Assessment Of Excessive Daytime Sleepiness Research Articles

Exploring Sleep Architecture in Polish Patients with Multiple Sclerosis: A Polysomnography Study

Background: Sleep disturbances are a prevalent phenomenon in patients with multiple sclerosis (PwMS). The present study employs polysomnography (PSG) to quantify sleep efficiency and architecture in PwMS, aiming to elucidate the relationships between PSG parameters and factors including gender, disability level, brain lesion location, and subjective measures of insomnia, excessive daytime sleepiness (EDS), fatigue, pain, and mood disorders. Methods: The study cohort comprised 51 adult PwMS, of whom 31 underwent overnight PSG. The demographic and clinical characteristics, including age, gender, and Expanded Disability Status Scale (EDSS), were collated. The Athens Insomnia Scale, the Epworth Sleepiness Scale, the Fatigue Severity Scale, the Modified Fatigue Impact Scale (MFIS), the Numerical Pain Rating Scale, and the Hospital Anxiety and Depression Scale were employed for the assessment of insomnia, EDS, fatigue, pain, and mood disorders. The brain and spinal cord magnetic resonance imaging (MRI) were evaluated. Results: A reduced sleep efficiency was observed among 30 PwMS (aged 38.9 ± 12.9), with a mean of 80 ± 12%, especially in those with brainstem demyelinating lesions. In those PwMS aberrant sleep onset latency (SOL) and wake after sleep onset were also noted (p < 0.05). The prevalence of sleep fragmentation, as measured by the total arousal index, was greater in male PwMS than in female (p < 0.05). Higher disability according to the EDSS correlated with longer SOL (ρ = 0.48, p < 0.05), and reduced N2 sleep stage correlated with cognitive fatigue according to MFIS (ρ = −0.46, p < 0.05). Age, disease duration, insomnia, EDS, physical fatigue, and mood disorders did not impact PSG parameters. Conclusions: The study demonstrated the disruption of sleep architecture in PwMS, and highlighted the importance of a comprehensive PSG assessment of sleep disturbances in this population.

Autonomic cardiovascular control is unaffected in children referred for assessment of excessive daytime sleepiness.

There is conflicting evidence for impaired autonomic control of heart rate (HR) in adults with narcolepsy and idiopathic hypersomnolence (IH). Despite these chronic hypersomnia conditions primarily being diagnosed around the age of puberty, there are limited studies in children. The present study investigated cardiovascular control using heart rate variability (HRV) and the extent of nocturnal HR dipping during sleep in children and adolescents with narcolepsy and IH. Children having an overnight polysomnographic study followed by a multiple sleep latency test (MSLT) for investigation of excessive daytime sleepiness (EDS) between May 2010 to December 2023 were included: 28 children diagnosed with narcolepsy, 11 with IH, and 26 subjectively sleepy children who did not meet the diagnostic criteria for either narcolepsy or IH. Each clinically referred child was matched for age and sex with a control. Time domain and frequency domain HRV were calculated from ECG recorded at 512 Hz. There were no differences in either time domain or spectral analysis of HRV between clinical groups or between clinical groups and their control group. The expected sleep state differences in HRV were observed in all groups. There was also no difference in HR nocturnal dipping between groups. Despite evidence for abnormal autonomic function in adults with narcolepsy and IH, our study did not identify any abnormalities in HR, HR control, or nocturnal dipping of HR in children referred for assessment of EDS. This suggests that autonomic dysfunction may be a feature of these conditions that develops in later life.

Risk stratification for frailty, impairment and assessment of sleep disorders in community-dwelling older adults

BackgroundFrailty is associated with an increased susceptibility to functional decline, impairment, hospitalization, and mortality among the older adults. However, the potential reversibility of frailty lies in identifying modifiable factors that could prevent, mitigate, or interrupt its progression. While there is a suggestion that sleep disorders may increase the risk of frailty and impairment, the risk stratification of this relationship remains inconclusive. ObjectiveStratify the risk of frailty and impairment and investigate potential connections with sleep quality, excessive daytime sleepiness, and the risk of obstructive sleep apnea in older adults dwelling in the community. MethodsThis was a quantitative cross-sectional investigation. Frailty risk and impairment were stratified using the Frail Non-disabled Questionnaire (for impairment) and the FRAIL Scale (for Frailty). The assessment of excessive daytime sleepiness, sleep quality, and the risk of obstructive sleep apnea involved the employment of the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and the STOP-BANG questionnaire, respectively. ResultsA total of 109 older adults living in the urban area (86 %, p = 0.010), females (61 %; p = 0.030), median age 68 (64–75) years, with overweight (36 %, p < 0.010) and self-identified as belonging to other racial or ethnic categories (71 %, p < 0.010). According to the impairment assessment, 32 % of participants were classified as disable (p < 0.01). Conversely, as per the frailty evaluation, 33 % were pre-frail and 25 % were identified as frail. Additionally, a substantial proportion experienced poor sleep quality (80 %, p = 0.010), exhibited a moderate risk of obstructive sleep apnea (49 %, p < 0.010), and showed no signs of excessive daytime sleepiness (62 %, p < 0.010). There was a modest correlation between frailty and impairment with poor sleep quality (rho = 0.39; p < 0.001) and the risk of obstructive sleep apnea (rho = 0.26; p = 0.000). However, the was no significant relationship was observed between frailty and impairment and excessive daytime sleepiness (rho = 0.04; p = 0.660). Similarly, a modest correlation was observed between sleep quality (rho = 0.33; p < 0.001), the risk of obstructive sleep apnea (rho = 0.27; p = 0.001), and frailty. Conversely, no correlation was found with excessive daytime sleepiness (rho = 0.05; p = 0.590). Also, the poor sleep quality and the risk of obstructive sleep apnea explain 14 % of the risk of frailty in the population of community-dwelling older adults (r2 = 0.14; p = 0.04). ConclusionThis study reveals a modest risk of frailty and impairment with sleep quality and the risk of obstructive sleep apnea, but not with excessive daytime sleepiness in community-dwelling older adults.

Validation of the Malay version of Epworth sleepiness scale for children and adolescents (MESS-CHAD)

BackgroundEpworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) is a valid and reliable eight-item self-administered questionnaire for the assessment of excessive daytime sleepiness and is commonly used to screen sleep-disordered breathing for children and adolescents. The cross-sectional study aimed to translate and cross-culturally adapt ESS-CHAD into a Malay version of Epworth Sleepiness Scale for Children and Adolescents (MESS-CHAD) for the Malaysian population, and to assess the validity and reliability of MESS-CHAD.MethodsForward-backward translation method was used to translate and cross-culturally adapt ESS-CHAD. Three linguistic experts and two paediatricians content validated the translated version. Face validity was conducted through audio-recorded semi-structured in-depth interviews with 14 native Malay-speaking children and adolescents followed by thematic analysis. The revised questionnaire was then proofread by a linguistic expert. A total of 40 subjects answered the MESS-CHAD twice, 2 weeks apart, for test-retest reliability and internal consistency. For criterion validity, 148 eligible subjects and their parents answered MESS-CHAD and the Malay version of Sleep-Related Breathing Disorder scale extracted from the Paediatric Sleep Questionnaire (M-PSQ:SRBD) concurrently. Variance Inflation Factor (VIF) and P values of the model’s outer weight and outer loading were analysed using SmartPLS software to assess the indicator’s multicollinearity and significance for formative construct validity.ResultsIntraclass Correlation Coefficient (ICC) ranging from 0.798 to 0.932 and Cronbach’s alpha ranging from 0.813 to 0.932 confirmed good to excellent test-retest reliability and internal consistency, respectively. Spearman Correlation Coefficient value of 0.789 suggested a very strong positive correlation between MESS-CHAD and M-PSQ:SRBD. VIF ranging from 1.109 to 1.455 indicated no collinearity problem. All questionnaire items in MESS-CHAD were retained as the P value of either outer model weight or outer model loading was significant (P < 0.05).ConclusionESS-CHAD has been translated and cross-culturally adapted into Malay version for the Malaysian population, and found to be valid and reliable.

Excessive day time sleepiness and its associated factors among adult population in an urban area of southern Rajasthan

Background: Sleep problems have been considered as an unmet public health problem. Sleep problems are mostly under reported and neglected by the Indian population. Very limited studies have been conducted in India on this aspect. Aims and Objectives: The aim of the study was to estimate the prevalence of excessive day time sleepiness (EDS) and its associated factors among urban adult population. Materials and Methods: A community based cross-sectional study was conducted among 409 adults of 20–60 years age group in urban Udaipur. Socio-demographic and other details were obtained using a semi structured questionnaire. Using Epworth Sleepiness Scale, assessment of EDS was assessed. Results: In the present study, mean age of the participants was 40.8 ± 11.3 years. Considering the ESS score of 10 or more, EDS was observed in 60.2% subjects. EDS was associated with age, gender, milk consumption, and mobile use. No significant association was found between EDS with central obesity, body mass index, marital status, literacy, occupation, exercise, smoking, and consumption of alcohol. Conclusion: In the present study, the prevalence of EDS was high. Therefore, early identification of excessive sleep problems and appropriate intervention that address the various determinants of the sleep problems is of prime importance.

Sleep Quality, Excessive Daytime Sleepiness, and Physical Activity Level in Health Professionals with and Without COVID-19: a Cross-Sectional Study.

Objective To compare the sleep quality, excessive daytime sleepiness, and physical activity level in health professionals infected and not infected with COVID-19. Methods Cross-sectional study based on online forms (Google Forms) filled out by health professionals who cared for COVID- 19 patients in hospitals in the Recife metropolitan area, Brazil, between October 2020 and May 2021. Anthropometric, sociodemographic, and occupational data were collected, along with the assessment of excessive daytime sleepiness (with Epworth Sleepiness Scale [ESE]), sleep quality (with Pittsburgh Sleep Quality Index [PSQI]), and physical activity level (with International Physical Activity Questionnaire [IPAQ] - short version). Results A total of 96 participants were assessed (37 with COVID-19, 59 without COVID-19). There were no differences between the groups regarding physical activity levels classified as sedentary, moderately active, or highly active (p = 0.850), or the weekly energy expenditure (p = 0.522). Infected professionals had a greater workload than non-infected ones, besides poorer sleep quality (10.46 ± 3.75 vs. 7.88 ± 3.75; p = 0.001) and excessive daytime sleepiness (10.19 ± 3.05 vs. 8.44 ± 3.85; p = 0.016). Conclusion Based on the results, this study shows that professionals infected with COVID-19 have poorer sleep quality, associated with excessive daytime sleepiness, in contrast with non-infected professionals.

Machine learning polysomnographically-derived electroencephalography biomarkers predictive of epworth sleepiness scale

Excessive daytime sleepiness (EDS) causes difficulty in concentrating and continuous fatigue during the day. In the clinical setting, the assessment and diagnosis of EDS rely mostly on subjective questionnaires and verbal reports, which compromises the reliability of clinical diagnosis and the ability to robustly discern candidacy for available therapies and track treatment response. In this study, we used a computational pipeline for the automated, rapid, high-throughput, and objective analysis of previously collected encephalography (EEG) data to identify surrogate biomarkers for EDS, thereby defining the quantitative EEG changes in individuals with high Epworth Sleepiness Scale (ESS) (n = 31), compared to a group of individuals with low ESS (n = 41) at the Cleveland Clinic. The epochs of EEG analyzed were extracted from a large overnight polysomnogram registry during the most proximate period of wakefulness. Signal processing of EEG showed significantly different EEG features in the low ESS group compared to high ESS, including enhanced power in the alpha and beta bands and attenuation in the delta and theta bands. Our machine learning (ML) algorithms trained on the binary classification of high vs. low ESS reached an accuracy of 80.2%, precision of 79.2%, recall of 73.8% and specificity of 85.3%. Moreover, we ruled out the effects of confounding clinical variables by evaluating the statistical contribution of these variables on our ML models. These results indicate that EEG data contain information in the form of rhythmic activity that could be leveraged for the quantitative assessment of EDS using ML.

Reliability and Validity of the Turkish Version of the Observation and Interview Based Diurnal Sleepiness Inventory

Objective: The Observation and Interview Based Diurnal Sleepiness Inventory (ODSI) is a valid 3-item tool used for assessment of excessive daytime sleepiness (EDS). The aim of this study was to investigate the reliability and validity of the ODSI in the Turkish language.Methods: Linguistic validation of the ODSI was performed by forward-backward translation. The Turkish version of the ODSI and the Epworth Sleepiness Scale (ESS) were administered in EDS and control groups.Results: The ODSI was tested in 106 older patients. The median age of the patients was 73 (65–89) years and 55.7% were female. The EDS group was older and more dependent on instrumental activities of daily living than the control group. The inter-rater reliability of the ODSI was high (interclass correlation coefficient [ICC]: 0.851, 95% confidence interval [CI]: 0.540–0.958, p&lt;0.001). Test-retest reliability was also high for the total sample (ICC: 0.871, 95% CI: 0.632–0.959, p&lt;0.001). Positive strong correlations were found with the ESS (Speraman’s rho=0.876, 95% bootstrap CI [0.813–0.918], p&lt;0.001). ROC curve analysis showed an area under the curve of 0.968 (95% CI: 0.937–0.998), a cutoff score of ≥6, a sensitivity of 94.1%, a specificity of 87.6%, a positive predictive value of 76.55%, and a negative predictive value of 97.2%.Conclusion: Our data validate the ODSI for application in Turkish-speaking populations. The simplicity, reliability, and the apparent lack of relevant influences of cultural background on performance of the 3-item ODSI make it a valuable tool for clinical management and research.

Assessment of excessive daytime sleepiness in cirrhotic patients

Background. It is known that alterations of the sleep-wake cycle are present from the early stages of hepatic encephalopathy (starting with grade I on the West Haven criteria). However, minimal hepatic encephalopathy (which is not included in the West Haven criteria) defines the earliest form of HE, with no obvious clinical manifestations, but with subtle alterations in cognitive domains such as attention, visuo-spatial perception, psychomotor speed and response inhibition. Aim. To determine if liver cirrhosis in otherwise asymptomatic individuals (without clinically manifest hepatic encephalopathy) is associated with an increased risk of altered sleep rhythm or excessive daytime sleepiness. Additionally, to determine if this risk is correlated with liver disease severity or other clinical and biological parameters. Material and methods. Cross-sectional study involving 25 adult patients with liver cirrhosis. Patients were evaluated through a standard neurological examination and with the Epworth Sleepiness Scale. Liver disease severity was measured using the MELD and Child-Pugh scores. Blood ammonia levels were also measured. Results. Mean age of the patients was 50±12 years-old. There was a predominance of males (68%, n=17). Mean MELD score was 17±7 points. Mean Child-Pugh score was 8±2 points. Mean blood ammonia level was 34±17 μg/dL. Subjective daytime somnolence was reported by 24% of patients (n=6). Mean ESS score was 6±5 points. No correlation was noted between the ESS scores and liver disease severity as measured by the Child-Pugh and MELD scores. Only three patients (12%) scored over 10 points on the ESS (none of them obese) and were consequently diagnosed with excessive daytime sleepiness (EDS). This proportion falls into the accepted prevalence of EDS in the general population. Conclusions. In our study, liver cirrhosis was not associated with a higher prevalence of excessive daytime sleepiness than in the general population.

Instruments For Assessment Of Excessive Daytime Sleepiness In Brazilian Children And Adolescents: Systematic Review

Objective:To systematically review the literature on the instruments used to assess excessive daytime sleepiness (EDS) in Brazilian children and adolescents.Data source:A systematic review of the literature was performed in the databases MEDLINE PubMed, Scopus, Web of Science, LILACS, Scielo and SPORTDiscus, with no time limit for searches. The eligibility criteria were studies published in English and Portuguese, original articles that used questionnaires to assess EDS and whose sample consisted of Brazilian children and/or adolescents. As search strategy, the following terms were combined with Boolean operators “OR” and/or “AND”: drowsiness, disorders of excessive somnolence, excessive daytime sleepiness, day sleepiness, midday sleepiness, daytime sleepiness, adolescents, Brazil, Brazilian adolescents, and children.Data synthesis:Sixteen articles were selected, in which nine different instruments were applied to 8.240 children and adolescents from the South, Southeast, Midwest and Northeast regions of Brazil. The mean of methodological quality of studies was 16.1±1.9 points. The instruments most frequently used were the Pediatric Daytime Sleepiness Scale (PDSS) and Karolinska Sleepiness Scale (KSS), but only PDSS was shown reliable to assess EDS in Brazilian children and adolescents.Conclusions:The PDSS was the only instrument considered reliable to assess EDS in Brazilian children and adolescents. Further research on EDS in children and adolescents are suggested to perform the validation of other instruments for Brazil and present internal consistency values.

Power spectral densities of nocturnal pulse oximetry signals differ in OSA patients with and without daytime sleepiness

BackgroundAs nocturnal hypoxemia and heart rate variability are associated with excessive daytime sleepiness (EDS) related to OSA, we hypothesize that the power spectral densities (PSD) of nocturnal pulse oximetry signals could be utilized in the assessment of EDS. Thus, we aimed to investigate if PSDs contain features that are related to EDS and whether a convolutional neural network (CNN) could detect patients with EDS using self-learned PSD features. MethodsA total of 915 OSA patients who had undergone polysomnography with multiple sleep latency test on the following day were investigated. PSDs for nocturnal blood oxygen saturation (SpO2), heart rate (HR), and photoplethysmogram (PPG), as well as power in the 15–35 mHz band in SpO2 (PSPO2) and HR (PHR), were computed. Differences in PSD features were investigated between EDS groups. Additionally, a CNN classifier was developed for identifying severe EDS patients based on spectral data. ResultsSpO2 power content increased significantly (p < 0.002) with increasing severity of EDS. Furthermore, a significant (p < 0.001) increase in HR-PSD was found in severe EDS (mean sleep latency < 5 min). Elevated odds of having severe EDS was found in PSPO2 (OR = 1.19–1.29) and PHR (OR = 1.81–1.83). Despite these significant spectral differences, the CNN classifier reached only moderate sensitivity (49.5%) alongside high specificity (80.4%) in identifying patients with severe EDS. ConclusionsWe conclude that PSDs of nocturnal pulse oximetry signals contain features significantly associated with OSA-related EDS. However, CNN-based identification of patients with EDS is challenging via pulse oximetry.

Association between excessive daytime sleepiness and measures of supraventricular arrhythmia burden: evidence from the Atherosclerosis Risk in Communities (ARIC) study.

Excessive daytime sleepiness is a common sleep complaint among older adults. Assessment of excessive daytime sleepiness is used to screen for obstructive sleep apnea, which may be linked to atrial fibrillation (AF) and other sustained arrhythmias. Using data from the Atherosclerosis Risk in Communities (ARIC) Study cohort, we examined the association of excessive daytime sleepiness with measures of arrhythmia burden derived from a continuous ECG recording device in a community-based sample of older adults. Participating older adults (N= 2306, mean age: 78.9 ± 4.5years, 57.8% female) wore a Zio® XT Patch for 14days. Excessive daytime sleepiness was assessed with the Epworth Sleepiness Scale. Measures of AF and supraventricular arrhythmia burden were derived from the Zio® XT Patch. Multiple adjusted logistic, multinomial, and linear regression models were used to assess associations of excessive daytime sleepiness with AF, AF burden, and supraventricular arrhythmia burden. Approximately 18% of the sample had excessive daytime sleepiness, and 8.5% had AF. After adjustment, excessive daytime sleepiness was not significantly associated with AF (odds ratio (OR), 1.20; Confidence Interval (CI), 0.81-1.75), continuous AF burden (OR, 1.36; CI, 0.85-2.16), or measures of supraventricular arrhythmia burden (SVE burden: β 0.01; 95% CI, -0.09-0.11; SVT burden: β 0.02; 95% CI, -0.04-0.08). In this community-based sample of older adults, excessive daytime sleepiness was not associated with measures of arrhythmia burden. Future studies with objective measures of sleep are needed to further examine the role of sleep in the development and progression of arrhythmia burden.

Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood. It is a heterogeneous disorder in terms of clinical presentation that is probably due to the frequent occurrence of comorbidity. Children with ADHD more frequently report sleep disorders (notably delayed sleep phase syndrome) and excessive daytime sleepiness (EDS) than typically developing children. The aim of this article is to propose a narrative review of the assessment of EDS in the context of ADHD with first a summary of the subjective and objective tools used to measure it. Secondly, perspectives in terms of electroencephalogram (EEG) markers and neurofeedback are proposed. Then, possibilities for new kinds of evaluation are discussed (virtual reality, ecological momentary assessment, etc.). Lastly, we discuss specific clinical situations with EDS in the context of ADHD as links with narcolepsy, the comorbidity with other psychiatric disorders, and the context of sluggish cognitive tempo.

Comparison of sleep latency measured by the oxford sleep resistance test and simultaneous EEG in Japanese patients

Excessive daytime sleepiness (EDS) is observed in various pathological conditions associated with sleep disorders. However, objective methods for the assessment of EDS rely on complex electroencephalographic (EEG) recording and are impractical for use in general clinical practice. To address this issue, the Oxford Sleep Resistance Test (OSLER) has been developed for use in clinical practice overseas, though few studies have examined the reliability of the OSLER test for measuring sleep latency in Japanese patients. Thus, in the present study, we aimed to determine whether sleep latency measured via the OSLER test (SLOSLER) is consistent with that measured via EEG (SLEEG) in Japanese patients with obstructive sleep apnea (OSA). Seventeen Japanese men with OSA (mean age: 51.5 ± 9.8 years) underwent simultaneous OSLER and EEG testing a total of four times on the day following polysomnography evaluation. SLOSLER and SLEEG were compared, and the reliability of the former was analysed using Bland-Altman plots. Mean SLOSLER and SLEEG for all patients were 26.9 ± 11.6 and 25.7 ± 12.2 minutes, respectively. A significant positive correlation was observed between these measurements (p<0.0001, r=0.963). Moreover, the Epworth Sleepiness Scale (ESS) scores were not significantly correlated with either SLOSLER or SLEEG. Bland-Altman plot analysis revealed that 94% of the plotted SLOSLER or SLEEG measurements converged within a range of mean ± 1.96 SD. Our findings thus demonstrated that SLOSLER is consistent with SLEEG in Japanese patients with OSA.

The Perception and Attention Functions test battery as a measure of neurocognitive impairment in patients with suspected central disorders of hypersomnolence.

The aim of the current study was to evaluate an attention test as a discriminative tool to measure neurocognitive impairment in patients with disorders of hypersomnolence. Chronic excessive daytime sleepiness is the main symptom in central disorders of hypersomnolence. For diagnostic purposes and treatment evaluation, reliable assessment of excessive daytime sleepiness is required. Thirty-six patients with central disorders of hypersomnolence were compared with 20 healthy controls. All participants performed the 'Perception and Attention Functions' (WAF) of the Vienna Test System. Patients underwent polysomnography, Multiple Sleep Latency Test and Maintenance of Wakefulness Test. Patients were divided into two groups: (i) patients who met the criteria of disorder of hypersomnolence (objective excessive daytime sleepiness); and (ii) patients with subjective excessive daytime sleepiness, i.e. with normal Multiple Sleep Latency Test results. Group 1 consisted of 23 patients with objective excessive daytime sleepiness (11 with idiopathic hypersomnia, nine with narcolepsy type 1, three with narcolepsy type 2); group 2 included 13 patients with subjective excessive daytime sleepiness. The results showed cognitive impairment in patients with objective excessive daytime sleepiness and even in patients with subjective excessive daytime sleepiness. WAF tests identified distinct attention profiles in patients with narcolepsy type 1, idiopathic hypersomnia/narcolepsy type 2, and patients with subjective excessive daytime sleepiness. WAF test measures correlated with Maintenance of Wakefulness Test and the Epworth Sleepiness Scale, but not with Multiple Sleep Latency Test and the Fatigue Severity Scale. In conclusion, the multidimensional WAF test battery detects cognitive impairment even in patients that complain of excessive daytime sleepiness but have normal Multiple Sleep Latency Test results. WAF tests offer valuable information that adds to the existing polysomnographic measures in discriminating patients with different types of chronic excessive daytime sleepiness. The results provide new insights into cognitive dysfunction underlying different types of chronic excessive daytime sleepiness.

Longitudinal assessment of excessive daytime sleepiness in early Parkinson’s disease

BackgroundExcessive daytime sleepiness (EDS) is common and disabling in Parkinson’s disease (PD). Predictors of EDS are unclear, and data on biological correlates of EDS in PD are limited. We investigated...

0437 THE CLINICAL UTILITY OF SUBJECTIVE VS. OBJECTIVE TESTS OF EXCESSIVE DAYTIME SLEEPINESS IN THE ASSESSMENT OF PATIENTS WITH SLEEP APNEA

Excessive daytime sleepiness (EDS) is highly prevalent in obstructive sleep apnea (OSA). In clinical practice, EDS is assessed subjectively with the Epworth Sleepiness Scale (ESS), whereas Multiple Sleep Latency Test (MSLT) is the standard test for the objective assessment of EDS. Psychomotor vigilance task (PVT) has been suggested as a convenient, simpler method than MSLT to assess EDS. In this study, we examined the association between these three methods and their possible utility as predictors of cardiovascular morbidity by examining their association with preclinical markers of metabolic risk, i.e. the proinflammatory cytokine interleukin-6 (IL-6). We studied 58 OSA patients (53.7 ± 7.0y, 63.8% male) who underwent 8-hour in-lab polysomnography for 4 consecutive nights. Four trials of MSLT and PVT were administered on the 4th day every 2 hours. PVT was performed an hour before MSLT. PVT variables included number of lapses, mean reciprocal of the fastest 10% and slowest 10% reaction times (RTs), and median of 1/RT. ESS was assessed on day 1 of the study. Twenty-four-hour profiles of IL-6 levels were assessed on the 4th day. Lower MSLT values were associated with significantly elevated 24-hour (β=-0.34, p=0.01), daytime (β=-0.30, p=0.02) and nighttime (β=-0.38, p<0.01) IL-6 levels. Higher ESS scores were significantly associated with greater number of lapses (β=0.34, p=0.021) and lower values of slowest 10% (β=-0.30, p=0.04) and 1/RT (β=-0.36, p=0.01) but not with IL-6 levels. No significant associations were found between PVT performance, and IL-6 levels or PVT and MSLT. Our findings suggest that in OSA, MSLT is associated with low-grade inflammation whereas ESS is associated with impaired sustained attention/vigilance as measured by PVT. It appears that MSLT is a good predictor for cardiovascular morbidity whereas ESS predicts impaired performance in OSA patients. R01 HL64415

Correlation of Epworth Sleepiness Scale with polysomnography changes in the assessment of excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome

Introduction: Excessive daytime sleepiness (EDS) is an important sleep disorder, frequently associated to the obstructive sleep apnea hypopnea syndrome (OSAHS). It is known to be an important predisposing factor to accidents, decreased productivity, neurocognitive disorders and social issues. Thus, early detection of EDS is crucial. Objective: To evaluate the correlation of the Epworth Sleepiness Scale (ESS) with polysomnographic parameters in patients with OSAHS. Method: The study evaluated 1264 reports of polysomnography of patients with OSAHS admitted from January 2009 to December 2013 at the Instituto do Sono dos Campos Gerais. The reports were initially divided into groups according to the severity of OSAHS and then according to the score obtained in ESE and evaluated according to the results of the polysomnographic parameters. Results: From the analyzed reports, 822 (65.03%) were male patients, and 442 (34.87%) were female patients. According to the ESS scores analysis, a relation was observed between the scale and OSAHS (r = 0.175, p &lt; 0.,00001). However, when divided into subgroups only severe OSAHS presented a significant correlation (r = 0.136, p = 0.0004). Conclusion: The scale is more strongly related with severe OSAHS, which is also more likely to develop EDS. Due to the importance of early detection of sleepiness, the ESS can be used as a method of rapid assessment in patients with OSAHS, to estimate its severity and the presence of SED

Comparison of Sleep Latency Measured by the Oxford Sleep Resistance Test and Simultaneous EEG in Japanese Patients

Excessive daytime sleepiness (EDS) is observed in various pathological conditions associated with sleep disorders. However, objective methods for the assessment of EDS rely on complex electroencephalographic (EEG) recording and are impractical for use in general clinical practice. To address this issue, the Oxford Sleep Resistance Test (OSLER) has been developed for use in clinical practice overseas, though few studies have examined the reliability of the OSLER test for measuring sleep latency in Japanese patients. Thus, in the present study, we aimed to determine whether sleep latency measured via the OSLER test (SLOSLER) is consistent with that measured via EEG (SLEEG) in Japanese patients with obstructive sleep apnea (OSA). Seventeen Japanese men with OSA (mean age: 51.5 ± 9.8 years) underwent simultaneous OSLER and EEG testing a total of four times on the day following polysomnography evaluation. SLOSLER and SLEEG were compared, and the reliability of the former was analysed using Bland-Altman plots. Mean SLOSLER and SLEEG for all patients were 26.9 ± 11.6 and 25.7 ± 12.2 minutes, respectively. A significant positive correlation was observed between these measurements (p<0.0001, r=0.963). Moreover, the Epworth Sleepiness Scale (ESS) scores were not significantly correlated with either SLOSLER or SLEEG. Bland-Altman plot analysis revealed that 94% of the plotted SLOSLER or SLEEG measurements converged within a range of mean ± 1.96 SD. Our findings thus demonstrated that SLOSLER is consistent with SLEEG in Japanese patients with OSA.

Observational study of prevalence of sleep disorder in patients with epilepsy

BackgroundReduced sleep quality with subsequent excessive daytime sleepiness (EDS) is found in patients with epilepsy. AimTo know the frequency of sleep disorders in comparison to control group to know the predictors of sleep disorders that have implications on management of patient with epilepsy. Materials and methods199 patients with epilepsy and 48 controls, who attended Nizam's Institute of Medical Sciences were taken into the study.The Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) are two questionnaires commonly used in clinical assessment of EDS and sleep quality. Results24.6% of PWE are found to have problems with sleep disorders when compared to controls (10.6%). PWE had significantly higher scores when compared to controls in global PSQI total scores (3.78 vs. 2.43). Sleep latency and medication use (0.83 vs. 0.53 and 0.52 vs. 0.06 respectively) as well as sleep quality and sleep efficiency are poor as indicated by high scores (0.75 vs. 0.40 and 0.22 vs.0.20 respectively). ConclusionPoor sleep quality of PWE in PSQI correlated with EDS of ESS. Poor control of seizures, polytherapy, and partial epilepsy make the PWE statistically more vulnerable to poor sleep quality thereby having therapeutic implications.