Berlin Sleep Questionnaire Research Articles

Sleep Apnea and Incident Stroke in a National Cohort of Black and White Adults.

Racial/ethnic differences have been documented in the relationship between obstructive sleep apnea (OSA) and stroke incidence, yet racial differences in OSA symptoms or treatment and their relationship with stroke incidence are underexplored and may contribute to stroke disparities. We comprehensively examined OSA symptoms and their relationships to stroke incidence by race/ethnicity. Data were collected from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort of Black and White individuals in the United States. Participants free from a stroke diagnosis at baseline were included. Participants self-reported the following: (1) snoring; (2) daytime sleepiness; (3) provider-diagnosed sleep apnea (PDSA); and (4) treatment for PDSA using positive airway pressure (PAP). OSA risk was categorized as high or low based on the Berlin Sleep Questionnaire. Incident stroke was defined as first occurrence of stroke over an average of 12 (SD 3.9) years of follow-up. We report the relationships between snoring, OSA risk, PDSA, PAP therapy use, and incident stroke by race/ethnicity using Cox proportional hazards models after adjusting for demographic and socioeconomic factors and stroke risk factors. Among the 22,192 participants (mean age [SD] 64.2[9.1] years), 38.1% identified as Black. Overall, snoring was not associated with incident stroke (hazard ratio [HR] 0.98, 95% CI 0.85-1.13). However, among White individuals but not Black individuals, high OSA risk and PDSA were associated with incident stroke (HR 1.22, 95% CI 1.01-1.47; HR 1.33, 95% CI 1.04-1.70, respectively). PAP therapy use among those with PDSA (compared with non-PDSA) was associated with incident stroke in White individuals (HR 1.38, 95% CI 1.05-1.80). PAP therapy use among those with PDSA (compared with those with PDSA without PAP therapy use) was associated with reduced risk of incident stroke in Black (HR 0.39, 95% CI 0.17-0.91) but not White (HR 0.63, 95% CI 0.37-1.10) individuals. White individuals with high OSA risk and those with PDSA with or without PAP therapy use were at increased incident stroke risk, whereas Black individuals reporting PDSA and PAP had reduced incident stroke risk relative to those not using PAP. Future research is needed to understand the mechanisms underlying racial differences in OSA and stroke such as differences in assessment modes and treatment.

Abstract P527: Acculturation and Family History Are Associated With Sleep Disturbances in US Americans of South Asian Origin

Introduction: Sleep disorders are an important risk for cardiovascular disease. Although the effects of sleep-disordered breathing have been widely studied in general populations, there is a gap in understanding its prevalence and determinants among South Asians in the United States of America (US), a group with high risk of cardiometabolic disease that presents unique genetic burdens and acculturation issues. We examined the association of family history of sleep disturbances and acculturation in a survey of South Asian immigrants. Methods: We surveyed 105 US South Asian participants (20-75 years, 69% male, 92% born in South Asia) recruited at a community event. Respondents provided information on age, gender, acculturation (measured by the adoption of English spoken at home), and family history of severe snoring in first degree relatives. We used a modified Berlin Sleep Questionnaire, where the obesity criterion was replaced with current diabetes to identify persons with high-risk sleep disturbances and asked about severe snoring in first degree relatives to identify family history of sleep disturbances. We examined the association of high-risk sleep disturbances with family history and acculturation metrics using Chi-squared tests, followed by logistic regression analysis. Results: Of the 105 participants, 28 (26.7%) were identified as high-risk for sleep disturbances. Those at high risk had a median age of 61 years, significantly older than their low-risk counterparts (median age 53; p=0.015). Of the 55% individuals who were acculturated to now speak English at home, 34% had high risk sleep disturbances as compared to 17% with sleep disturbances among those that continued to speak their native non-English language (p=0.044). Of the 10% individuals whose siblings had severe snoring problems, 50% had high risk sleep disturbances vs. 24% in those without sibling history (p = 0.079). In logistic regression models adjusting for age and gender, both sibling history (Odds Ratio 4.6, 95% CI 1.0 to 20.3, p = 0.047) and acculturation (Odds Ratio 3.0, 95% CI 1.1 to 8.6, p = 0.037) were associated with high-risk sleep disturbances. Conclusions: Acculturation as measured by adoption of English as the home language and family history of severe snoring are both associated with sleep disturbances among US South Asians in. Healthcare providers should be especially vigilant for sleep disorders in acculturated South Asian patients and those with such family and social history. Further studies are needed to understand the relationships between genetic predispositions, acculturation, and environmental factors in this population.

Lung Structure and Risk of Sleep Apnea in SPIROMICS.

The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions. The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers. Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk. The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03-1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998-1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03-1.22) and BSQ (OR=1.09, 95%CI:1.01-1.18). Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.

P059 Sleep and Fibromyalgia: Identifying and Managing Sleep Disorders.

Abstract Introduction Little is known about the presentation and management of sleep problems in patients with fibromyalgia [FMS]. This pilot study aims to 1) characterise sleep/wake patterns and sleep disorders in participants with FMS, and 2) assess changes in sleep and FMS symptoms with individualised sleep disorder treatment. Methods Women with FMS were recruited from the Rheumatology Unit at The Queen Elizabeth Hospital, South Australia. Participants recorded their sleep and activity for two-weeks using an under-mattress sleep sensor (Withings), sleep diaries and a wrist accelerometer. Questionnaires included Berlin Sleep Questionnaire (OSA); Epworth Sleepiness Scale; Flinders Fatigue Scale; Restless Legs Syndrome (RLS) Screener, Sleep Condition Indicator, and Fibromyalgia Impact Questionnaire. Results Preliminary data from 7 women (aged 49.3±12.8years, BMI 30.9±7.8kg/m2, average pain duration 14.1±9.4 years) were investigated. Sleep efficiency was low (65.9%±11.9). Five women were ‘high-risk’ for a sleep disorder (3 RLS, 3 OSA, 3 insomnia, 3 circadian rhythm disorders). Two were ‘high-risk’ for >2 sleep disorders. Two women had delayed, and one had advanced, circadian rhythms. Average self-reported sleep time in ‘high-risk’ women was shorter than the two women not at risk (6.2±1.1 vs 7.8±0.4hours). (6.2±1.1 vs 7.8±0.4hours). Fatigue Scores exceeded those commonly observed for respondents living with a medical condition (25.2±2.4 vs. 20.4 + 6.2). Participants are currently undergoing sleep disorder treatments and preliminary results will be reported. Conclusion Identifying and managing sleep disorders, using cognitive behavioural therapy for insomnia and chronotherapeutic approaches may be an important therapeutic target for FMS patients to improve sleep quality, daytime functioning, and FMS symptoms.

History of obstructive sleep apnea associated with incident cognitive impairment in white but not black individuals in a US national cohort study

BackgroundWe sought to determine if risk for obstructive sleep apnea (OSA), a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals. MethodsTo determine whether the risk for OSA, a history of OSA, and/or treatment of OSA has a different association with incident cognitive impairment or cognitive decline in Black individuals and White individuals; data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) was used. Participants that completed the sleep questionnaire module, had baseline cognitive assessment, and at least one cognitive assessment during follow-up were included. Risk of OSA was determined based on Berlin Sleep Questionnaire. History of sleep apnea was determined based on structured interview questions. Optimally treated OSA was defined as treated sleep apnea as at least 4 h of continuous positive airway pressure use per night for ≥5 nights per week. ResultsIn 19,017 participants stratified by race, White participants with history of OSA were 1.62 times more likely to have incident cognitive impairment compared to White participants without history of OSA after adjusting for demographic characteristics, history, and lifestyle factors (OR = 1.62, 95% CI = 1.05–2.50, p-value = 0.03). This relationship was not seen in Black participants (OR = 0.92, 95% CI = 0.60–1.43, p-value = 0.72). DiscussionA previous diagnosis of OSA is associated with incident cognitive impairment in White Americans but not Black Americans. Further investigations are required to determine the mechanism for this difference.

Comparison of the pharyngeal airway in snoring and non-snoring patients based on the lateral cephalometric study: A case-control study.

Normal airways are a key factor during the craniofacial growth of the young. Therefore, sleep-disordered breathing (SDB) without treatment can have harmful consequences for development and health. This study aimed to evaluate the cephalometric characteristics in non-snoring individuals and snoring subjects, and investigate differences in the pharyngeal airway space between the 2 groups. This case-control study included 70 patients aged over 18 years, selected from a radiology center. The patients were divided into 2 groups: case (35 patients with a history of habitual snoring); and control (35 healthy patients). The Berlin sleep questionnaire was administered to the parents of the patients. The nasopharyngeal airway was measured according to the analysis of Linder-Aronson (1970), and 4 indices were measured and analyzed in each of the lateral cephalometric radiographs. No statistically significant differences were observed in the pharyngeal measurements between the 2 groups, although all means in the control group were higher than in the experimental group. However, there was a significant relationship between gender and the Ba-S-PNS and PNS-AD2 indices. Although the patients with nocturnal snoring had smaller airway dimensions, their pharyngeal measurements were not significantly different from the control group.

Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia.

Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical collegestudents in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.

P059 Respiratory control stability in posttraumatic stress disorder

Abstract Rationale A recent meta-analysis indicated that 75.7% of individuals with posttraumatic stress disorder (PTSD) also suffer from obstructive sleep apnoea (OSA). The reason for the high prevalence of OSA in PTSD is currently unknown. This study investigated whether respiratory control stability (which is known to contribute to OSA in the general population) varies with PTSD symptoms. Methods First year University students were recruited and completed an online questionnaire battery including: Life Events Checklist (LEC), PTSD checklist for DSM-5 (PCL-5), Shortness of Breath Questionnaire (SOBQ) and Berlin Sleep Questionnaire. 1/3 of participants timed their maximum breath hold (performed at functional residual capacity) at home on 3 occasions using a stopwatch as per Messieno et al (2018). Results 313 complete survey responses were obtained. The mean age of participants was 19.9 years and 214 respondents were women. 19 participants were at high risk of OSA based (Berlin Questionnaire) and 80 had probable PTSD (LEC items 1-16 “happened to me” or “witnessed it” plus PCL-5>33). In the whole sample, there was a significant relationship between PTSD symptoms and Shortness of Breath (Pearson p<0.001, r2=0.2). There was no relationship between PTSD symptoms and at-home measured maximum breath-hold duration (n=107, p=0.44, r2=0.006). Conclusions In an unselected University student population, posttraumatic stress disorder symptoms are associated with self-reported shortness of breath during everyday activities. However, there was no evidence of a relationship between a surrogate of respiratory control stability (maximum breath-hold duration) and PTSD symptoms.

Gece yeme bozukluğu ve uyku kalitesini ameliyat ile tedavi etmek mümkün mü? Obezite cerrahisinin faydaları

Aim: This study was conducted to assess sleep quality and night eating syndrome in patients with morbid obesity after bariatric surgery. 
 Material and Method: Patients with morbid obesity who underwent sleeve gastrectomy were evaluated. The preoperative and postoperative values of Body Mass Index (BMI), Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Night Eating Questionnaire (NEQ), Pittsburgh Sleep Quality Index (PSQI), and Berlin Sleep Questionnaire (BSQ) were compared. 
 Results: A total of 82 surgery candidates who were aged between 18 and 65 (36.36±10.37) were planned for bariatric surgery participated in our study. We completed our study with 77 patients since 5 of the patients did not come to their postoperative 6th-month controls for various reasons. Standard psychiatric examinations of the candidates were performed before and after the surgery, and their written consent was obtained after they had been informed about the study. Mean preoperative BMI value was found as 44.53±4.33, HAM-A value as 4.96±6.14, HAM-D value as 3.82±3.84, PSQI value as 4.69±3.64, and NEQ score as 15.94±7.94. In the 6th month evaluations after surgery, the mean BMI value was found as 30.74±3.55, HAM-A value as 2.39±3.47, HAM-D value as 1.57±2.39, PSQI value as 1.48±1.42, and NEQ score as 5.58±3.06. The mean EWL value was found as 61.71±10.58. 
 Conclusion: In conclusion, morbid obesity may cause anxiety, depression, and night eating syndrome and may impair sleep quality in parallel to them. We observed that these clinical conditions improved after bariatric surgery.

Abstract 66: Spectrum of sleep abnormalities in primary hypothyroidism

Background: The spectrum of sleep abnormalities in hypothyroidism includes daytime sleepiness, sleep apnoea, rapid eye movement sleep disorder, restless leg syndrome and periodic limb movement disorder.Aims and Objectives: To assess daytime somnolence, risk of sleep apnoea, quality of sleep, depression, and anxiety in subjects with primary hypothyroidism using Epworth Sleepiness Score (ESS), Berlin questionnaire, Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Hamilton Anxiety Rating Scale (HAM-A).Results: This was a questionnaire-based cross-sectional study that included 55 subjects (females=44, males=11), both treatment naïve (N=41) and on treatment (N=14), who had TSH >4.5 mIU/L. The mean age was 37.09±12.49. Median TSH was 13.5 (IQR-19.781). The Median ESS score was 3/24 (IQR-7), three subjects had severe excessive daytime sleepiness. Seventeen individuals were predisposed to sleep apnoea as assessed by the Berlin Sleep questionnaire. Twenty subjects had a PSQI score of >5, indicating poor sleep quality. The median PHQ-9 score was 4/27 (IQR-7), one individual had severe, and one had moderately severe depression. The Median HAM-A score was 6/56 (IQR-11); two had severe anxiety.Conclusion: Individuals with hypothyroidism need to be screened for sleep abnormalities like sleep apnea, daytime somnolence, REM sleep disorders and neuropsychiatric manifestations like anxiety and depression.

Specific cortical and subcortical grey matter regions are associated with insomnia severity.

There is an increasing awareness that sleep disturbances are a risk factor for dementia. Prior case-control studies suggested that brain grey matter (GM) changes involving cortical (i.e, prefrontal areas) and subcortical structures (i.e, putamen, thalamus) could be associated with insomnia status. However, it remains unclear whether there is a gradient association between these regions and the severity of insomnia in older adults who could be at risk for dementia. Since depressive symptoms and sleep apnea can both feature insomnia-related factors, can impact brain health and are frequently present in older populations, it is important to include them when studying insomnia. Therefore, our goal was to investigate GM changes associated with insomnia severity in a cohort of healthy older adults, taking into account the potential effect of depression and sleep apnea as well. We hypothesized that insomnia severity is correlated with 1) cortical regions responsible for regulation of sleep and emotion, such as the orbitofrontal cortex and, 2) subcortical regions, such as the putamen. 120 healthy subjects (age 74.8±5.7 years old, 55.7% female) were recruited from the Hillblom Healthy Aging Network at the Memory and Aging Center, UCSF. All participants were determined to be cognitively healthy following a neurological evaluation, neuropsychological assessment and informant interview. Participants had a 3T brain MRI and completed the Insomnia Severity Index (ISI), Geriatric Depression Scale (GDS) and Berlin Sleep Questionnaire (BA) to assess sleep apnea. Cortical thickness (CTh) and subcortical volumes were obtained by the CAT12 toolbox within SPM12. We studied the correlation of CTh and subcortical volumes with ISI using multiple regressions adjusted by age, sex, handedness and MRI scan type. Additional models adjusting by GDS and BA were also performed. ISI and GDS were predominantly mild (4.9±4.2 and 2.5±2.9, respectively) and BA was mostly low risk (80%). Higher ISI correlated with lower CTh of the right orbitofrontal, right superior and caudal middle frontal areas, right temporo-parietal junction and left anterior cingulate cortex (p<0.001, uncorrected FWE). When adjusting by GDS, right ventral orbitofrontal and temporo-parietal junction remained significant, and left insula became significant (p<0.001, uncorrected FWE). Conversely, BA showed no effect. The results were no longer significant following FWE multiple comparisons. Regarding subcortical areas, higher putamen volumes were associated with higher ISI (p<0.01). Our findings highlight a relationship between insomnia severity and brain health, even with relatively mild insomnia, and independent of depression and likelihood of sleep apnea. The results extend the previous literature showing the association of specific GM areas (i.e, orbitofrontal, insular and temporo-parietal junction) not just with the presence of insomnia, but across the spectrum of severity itself. Moreover, our results suggest subcortical structures (i.e., putamen) are involved as well. Longitudinal studies are needed to clarify how these insomnia-related brain changes in healthy subjects align with an increased risk of dementia.

P099 Risk of obstructive sleep apnoea in patients with rheumatic disease: a prospective cohort study

Abstract Background/Aims Sleep plays an important component in our lives and sleep abnormalities have been known to be linked with various rheumatic conditions. Obstructive sleep apnoea (OSA) could potentially affect the severity of rheumatic symptoms such as pain, fatigue and also influence the disease activity. This study aims to evaluate the risk of OSA in patients with rheumatic diseases in an Irish cohort. Methods Patients with a diagnosis of a rheumatic disease were recruited from rheumatology outpatients. These patients were asked to complete the Berlin Sleep Questionnaire (BSQ) to evaluate their level of risk for OSA. The Health Assessment Questionnaire (HAQ), Patient Global Assessment (PtGA) and the Physician Global Assessment (PhGA) were also completed. Results These patients were asked to complete the Berlin Sleep Questionnaire (BSQ) to evaluate their level of risk for OSA. The Health Assessment Questionnaire (HAQ), Patient Global Assessment (PtGA) and the Physician Global Assessment (PhGA) 111 patients were recruited. Mean age was 52 years and 22 (19.8%) were males. The most common diagnosis in our cohort was rheumatoid arthritis 54 (45.4%), followed by spondyloarthritis 12 (10.1%), psoriatic arthritis 11 (9.2%), systemic lupus erythematosus 9 (7.6%), Behçet’s disease 7 (5.9%), scleroderma 6 (5.0%) and others 20 (16.8%); with 8 patients having two diagnoses. Our cohort also completed the HAQ which demonstrated 98 (88.3%) having mild to moderate disability and 13 (11.7%) having moderate to severe disability. 39 out of 111 were noted to have a high risk for OSA based on the BSQ. In the high risk cohort, the mean PtGA score was 46.5 while PhGA score was 30.3, compared to the low risk cohort which was 36.7 for PtGA and 24.9 for PhGA. 33 (84.6%) patients in the high risk cohort had mild to moderate disability and 6 (15.4%) had moderate to severe disability as compared to 64 (88.9%) with mild to moderate disability and 8 (11.1%) with moderate to severe disability in the low risk cohort.were also completed. Conclusion This is the first prospective study in Ireland to evaluate the risk of OSA in patients with rheumatic diseases. 35.1% from our cohort were found to be at high risk for OSA and are due to undergo overnight pulse oximetry and polysomnography to objectively assess the presence or absence of OSA. The disease activity reported by both patient and physician along with the level of disability were greater in the high risk cohort. This suggests that OSA increases the likelihood of exacerbating rheumatic activities. Disclosure W. Ng: None. N. Kamarudin: None. A. Anjum: None. J. Devlin: None. A. O'Brien: None. A. Fraser: None.

Prevalence and pattern of obstructive sleep apnea in chronic obstructive pulmonary disease patients from northern India

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, hyperinflation, and ventilation-perfusion mismatch. It is now considered as a systemic disease. The prevalence of obstructive sleep apnea (OSA) in COPD is variable with a paucity of literature from Indian subcontinent. AIM: This study was conducted to observe the regional prevalence and pattern of OSA in patients of COPD. MATERIALS AND METHODS: The present prospective study was carried out in the Department of Internal Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, for a period of 20 months, i.e. during July 2012 to February 2014. Patients seeking care at the Department of Internal Medicine and diagnosed with COPD formed the study population. COPD patients stable for at least 6 weeks were included in this study. Mild COPD patients, ischemic heart disease patients, any comorbid state, known case of OSA, and patients having COPD with acute exacerbation were excluded. The prescreening tools for the identification of OSA are Berlin sleep questionnaire and the Epworth sleepiness scale (ESS). Polysomnography was done using Somnologica studio 3.3.2 Embla N7000 sleep unit system. RESULTS: OSA with apnea–hypopnea index (AHI) ≥5/h was present in 10 out of 40 participants (25.0%). Berlin scores were found to be 0.10 ± 0.03 and 0.70 ± 0.04 in nonsleep-disordered breathing (SDB) and SDB participants, respectively. ESS scores were observed to be 2.60 ± 0.82 and 7.90 ± 2.51 between non-SDB and SDB participants, respectively. The difference in AHI between patients with non-SDB and SDB was statistically highly significant (1.36 ± 0.37, 13.41 ± 3.40; P CONCLUSIONS: The prevalence of OSA in COPD patients was found to be in the higher range. Sleep was significantly distorted in all its aspects in patients of COPD. ESS was found efficient in screening the patients of COPD for coexistent OSA. Berlin's questionnaire can be used to evaluate patients of overlap syndrome.

Sleep apnea syndrome, pregnancy and fetal condition

To assess fetal cardiac activity with simultaneous polysomnographic (PSG) study of pregnancy with obstructive sleep apnea syndrome (OSAS). Forty-nine women, aged 18-30 years, 30-34 weeks pregnant, complaining of snoring, with a positive rating in 2 and/or 3 sections of the Berlin Sleep Questionnaire were included in the study. Sixteen pregnant women with the corresponding gestational age, without complaints of snoring, made up the control group. All participants underwent PSG monitoring and fetal cardiotocography (CTG) according to standard techniques. PSG results demonstrate significant changes in sleep patterns in pregnant women with OSAS. There is a significant reduction in SWS 3, REM. High AHI, accompanied by desaturation and the appearance of activation EEG- patterns of cyclic alternations are characterized the sleep of pregnant women with OSAS. Analysis of CTG results shows that the average values of the basal rhythm are statistically higher in women with OSAS than in the control group. Also, the indicators of the amplitude of the oscillations, the frequency of oscillations and the number of movements in 30 minutes are statistically significantly different. Reaction of the fetus to episodes of apnea in the form of active perturbation, changes in heart rate as bradycardia (to 105-110 beats per minute) or tachycardia (to 155-160 beats per minute) compared to basal level (140 beats per minute) are noted. OSAS during nocturnal sleep in pregnant women causes the changes in motor activity and cardiac activity of the fetus that indicates fetal hypoxemia.

Evaluation of sleep quality, insomnia severity and OSAS risk in primary care population: A descriptive study.

In our study, we aimed to evaluate the sleep quality, insomnia presence and severity, obstructive sleep apnoea syndrome (OSAS) risk of the patients who applied to family health centres and to determine the situations that might be related with these features. This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Centre policlinics. The study population consisted of all patients over 18years of age who were admitted to the family health centres for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality questionare and insomnia severity questionare were applied by the researchers from October to December 2017 by using face-to-face interview method. Two hundred nineteen nine people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Questionare, it was found that 27.1% of the participants' sleep quality was good; according to the Berlin sleep questionnaire, 27.4% of the participants had high OSAS risk. According to Insomnia Severity Questionare, 27.1% of them had insomnia lower threshold, 15.4% had moderate insomnia and 3.7% severe insomnia. In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary healthcare institutions and the other patients to be delivered to the related upper levels.

Serum bicarbonate level improves specificity of Berlin Sleep Questionnaire for obstructive sleep apnea

Several questionnaires have been developed to assist the diagnostic process in obstructive sleep apnea syndrome (OSAS). Berlin Sleep Questionnaire (BSQ) represents a validated screening tool for OSAS. Totally 450 patients admitted to the Sleep Center at Dicle University Medical Faculty were included prospectively. A risk analysis was performed for presence of OSAS using the BSQ. Arterial blood gas measurements were performed including bicarbonate (HCO3) level. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BSQ for presence of OSAS and severe OSAS were determined. In patients with arterial HCO3 >24.94 mEq/L; sensitivity, specificity, PPV and NPV, of the BSQ were 93.04, 57.1, 98.3, and 23.5%, respectively. The addition of arterial HCO3 value increased the sensitivity of the BSQ in detecting OSAS patients. Although the cost of sleep studies is high for false positives from the BSQ plus arterial HCO3 level, this cost should be compared with the loss of work efficiency and severe healthcare costs of undiagnosed cases in the future. Therefore, finding possible OSAS cases in primary care health centers is important and adding serum HCO3 value to BSQ questionnaire may contribute to this topic.

Assessing the reliability of obstructive sleep apnea screening instruments in isolation or in combination

Study objectivesA) Compare the standard obstructive sleep apnea (OSA) screening instruments to each other and to the judgement of experienced sleep clinicians. B) Evaluate if a novel OSA screening instrument constructed from components of the standard OSA screening instruments would improve the accuracy of screening. MethodsWe screened 344 subjects using the most commonly used OSA screening instruments- Berlin sleep questionnaire, STOP, STOP-BANG, Mallampati upper airway score and Epworth sleepiness scale. A clinical impression score (CIS) reflected the clinician's likelihood of OSA being present. All subjects underwent nocturnal polysomnography. The sensitivity and specificity of all screening instruments and the CIS for any OSA and for moderate-to-severe OSA were calculated. We constructed a logistic regression model incorporating all the components of these OSA screening instruments in an effort to develop a more accurate OSA screening metric. ResultsSTOP-BANG was the most sensitive instrument (sensitivity of 93% and 97% for any OSA and moderate-to-severe OSA respectively). Its ability to exclude OSA was on par with the CIS (sensitivity of 95% and 97% respectively). The logistic regression model incorporating all the individual items of the OSA screening instruments did not meaningfully improve accuracy. ConclusionsA comprehensive clinical evaluation and STOP-BANG both possess sufficiently high sensitivity to be useful screening tools. Combining the existing OSA screening instruments into a single instrument did not appreciably improve upon the accuracy of the STOP-BANG. Further refinements of the existing OSA screening instruments would require identifying new, easily recognizable risk factors.

Screening for obstructive sleep apnea among patients undergoing coronary catheterization in Jordan.

Aims: This study aimed to utilize a validated sleep questionnaire as a screening tool for symptoms and risk of obstructive sleep apnea in patients undergoing coronary catheterization in Jordan.Materials and methods: A cross-sectional design was used to screen adult patients undergoing coronary catheterization for obstructive sleep apnea (OSA). The Berlin sleep questionnaire was used to record nocturnal and daytime symptoms of OSA and to stratify patients into “low-risk” or “high-risk” for OSA. Coronary artery disease was defined as ≥50% intraluminal stenosis in at least one coronary vessel.Results: A total of 398 patients were studied, mean age was 58.7 years (SD=10.70), ranging from 21–92 years, and 68.6% were males. Based on the Berlin sleep questionnaire’s definition, 176 patients (44.2%) were at high-risk for obstructive sleep apnea. Snoring was reported by 61%; loud in 42.1%, and frequent in 62%. Daytime sleepiness was reported by 36%, and 18.9% had fallen asleep while driving. Witnessed apnea during sleep was less reported (7.8%). Prevalence of symptoms and risk of OSA were not different between patients with and without coronary artery disease, P>0.05. In addition, logistic regression indicated that there was no significant association between risk of OSA and coronary artery disease, adjusted (odds ratio=0.93, 95% Confidence Interval=0.60–1.44, P=0.752).Conclusions: Symptoms and risk of obstructive sleep apnea were common among adult Jordanians undergoing coronary catheterization. There was no association between risk of obstructive sleep apnea and coronary artery disease. Larger studies are needed to assess the role of screening for obstructive sleep apnea in this patient population.

OBSTRUCTIVE SLEEP APNEA;

Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two different diseases that may coexist within an individual and is known as overlap syndrome. Treatment of choice for overlap patients is CPAP along with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep, which is different from the treatment of COPD or OSA alone so detection of these cases is important for proper management of these patients. Objectives: To find out the frequency of obstructive sleep apnea in patients with COPD. Study Design: Cross section study. Setting: Department of Pulmonology Multan Medical and Dental College; Tertiary care hospital. Period: Six months from July to Dec 2017. Materials &amp; Methods: 151 consecutive patients with diagnosed COPD attending our Pulmonology Outpatient Department and fulfilling the inclusion and exclusion criteria were included in the study. All the patients were asked questions from Berlin Sleep Questionnaire and categorized into high or low likelihood for having OSA. Overnight polysomnography was done in those with high likelihood to confirm the diagnosis of obstructive sleep apnea. Results: There were 151 patients. Males were 125 (82.8%) whereas females were 26 (17.2%). Mean age of all patients was 54.49+10.33 years. Mean values for height and weight were 160.9+1.05cm and 62.33+1.39kg respectively. Mean BMI was 24.13+5. Mean for number of smoking pack years was 16.45+7.22. We found 16 patients (10.5%) to have OSA. Conclusion: Frequency of OSA in COPD patients is high and needs special attention while managing these patients. This can be achieved by routine use of screening questionnaires and by conducting polysomnography where indicated.

Utilization of Overnight Pulse Oximetry in Fibromyalgia Patients.

ObjectiveTo assess whether the Berlin Sleep Questionnaire and the Snoring, Tired, Observed, Pressure, Body mass, Age, Neck, and Gender questionnaire (STOP-BANG) might be suitable replacements for an overnight sleep pulse oximetry as screening tools for sleep disordered breathing in patients with fibromyalgia.Participants: From June 8, 2018 through July 25, 2018, adult patients with a confirmed diagnosis of fibromyalgia (via the 1990 and/or 2010 American College of Rheumatology Fibromyalgia Classification Criteria) who attended Mayo Clinic’s Fibromyalgia Treatment Program were invited to participate in the study.Methods: The design was a prospective comparative study with a retrospective chart review component. Participants completed 2 validated surveys: the Berlin Sleep Questionnaire and the STOP-BANG. Medical records were reviewed for demographic information and overnight pulse oximetry test results.Results: Results from both questionnaires indicate that there is an association between sleep apnea risk category (defined by questionnaire) and oximetry results. Fisher’s exact test for STOP-BANG and Berlin Sleep Questionnaire are statistically significant (P < .001), indicating that participants at high risk for sleep apnea (based on the questionnaires) had a greater prevalence of abnormal oximetry results than those at low risk for sleep apnea. Participants who were classified as high risk (85.7%) or intermediate risk (61.5%) on the STOP-BANG questionnaire for sleep apnea had abnormal oximetry results. Participants who scored as high risk (85.7%) for sleep apnea on the Berlin Sleep Questionnaire had abnormal oximetry results.Conclusions: In patients with fibromyalgia, the Berlin Sleep Questionnaire and the STOP-BANG questionnaires could be beneficial in determining the probability of obstructive sleep apnea and the subsequent need for pulse oximetry testing, in higher risk patients.