regarding snoring, gasping, and witnessed apneas in the last 3 months of pregnancy. Participants were also asked to answer Epworth Sleepiness Scale (ESS) questions, and a score 0-24 was calculated (>10 considered abnormal). Medical history and medication use were obtained both by history and review of the medical record. RESULTS Out of 1,000 women recruited, 990 women answered the ESS questionnaire completely. Mean prepregnancy body mass index (BMI) was 26.1 ± 6.2 with 21.7 % of the sample having a prepregnancy BMI ≥30. Mean ESS score was 7.1 ± 3.9, and 1.7 % of the total sample scored 16 or greater. ESS increased significantly with age, BMI, and neck circumference. All three symptoms of SDB were associated with higher mean ESS scores. In a multiple linear regression analysis, loud snoring, gasping, and apneas were statistically significant independent predictors of mean ESS score. CONCLUSIONS EDS measured by ESS is a common finding in pregnancy. Snoring, gasping, and apneas appear to be independent predictors of mean ESS scores.
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Forsythe LP, Helzlsouer KJ, MacDonald R, Gallicchio L. Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study. Support Care Cancer 2012; 20:2425-32. [PMID: 22218738 DOI: 10.1007/s00520-011-1358-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/12/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Sleep-related complaints are common in cancer survivors. Although daytime sleepiness and sleep duration are associated with poor functional status, quality of life, and mortality in the general population, little is known about these issues in long-term cancer survivors. This study examined differences in daytime sleepiness and sleep duration between long-term cancer survivors and non-cancer controls. METHODS Survey data were analyzed from individuals diagnosed with cancer ≥2 years in the past (n = 1,171, mean age = 64.30, 80.8% white, 22.8% male) and spouse/friends controls (n = 250, mean age = 60.78, 88.0% white, 64.8% male). Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Associations between sleep-related variables and history of cancer were estimated with multivariable logistic regression, adjusting for potential confounders. Stratified analyses were conducted to identify subgroups of survivors most at risk for sleep problems. RESULTS Cancer survivors were more likely than controls to report excessive daytime sleepiness (OR = 1.64, 95% CI: 1.07, 2.50). A cancer diagnosis was associated with longer sleep duration among males (OR = 1.25, 95% CI: 1.02, 1.53), but not in females (OR = 0.87, 95% CI: 0.37, 1.05). All other associations were similar regardless of cancer site, histology, time since diagnosis, treatment history, and history of multiple cancers. CONCLUSIONS Disturbances in daytime sleepiness and sleep duration persist among long-term cancer survivors and should be monitored in routine survivorship care. More research is needed to identify cancer survivors who are at increased risk for daytime sleepiness and disturbed sleep duration, as well as to identify causal mechanisms for, and interventions to mitigate, persistent differences.
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Affiliation(s)
- Laura P Forsythe
- Cancer Prevention Fellowship Program, Center for Cancer Training, National Cancer Institute, Rockville, MD 20892, USA.
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