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Chen H, Fang Z, Wu YY, Zhao CH, Wang YJ, Zhu XH, Cheng XQ. Association between perioperative self-reported sleep disturbances and delirium risk in elderly patients following total joint arthroplasty: a cohort study. J Sleep Res 2024:e14168. [PMID: 38380761 DOI: 10.1111/jsr.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/28/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
Perioperative sleep disturbance may increase delirium risk. However, the role of perioperative sleep disturbance in delirium following total joint arthroplasty remains unclear. This prospective cohort study aimed to observe the delirium risk in patients with sleep disturbances. After excluding pre-existing sleep disturbances, older patients scheduled for total joint arthroplasty from July 17, 2022, to January 12, 2023, were recruited. Preoperative sleep disturbance or postoperative sleep disturbance was defined as a Chinese version of the Richards-Campbell Sleep Questionnaire (RCSQ) score of <50 during hospitalisation. A cut-off score of 25 was used to classify the severity of sleep disturbance. The primary outcome was the incidence of postoperative delirium. In all, 11.6% of cohort patients (34/294) developed delirium. After multivariate analysis, a preoperative Day 1 RCSQ score of ≤25 (odds ratio [OR] 3.62, 95% confidence interval [CI] 1.19-10.92; p = 0.02), occurrence of sleep disturbances (OR 2.76, 95% CI 1.19-6.38; p = 0.02) and RCSQ score of ≤25(OR 2.91, 95% CI 1.33-6.37; p = 0.007) postoperatively were strong independent predictors of delirium. After sensitivity analysis for daily delirium, a postoperative Day 1 RCSQ score of ≤25 (OR 9.27, 95% CI 2.72-36.15; p < 0.001) was associated with a greater risk of delirium on postoperative Day 1, with a reasonable discriminative area under the curve of 0.730. We concluded that postoperative but not preoperative sleep disturbances may be an independent factor for delirium risk. Sleep disturbance on the first night after surgery was a good predictor of subsequent delirium, no matter the nature of self-reported sleep disturbance.
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Affiliation(s)
- Hao Chen
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Zheng Fang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yang-Yang Wu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Cheng-Hui Zhao
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yu-Jie Wang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Xiao-He Zhu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Xin-Qi Cheng
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
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Finch CE, Leu RM, Harford KL, Westbrook AL, Kasi AS. Sleep disturbances in parental caregivers and patients with congenital central hypoventilation syndrome. J Clin Sleep Med 2023; 19:549-554. [PMID: 36541215 PMCID: PMC9978429 DOI: 10.5664/jcsm.10384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Congenital central hypoventilation syndrome (CCHS) is a rare disease characterized by impaired control of breathing caused by paired-like homeobox 2B (PHOX2B) gene variants, necessitating lifelong assisted ventilation (AV). This study aimed to assess sleep quality in patients with CCHS and their parents using sleep questionnaires. METHODS Parents of patients with CCHS completed the Pittsburgh Sleep Quality Index (PSQI) regarding their sleep and the Sleep Disturbance Scale for Children (SDSC) regarding their child's sleep. RESULTS Twenty participants completed the questionnaires. The median (interquartile range) ages of the parents and patients were 41.5 (38.5-51.5) and 11.5 (7.4-16.7) years, respectively. The median (interquartile range) PSQI and SDSC scores were elevated at 6.5 (4-10) and 41.5 (34-51.5), respectively, suggesting that parents and patients with CCHS can experience sleep disturbances and poor sleep quality. There were no significant differences in SDSC (P = 1.0) and PSQI (P = .76) scores for AV with or without tracheostomy. Similarly, there were no significant differences in SDSC (P = .22) and PSQI (P = .34) scores based on PHOX2B genotypes. There was a moderately strong, significant, and positive correlation between the CCHS SDSC scores and parental PSQI scores (r = .48, P = .03), suggesting that sleep disturbances in patients with CCHS were associated with poor parental sleep quality. There was no difference in the median parental sleep duration between those with and without nighttime home nursing (P = .09). CONCLUSIONS Patients with CCHS and their parents are at risk for sleep disturbances regardless of their AV modality and PHOX2B genotype. In addition to AV management, patients with CCHS and their parents should be assessed for sleep disturbances. CITATION Finch CE, Leu RM, Harford K-L, Westbrook AL, Kasi AS. Sleep disturbances in parental caregivers and patients with congenital central hypoventilation syndrome. J Clin Sleep Med. 2023;19(3):549-554.
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Affiliation(s)
- Christina E. Finch
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Roberta M. Leu
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Kelli-Lee Harford
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Adrianna L. Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Ajay S. Kasi
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Borrelli M, Corcione A, Rongo R, Cantone E, Scala I, Bruzzese D, Martina S, Strisciuglio P, Michelotti A, Santamaria F. Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach. J Pers Med 2022; 13:jpm13010071. [PMID: 36675732 PMCID: PMC9862921 DOI: 10.3390/jpm13010071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
A comprehensive evaluation of obstructive sleep apnoea (OSA) may allow for the development of more efficient management of Down syndrome (DS). We aimed to evaluate the effect of a multidisciplinary approach to DS with OSA. A total of 48 DS children aged 4−12 years were prospectively investigated with nasal endoscopy, orthodontic examination, and overnight polygraphy (PG); the Italian Child Sleep Habits Questionnaire (CSHQ-IT) was filled out by the mothers. The total CSHQ-IT score was 63 (96% of children reporting sleep problems). The major ear, nose, and throat characteristics were enlarged palatine tonsils (62%), adenoid tonsils (85%), and chronic rhinosinusitis (85%). DS children showed orthognathic profile in 68% of cases, class I relationship in 63%, and cross-bite in 51%. PG revealed OSA in 67% of cases (37% mild, 63% moderate−severe). The oxygen desaturation index (ODI) was higher in the group with OSA (5.2) than with non-OSA (1.3; p < 0.001). The ODI was higher (p = 0.001) and SpO2 lower (p = 0.03) in children with moderate−severe OSA than with mild OSA. The apnoea−hypopnea index (AHI) and percentage time with SpO2 < 90% were higher in DS children with grade III than with grade I or II adenoids (5 vs. 1, p = 0.04, and 1.2 vs. 0.1, p = 0.01, respectively). No significant correlations were found between PG and the total CSHQ-IT score or orthodontic data. However, children showing associated cross-bite, grade III adenoids and size 3 or 4 palatine tonsils showed higher AHI and ODI than those without (p = 0.01 and p = 0.04, respectively). A coordinated multidisciplinary approach with overnight PG is a valuable tool when developing diagnostic protocols for OSA in DS.
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Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
| | - Adele Corcione
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
| | - Roberto Rongo
- Department of Neurosciences, Reproductive Sciences and Odontostomatologic Sciences, School of Orthodontics, Federico II University, 80131 Naples, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive Sciences and Ear Nose Throat Section, Federico II University, 80131 Naples, Italy
| | - Iris Scala
- Department of Maternal and Child Health, Clinical Genetics, Federico II University, 80131 Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84121 Salerno, Italy
| | - Pietro Strisciuglio
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive Sciences and Odontostomatologic Sciences, School of Orthodontics, Federico II University, 80131 Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-08-1746-3495
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Tripathi A, Gupta A, Rai P, Sharma P. Reliability of STOP-Bang questionnaire and pulse oximetry as predictors of OSA - a retrospective study. Cranio 2022:1-5. [PMID: 36018795 DOI: 10.1080/08869634.2022.2114685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To verify the reliability of a STOP-Bang questionnaire and objective blood oxygen concentration (SpO2) estimation by pulse oximetry as an indicator of patients' vulnerability to OSA, by correlating data of these two tests with that of the "gold standard" all-night polysomnography. METHODS STOP-Bang score and pulse oximetry value (SpO2) for each patient were tabulated against the total sleep AHI score (obtained from subsequent all-night polysomnography) and analyzed to evaluate the diagnostic accuracy of the STOP-Bang questionnaire and pulse oximetry. RESULTS With sensitivity and specificity scores of 91.2% and 88.6%, respectively, positive predictive value 90.5%, negative predictive value 40.2%, the twin diagnostic test (STOP-Bang and pulse oximetry) was found to be highly congruent with the polysomnography (PSG), achieving a diagnostic accuracy of 85%. CONCLUSION Dental chairside screening by STOP-Bang questionnaire and pulse oximetry would be a good option, especially where logistic and economic constraints impede all-night polysomnography.
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Affiliation(s)
- Arvind Tripathi
- Postgraduate Studies and Research, Saraswati Dental College, Lucknow, India
| | - Ashutosh Gupta
- Department of Prosthodontics, Saraswati Dental College, Lucknow, India
| | - Praveen Rai
- Department of Prosthodontics, Saraswati Dental College, Lucknow, India
| | - Piyush Sharma
- Department of Orthodontics, Azamgarh Dental College, Lucknow, India
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Namen AM, Forest D, Saha AK, Xiang KR, Younger K, Maurer S, Ahmad Z, Chatterjee AB, O’Donovan C, Sy A, Peters SP, Haponik EF. DOISNORE50: a perioperative sleep questionnaire predictive of obstructive sleep apnea and postoperative medical emergency team activation. A learning health system approach to sleep questionnaire development and screening. J Clin Sleep Med 2022; 18:1909-1919. [PMID: 35499151 PMCID: PMC9340585 DOI: 10.5664/jcsm.10006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) have a disproportionate increase in postoperative complications and medical emergency team activation (META). We previously introduced DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with BMI > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) from sleep questionnaire ISNORED using features associated with increased odds of META in perioperative patients. Performance of DOISNORE50 (DOISNORE) had yet to be tested. METHODS The performance of DOISNORE was tested along with questionnaire ISNORED and STOP-BANG questionnaires among 300 out of 392 participants without known OSA referred to the sleep lab. In study 2, the performance of DOISNORE was tested among 64,949 lives screened in perioperative assessment clinic from 2016 to 2020. RESULTS Receiver operating characteristic curve demonstrated that best performance was achieved with responses, with area under curve of 0.801. DOISNORE's predictability of OSA risk remained stable from 2018 to 2020 with area under curve of 0.78 and a Cronbach alpha of 0.65. Patients at high risk for OSA (DOISNORE ≥ 6) were associated with an increase of META (odds ratio 1.30, 95% confidence interval 1.12-1.45). Higher relative risk was noted among patients with congestive heart failure and hypercapnia. CONCLUSIONS DOISNORE is predictive of OSA and postoperative META. Perioperative strategies against META should consider DOISNORE questionnaire and focused screening among patients with heart failure and hypercapnia. CITATION Namen AM, Forest D, Saha AK, et al. DOISNORE50: a perioperative sleep questionnaire predictive of obstructive sleep apnea and postoperative medical emergency team activation. A learning health system approach to sleep questionnaire development and screening. J Clin Sleep Med. 2022;18(8):1909-1919.
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Affiliation(s)
- Andrew M. Namen
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina,Address correspondence to: Andrew M. Namen, MD, Atrium Health Wake Forest Baptist Medical Center Blvd., Winston–Salem, NC 27006; Tel: (336) 716-4649;
| | | | - Amit K. Saha
- Department of Anesthesiology and Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kang Rui Xiang
- Section on Pulmonary Critical Care and Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Sheila Maurer
- Section on Pulmonary Critical Care and Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Zeeshan Ahmad
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Arjun B. Chatterjee
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Cormac O’Donovan
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alexander Sy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Stephen P. Peters
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Edward F. Haponik
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Shteinberg YH, Eisenbach N, Gruber M, Ronen O. Impact of Tonsillectomy on the Life Quality of Parents to Children With Obstructive Sleep-Disordered Breathing. Otolaryngol Head Neck Surg 2021; 167:753-759. [PMID: 34874788 DOI: 10.1177/01945998211064188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Parents of children with any chronic illness may experience increased anxiety and reduced health-related quality of life (QoL). Our objective was to evaluate the change in parental QoL before vs after tonsillectomy. Our hypothesis was that pediatric tonsil surgery with or without adenoidectomy would improve parental QoL. STUDY DESIGN A prospective cohort study. SETTING An otolaryngology department in a tertiary academic center. METHODS We enrolled parents of 79 children <5 years old. Adenotonsillectomy due to an obstructive airway indication was performed in 45 children. A group of 34 parents to healthy children served as a control group. Initially, we validated a modified version of the PAR-ENT-QoL questionnaire; then, we analyzed QoL parameters among parents of children with obstructive sleep-disordered breathing before and after surgical treatment. RESULTS We found significant differences between the QoL score before and after surgery (P = .003). The QoL score after surgery significantly improved and was even lower than that of the control group (P < .001). CONCLUSIONS These results highlight the importance of timely diagnosis and treatment of children with obstructive sleep-disordered breathing, as this condition may affect not only the children themselves but also their caregivers.
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Affiliation(s)
| | - Netanel Eisenbach
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Maayan Gruber
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
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Abstract
Background: Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice. Methods: CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients. Results: Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep. Conclusions: Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.
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Affiliation(s)
- Kathy C Richards
- University of Texas at Austin School of Nursing, Austin, TX, United States
| | - Yan-Yan Wang
- University of Texas at Austin School of Nursing, Austin, TX, United States.,West China Hospital, Sichuan University, Chengdu, China
| | - Jeehye Jun
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Lichuan Ye
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
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Wang TY, Tsai MH, Ni YL, Lin TY, Huang SY, Lo YL. A Simplified Screening Questionnaire for Detecting Severe OSA in Chronic Obstructive Airway Disease in Asian Population. COPD 2020; 17:191-196. [PMID: 32131647 DOI: 10.1080/15412555.2020.1733513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to develop a simplified screening questionnaire to detect the existence of severe obstructive sleep apnea (OSA) in chronic obstructive pulmonary disease (COPD) patients to reduce mortality and hospitalization rates. Seventy-seven stable Asian COPD patients aged 69.2 ± 11.5 years were retrospectively analyzed into the development group. The simplified screening questionnaire was developed from factors identified from sleep surveys and demographic data to predict severe OSA. Receiver operating characteristic (ROC) curve analysis was used to validate the simplified screening questionnaire. Data from another 78 stable COPD patients were used for validation. The apnea-hypopnea index was similar between the development and validation groups (26.3 ± 21.9 and 27.6 ± 21.1, respectively). After logistic regression analysis in the development group, snoring, body mass index ≥27.5 kg/m2, witnessed apnea and coronary artery disease were incorporated into the screening questionnaire to predict OSA. When this questionnaire was applied to the validation group, the results were similar. The simplified screening questionnaire developed is useful in identifying severe OSA in COPD patients.
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Affiliation(s)
- Tsai-Yu Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Meng-Huan Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Lun Ni
- Department of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ting-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Sui-Ya Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Yu-Lun Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
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Jasti DB, Mallipeddi S, Apparao A, Vengamma B, Kolli S, Mohan A. Quality of Sleep and Sleep Disorders in Patients with Parkinsonism: A Polysomnography Based Study from Rural South India. J Neurosci Rural Pract 2018; 9:92-99. [PMID: 29456351 PMCID: PMC5812167 DOI: 10.4103/jnrp.jnrp_189_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study is to study the quality of sleep, sleep disorders, and polysomnographic profile in Parkinsonism patients from rural areas and to correlate polysomnographic profile with the staging of disease and with sleep questionnaire. MATERIALS AND METHODS Between May 2014 and December 2015, 168 Parkinsonism patients were prospectively screened using sleep questionnaire; Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Parkinson Disease Sleep Score-2 (PDSS-2). Sixty patients underwent overnight polysomnography subsequently. RESULTS The mean age of 168 patients in the study was 65.3 ± 12.8 years. The mean duration of Parkinsonism was 4.6 ± 3.1 years. The mean ESS, PSQI and PDSS-2 were 12.4 ± 3.2, 7.9 ± 2.1 and 44.7 ± 5.8, respectively. A total of 148 patients (88.1%) had poor quality sleep, which was reported only in 37 patients (22%). Excessive daytime sleepiness (80%) and insomnia (76.7%) were most common symptoms. Polysomnographic profile showed poor sleep efficiency (median interquartile range [IQR] 74.8% [17.8%-99.5%]), reduced slow wave sleep (median [IQR] 0% [0%-9.5%]), and reduced rapid eye movement [REM] sleep (median (IQR) 4.9% [0.1%-24.2%]). Sleep disorders in the study were sleep fragmentation (n = 60, 100%), obstructive sleep apnea syndrome (n = 40, 66.7%), central sleep apnea syndrome (n = 6, 10%), and periodic limb movement disorder (n = 52, 86.7%). Two patients had REM sleep behavioral disorder clinically. There was statistically significant positive correlation between staging of disease, sleep latencies, and sleep questionnaire. CONCLUSION Sleep is impaired in majority of Parkinsonism patients which needs to be diagnosed early and managed effectively. Patient education and awareness programs in rural areas regarding sleep disorders in Parkinsonism are required for early diagnosis.
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Affiliation(s)
| | | | - A. Apparao
- Department of Neurology, SVIMS, Tirupati, Andhra Pradesh, India
| | - B. Vengamma
- Department of Neurology, SVIMS, Tirupati, Andhra Pradesh, India
| | - Satyarao Kolli
- Department of Neurology, SVIMS, Tirupati, Andhra Pradesh, India
| | - A. Mohan
- Department of Medicine, SVIMS, Tirupati, Andhra Pradesh, India
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Royant-Parola S. [Initial consultation, analysis of complaint, causal investigation of insomnia]. Rev Prat 2017; 67:855-858. [PMID: 30512813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Initial consultation, analysis of complaint, causal investigation of insomnia Insomnia requires an initial clinical check-up with a full examination that explores both the complaint of sleep (difficulties in falling sleep, awakening in the night, early awakening) and the repercussion on the day. Lifestyle and behaviors are assessed (meals, sporting activity, type of activity before and at bedtime, regularity of schedules, working hours). Comorbidities are evaluated : depression, anxiety, restless legs syndrome, sleep apnea, somatic diseases, medication. Simple tools are used to complete this assessment : questionnaire of sleep assessment and its disorders, sleep schedule, possibly actimetry.
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Affiliation(s)
- Sylvie Royant-Parola
- Hôpital Antoine- Béclère, service d'explorations fonctionnelles multidisciplinaires, service de psychiatrie, Clamart, France. Réseau Morphée, Paris, France
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Uyan ZS, Turan I, Ay P, Cakir E, Ozturk E, Gedik AH, Gokdemir Y, Erdem E, Şen V, Karadag B, Karakoc F, Ersu R. Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans. Pediatr Pulmonol 2016; 51:308-15. [PMID: 26129911 DOI: 10.1002/ppul.23246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/17/2015] [Accepted: 05/28/2015] [Indexed: 01/13/2023]
Abstract
The incidence of sleep-disordered breathing (SDB) increases in chronic lung diseases. Our aim was to evaluate SDB and sleep quality in children with postinfectious bronchiolitis obliterans (BO) and assess associated risk factors. We hypothesized that children with BO are at increased risk for SDB and have impaired sleep quality. We also hypothesized that severity of SDB and impairment of sleep quality is related to the severity of lung disease. Sleep Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI) questionnaires; spirometry, impulse oscillometry (IOS), and overnight polysomnography (PSG) were performed. Twenty-one patients (14 male, median age: 8.3 years) were enrolled. Five patients (25%) had a PSQ score of >0.33, predictive of a SDB. Ten patients (48%) had poor sleep quality. Four patients (19%) had an OAHI of >1/hr. Nineteen patients (90%) had a high desaturation index. Four patients (19%) had a mean oxygen saturation of <93%. Median central apnea time was 7.5 (IQR: 6.9-9.1) seconds. Central apnea index of the patients correlated positively with R5, R10, R15, R20, Z5, and negatively with X10 and X15 at IOS. There was a positive correlation between the lowest oxygen saturation and FVC, FEV1 , X5, X10, X15, X20 while there was a negative correlation between lowest saturation and the central apnea index at PSG, R5, R10, and Z5 at IOS. Mean oxygen saturation during PSG correlated positively with FVC, FEV1, FEF(25-75), X5, X10, X15, X20 results. The risk of nocturnal hypoxia is increased in patients with BO and correlated to the severity of lung disease determined by pulmonary function tests. Although BO patients have a shorter duration of central apneas, they are more prone to desaturate.
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Affiliation(s)
- Zeynep S Uyan
- Division of Pediatric Pulmonology, Kocaeli University, Kocaeli, Turkey
| | - Ihsan Turan
- Department of Pediatrics, Marmara University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Ersin Ozturk
- Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Ahmet H Gedik
- Division of Pediatric Pulmonology, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Ela Erdem
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Velat Şen
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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Abstract
STUDY OBJECTIVES The aim of this study was to assess the role of clinical context in determining the correspondence between actigraphic and reported sleep measures in preschool children. METHODS Sleep was assessed using actigraphy and parental reports in a clinical sample of 109 preschool children between the ages 4 and 6 years suffering from significant nighttime fears and in a sample of 30 healthy controls. RESULTS In comparison to actigraphy, parents in both groups indicated that their children fell asleep earlier and overestimated their sleep period. These gaps were significantly larger in the control group than the clinical group. Parents from both groups similarly underestimated the time their child was awake during the night in comparison to actigraphy. Significant correlations were found in both groups between parental reports and actigraphy sleep schedule measures. Low correlations were found for wake after sleep onset in both groups and for the number of night wakings. CONCLUSIONS Clinicians and researchers should be highly aware that parental reports on their children's sleep may not be accurate, and that accuracy may be affected by the context of the study. The use of complimentary sleep assessment tools in clinical and research settings should be encouraged.
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Affiliation(s)
- Jonathan Kushnir
- The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Avi Sadeh
- The Adler Center for Research in Child Development and Psychopathology, School of Psychological Sciences, Tel-Aviv University, Israel
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13
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Diederich NJ, Rufra O, Pieri V, Hipp G, Vaillant M. Lack of polysomnographic Non-REM sleep changes in early Parkinson's disease. Mov Disord 2013; 28:1443-6. [PMID: 23744568 PMCID: PMC4238738 DOI: 10.1002/mds.25520] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 04/10/2013] [Accepted: 04/22/2013] [Indexed: 12/02/2022] Open
Abstract
Background Polysomnography (PSG) data are rare in patients who have early stage idiopathic Parkinson’s disease (IPD). Methods Thirty-three patients who had IPD with a disease duration ≤3 years and 37 age-matched controls were recruited. PSG analysis was performed on current medication. Results Patients with IPD had a reduced mean percentage of muscle atonia during rapid eye movement (REM) sleep (80% vs 93%; P < 0.05). Total sleep time, sleep efficiency, indices/hour of arousals, awakenings, apnea/hypopnea, and periodic leg movements were similar in both groups. Age, but not dopaminergic medication, had a negative impact on sleep architecture in patients with IPD. There was no correlation between sleep efficiency assessed by PSG and sleep quality assessed by questionnaire. Conclusions The results confirmed a reduction in muscle atonia during REM sleep as a characteristic finding in early IPD. However, there were no further disease-inherent or medication-induced changes in sleep architecture. Although sleep disturbances are considered to be an integral part of IPD, PSG cannot yet identify them objectively at an early stage. © 2013 International Parkinson and Movement Disorder Society
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Affiliation(s)
- Nico J Diederich
- Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg; Interdisciplinary Sleep Laboratory, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg; Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, Luxembourg
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14
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Elsayed RM, Hasanein BM, Sayyah HE, El-Auoty MM, Tharwat N, Belal TM. Sleep assessment of children with cerebral palsy: Using validated sleep questionnaire. Ann Indian Acad Neurol 2013; 16:62-5. [PMID: 23661965 PMCID: PMC3644784 DOI: 10.4103/0972-2327.107708] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/01/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022] Open
Abstract
Background: On the basis of clinical experience, it seems that sleep disturbances are common in children with cerebral palsy (CP); however, there is a lack of research and objective data to support this observation. Aim of Work: Our aim was to assess sleep of children with cerebral palsy, using validated sleep questionnaire. Subjects and Methods: one hundred children with diagnosis of CP were investigated via sleep questionnaires, with their ages from 2-12 years. The 100 children with CP were divided into two groups, pre-school group (52 children had a mean age 2.35 ± 1.04 years) and school ages group (48 children had a mean age 10.21 ± 3.75 years). Results: We found high incidence of sleep problem in both pre-school and school age groups. We found that pre-school children have more prevalence of early insomnia (46.2%, P value 0.028) and sleep bruxism (50%, P value 0.000), while school group suffer more sleep disordered breathing (SDB) (50%, P value 0.001), more nightmares (50%, P value 0.001), more sleep talking (12.5% P value 0.049), and more excessive daytime sleepiness (EDS) (62.5%, P value 0.001). Conclusion: Results of our study indicate that CP children have high incidence of sleep problem in both pre-school and school age groups.
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Affiliation(s)
- Riad M Elsayed
- Department of Pediatrics, Pediatric Neurology Unit, Mansoura University, Egypt
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15
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Kobayashi I, Huntley E, Lavela J, Mellman TA. Subjectively and objectively measured sleep with and without posttraumatic stress disorder and trauma exposure. Sleep 2012; 35:957-65. [PMID: 22754042 PMCID: PMC3369231 DOI: 10.5665/sleep.1960] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Although reports of sleep disturbances are common among individuals with posttraumatic stress disorder (PTSD), results of polysomnographic (PSG) studies have inconsistently documented abnormalities and have therefore suggested "sleep state misperception." The authors' study objectives were to compare sleep parameters measured objectively and subjectively in the laboratory and at home in civilians with and without trauma exposure and PTSD. DESIGN Cross-sectional study. SETTING PSG recordings in a sleep laboratory and actigraphic recordings in participants' homes. PARTICIPANTS One hundred three urban-residing African Americans with and without trauma exposure and PTSD who participated in a larger study. INTERVENTIONS N/A. MEASUREMENTS Sleep parameters (total sleep time [TST], sleep onset latency [SOL], and wake after sleep onset [WASO]) were assessed using laboratory PSG and home actigraphy. A sleep diary was completed in the morning after PSG and actigraphy recordings. Habitual TST, SOL, and WASO were assessed using a sleep questionnaire. The Clinician Administered PTSD Scale was administered to assess participants' trauma exposure and PTSD diagnostic status. RESULTS Participants, regardless of their trauma exposure/PTSD status, underestimated WASO in the diary and questionnaire relative to actigraphy and overestimated SOL in the diary relative to PSG. Among participants with current PTSD, TST diary estimates did not differ from the actigraphy measure in contrast with those without current PTSD who overestimated TST. No other significant group differences in discrepancies between subjective and objective sleep measures were found. CONCLUSIONS Discrepancies between subjectively and objectively measured sleep parameters were not associated with trauma exposure or PTSD. This challenges prior assertions that individuals with PTSD overreport their sleep disturbances.
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Affiliation(s)
| | - Edward Huntley
- Department of Psychology, American University, Washington, DC
| | - Joseph Lavela
- Department of Psychiatry, Howard University, Washington, DC
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Bihari S, Doug McEvoy R, Matheson E, Kim S, Woodman RJ, Bersten AD. Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med 2012; 8:301-7. [PMID: 22701388 DOI: 10.5664/jcsm.1920] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Sleep disturbance is a frequently overlooked complication of intensive care unit (ICU) stay. AIM To evaluate sleep quality among patients admitted to ICU and investigate environmental and non-environmental factors that affect sleep quality in ICU. METHODS Over a 22-month period, we consecutively recruited patients who spent ≥ 2 nights post-endotracheal extubation in ICU and who were orientated to time, place, and person on the day of discharge. Self-reported sleep quality, according to a modified Freedman questionnaire, which provided data on self-reported ICU sleep quality in ICU and environmental factors affecting sleep quality in the ICU, were collected. We also investigated non-environmental factors, such as severity of illness, ICU interventions, and medications that can affect sleep quality. RESULTS Fifty males and 50 females were recruited with a mean (± SD) age of 65.1 ± 15.2 years. APACHE II score at admission to ICU was 18.1 ± 7.5 with duration of stay 6.7 ± 6.5days. Self-reported sleep quality score at home (1 = worst; 10 = best) was 7.0 ± 2.2; this decreased to 4.0 ± 1.7 during their stay in ICU (p < 0.001). In multivariate analysis with APACHE III as severity of illness (R(2) = 0.25), factors [exp(b)(95% CI), p value] which significantly affected sleep in ICU were sex [0.37(0.19-0.72), p < 0.01], age and sex interaction [1.02(1.01-1.03), p < 0.01], bedside phone [0.92(0.87-0.97), p < 0.01], prior quality of sleep at home [1.30(1.05-1.62), p = 0.02], and use of steroids [0.82(0.69-0.98), p = 0.03] during the stay in ICU. CONCLUSION Reduced sleep quality is a common problem in ICU with a multifactorial etiology.
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Affiliation(s)
- Shailesh Bihari
- Department of Intensive and Critical Care Medicine, Flinders Medical Centre, Bedford Park South Australia, Australia
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Netto AB, Sinha S, Taly AB, Panda S, Rao S. Sleep in Wilson's disease: Questionnaire based study. Ann Indian Acad Neurol 2011; 14:31-4. [PMID: 21633612 PMCID: PMC3098521 DOI: 10.4103/0972-2327.78047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 11/05/2010] [Accepted: 12/29/2010] [Indexed: 11/08/2022] Open
Abstract
Objective: We proposed to detect sleep abnormalities in Wilson’s disease, (WD) using sleep questionnaires. Materials and Methods: Twenty-five patients (M:F = 18:7; age: 24.4 ± 9.2 years) with WD and 24 controls (all males; age: 33.1 ± 9.7 years) were recruited. They underwent phenotypic/magnetic resonance imaging (MRI) evaluation followed by administration of Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. Results: The mean age at presentation and diagnosis was 24.4 ± 9.2 and 17.6 ± 7.5 years, respectively. The duration of illness at diagnosis was 14 ± 21.9 months. On PSQI, 15 patients with WD had abnormal PSQI scores of >5 as compared to 6 patients among the controls. The mean PSQI score was significantly more (P = 0.03) in patients compared to the controls. The PSQI worst scores were noted only in WD. Evaluation with ESS showed that three patients with WD scored >10/24, while two among the controls qualified for excessive daytime sleepiness. Overall, assessment by sleep questionnaires detected abnormality in 16 patients with WD as compared to 8 controls (P = 0.004). Subgroup analysis revealed that patients whose duration of illness was >8 years and who were on decoppering treatment had significantly lesser excessive daytime somnolence. Conclusions: Sleep disturbances were observed more often in WD than in controls. Better designed studies will provide a better understanding.
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Affiliation(s)
- Archana B Netto
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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