Abstract
Dear editor Recently we published a retrospective study in this journal which reported the significant relationship between nocturnal awakening, respectively high arousal index, and fatigue in 410 patients with sleep disorders admitted to our sleep laboratory.1 In this study we noticed that Pittsburgh Sleep Quality Index (PSQI) mean values2 were lower in patients who have been treated for sleep-related breathing disorders (SRBD) compared with either treatment-naive SRBD patients, or with patients with periodic limb movement disorder (PLMD), restless legs syndrome (RLS), or insomnia. However, this study was not focused on PSQI values and we did not classify the patients into good and poor sleepers according to the established PSQI cut-off (less than or equal to versus greater than five). The PSQI was initially developed to screen impaired subjective sleep quality in patients with insomnia and depression, but today it is widely used in sleep medicine in general. We now report the results of a classification of our patients into good and poor sleepers according to their PSQI values, using the PSQI-cut-off of ≤ or >5 that we performed subsequent to our original study. To our knowledge, there have been to date only a few studies in this issue that have investigated the use of PSQI in obstructive sleep apnea (OSA) patients. These studies had inconsistent findings and small sample sizes. Macey et al3 did not find a significant relationship between the apnea-hypopnea-index per hour of sleep (AHI) and PSQI values in 49 untreated OSA patients. Chihara et al4 reported a significant improvement of PSQI values after auto-adjusting positive airway pressure (APAP) with flexible positive airway pressure (C-Flex) (n=29), but not with APAP alone (n=28) or APAP in combination with fixed inspiration/expiration pressure difference (A-Flex) (n=28). Mermigkis et al5 found no significant improvement of PSQI values before and after continuous positive airway pressure (CPAP) in a small sample of 12 patients.
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