Complaints Of Excessive Daytime Sleepiness Research Articles

Physical Activity Level and Sleep Quality in Community-Dwelling Older Adults. A Cross-Sectional Study

AbstractThe worldwide increase in life expectancy has resulted in a significant aging of the population. The physiological and functional changes that result from the aging process, changes in sleep patterns, and the prevalence of chronic diseases affect the health and well-being of individuals aged over 60. Objective The aim of this study was to investigate the relationship between levels of physical activity (PA) and sleep quality in community-dwelling older adults. Methods This is a cross-sectional study, with the participants randomly recruited according to the region and street in which they live. The Pittsburgh Sleep Quality Index (PSQI) was applied to assess sleep quality, the Modified Baecke Questionnaire for the Elderly (MBQ-E) to assess PA levels, as well as questionnaires to obtain social, demographic and anthropometric data. Multivariable regression analyses were conducted with PA activity as the independent variable and sleep quality as the dependent variable of interest, while also considering all potential covariates. Results A total of 503 older adults were analyzed, of whom 377 (75%) were classified as inactive and only 126 (25%) as active. Among the participants, 344 (68.4%) had poor sleep quality, 86 (17.1%) had symptoms of insomnia, and 57 (11.5%) reported complaints of excessive daytime sleepiness. We found that 128 participants (25.4%) consumed alcohol and 41 (8.2%) were current smokers. Multivariate regression results showed an inverse association between PA levels and sleep (Beta coefficient = −0.67 ([95% confidence interval = −1.29 to −0.04]). Conclusions The results of the study indicate that being physically inactive is associated with poor sleep quality.

0973 HGNS Sensing Lead Damage After 3D Mammogram Requiring HGNS IPG and Lead Re-Implantation

Abstract Introduction Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, nocturnal hypoxemia, and daytime fatigue. Standard therapy is with positive airway pressure (PAP) therapy. If this is unsuccessful or poorly tolerated, a hypoglossal nerve stimulator (HGNS) can be surgically implanted for treatment. The goal of HGNS treatment is to advance the tongue with each respiration during sleep to relieve oropharyngeal obstruction causing OSA. This therapy has been shown to be efficacious and well tolerated for moderate to severe sleep apnea with a low complication rate. Report of case(s) A 61 year-old female with history of obesity and severe OSA presented to the sleep clinic with complaint of excessive daytime sleepiness and persistently elevated apnea-hypopnea index (AHI) of 42 events/hour despite adequate usage of CPAP therapy. She underwent an HGNS placement for treatment. Following HGNS activation she used it nightly and three months after implantation underwent an HGNS titration study which was successful (AHI 5.7) and the patient was started on optimal treatment settings with resulting resolution of OSA symptoms. After a period of successful device usage, she presented for follow up and reported complaints of excessive fatigue and sleepiness that was sudden. She attributed these changes to a 3D mammography study she underwent for breast cancer surveillance. Repeat home sleep apnea testing showed sudden worsening of her AHI to 50.6. During a thorough investigation of her device, HGNS sensing waveforms indicated possible sensing lead fracture. The patient was taken to the operating room for implanted pulse generator removal and replacement with new sensing and stimulation leads. Intra-operatively, it was noted that the distal sensing lead had several tears of the polyurethane insulation near the hub of the sensor. Following successful re-implantation sensing returned to normal and she has continued HGNS treatment. Conclusion We present a case of an unusual complication of HGNS sensing lead damage following a 3D mammography study. This led to surgical exploration with removal of a torn sensing lead and re-implantation of the HGNS generator and leads. Attention should be brought to patients and providers in the future regarding this rare, but potentially serious complication. Support (if any)

Effect of Tinnitus on Sleep Quality and Insomnia.

Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objective To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

0412 Post-Traumatic Narcolepsy in 9 Military Veterans with a History of a Head Injury

Abstract Introduction Head injuries can be associated with hypersomnia acutely and chronically and can occur in those with mild/moderate/severe head injuries and with or without loss of consciousness. If hypersomnia persists, additional evaluation is warranted. Head injuries are increasingly reported in the military due to falls, assaults, motor vehicle accidents, and IED explosions, with some reporting, repeated blast injuries; secondary narcolepsy should be considered within the differential. Untreated narcolepsy can lead to safety issues for both the patient and others; therefore, aggressive evaluation is necessary with a PSG/MSLT combination and/or by the patient meeting the diagnostic criteria outlined in the DSM-V. Methods At the 2021 SLEEP conference, we presented a poster on our retrospective chart review of 176 patients diagnosed with narcolepsy from 2013 through 2020, with 50 patients having a history of head injury (28.4%). Of those 50 patients, nine were military veterans who reported a history of some degree of traumatic brain injury. While the majority had coexisting psychiatric disorders and/or other sleep disorders, the complaints of excessive daytime sleepiness were persistent despite aggressive treatment of the other associated diseases. The diagnosis of narcolepsy was confirmed by MSLT and/or DSM-V criteria. Results This study is a case series of 9 U.S. military veterans diagnosed with narcolepsy and a head injury history. There were eight males and one female, with the average age being 48. Five of the patients were diagnosed with type 1 narcolepsy with cataplexy, the other four without cataplexy were all on long-term treatment with antidepressants. The use of antidepressants while evaluating narcolepsy should be considered as they are REM suppressants, can interfere with MSLT findings, and can inhibit cataplexy symptoms preventing the appropriate diagnosis of Narcolepsy by DSM-V criteria. Conclusion Persistent hypersomnia in a patient with a history of a head injury could suggest a disorder of narcolepsy, and appropriate evaluation for this disorder appears indicated. The military having a high risk of head injuries may require assessment of narcolepsy while in active duty or long after discharge as the hypersomnia may be chronic and previously undiagnosed. Support (If Any) **No support was given for this research

P-SP003. Idiopathic central sleep apnea with periodicity presenting as cheyne-stokes breathing

Introduction . Cheyne-Stokes breathing (CSB) is described by a cyclic variation in breathing with periods of central apneas or hypopneas alternating with periods of hyperpneas in a gradual waxing and waning manner. We describe this rare case of idiopathic central sleep apnea coming in a periodic fashion presenting as CSB pattern without specific causes. Results . A 72-year-old male (body mass index: 21.9 kg/m 2 ) with the complaints of excessive daytime sleepiness and fatigue for about 2 years. On detailed sleep history patient denied snoring, cataplexy, hypnogogic hallucination, sleep paralysis and sleep attack. No neurological deficit was seen in clinical evaluation. ENT evaluation was normal. Cardiac evaluation showed artrial fibrillation with no cardiac failure. An overnight Polysomnography (PSG) test showed total sleep time of 443 minutes, sleep latency of 19.0 min, and sleep efficiency of 70.0%. Sleep architecture for stage 1 sleep was 31.7%, stage 2 sleep was 52.4%, slow wave sleep was 12.9%, REM sleep was 3.1%. Total arousal index was 21.8/hr. Mean SaO2 was 96.4%, the lowest SaO2 was 82.8%, and SaO2 below 90% was 0.1%. Snoring was not observed and periodic limb movement index was 8.8/hr. PSG also showed cyclic fluctuation in breathing with periods of central apneas; alternating with periods of hyperpneas in a gradual waxing and waning fashion; but cardiac evaluation and magnetic resonance imaging of the brain could not find any cause of this sleep-disordered breathing. Conclusion . The pathogenesis and etiology of CSA is still vague. We think that further studies and follow up will be required to determine whether idiopathic central sleep apnea presenting as CSB pattern is the initial indication of certain diseases. So we concluded that this case was an idiopathic central sleep apnea with periodicity; presenting as CSB pattern.

Dream Generation and Recall in Daytime NREM Sleep of Patients With Narcolepsy Type 1.

The less rigid architecture of sleep in patients with narcolepsy type 1 (NT1) compared with healthy subjects may provide new insights into some unresolved issues of dream experience (DE), under the assumption that their DE frequencies are comparable. The multiple transition from wakefulness to REM sleep (sleep onset REM period: SOREMP) during the five trials of the Multiple Sleep Latency Test (MSLT) appears of particular interest. In MSLT studies, NT1 patients reported a DE after about 80% of SOREMP naps (as often as after nighttime REM sleep of themselves and healthy subjects), but only after about 30% of NREM naps compared to 60% of daytime and nighttime NREM sleep of healthy subjects. To estimate accurately the “real” DE frequency, we asked participants to report DE (“dream”) after each MSLT nap and, in case of failure, to specify if they were unable to retrieve any content (“white dream”) or DE did not occur (“no-dream”). The proportions of dreams, white dreams, and no dreams and the indicators of structural organization of DEs reported after NREM naps by 17 adult NT1 patients were compared with those reported by 25 subjects with subjective complaints of excessive daytime sleepiness (sc-EDS), who take multiple daytime NREM naps. Findings were consistent with the hypothesis of a failure in recall after awakening rather than in generation during sleep: white dreams were more frequent in NT1 patients than in sc-EDS subjects (42.86 vs 17.64%), while their frequency of dreams plus white dreams were similar (67.86 and 61.78%) and comparable with that of NREM-DEs in healthy subjects. The longer and more complex NREM-DEs of NT1 patients compared with sc-EDS subjects suggest that the difficulty in DE reporting depends on their negative attitude toward recall of contents less vivid and bizarre than those they usually retrieve after daytime SOREMP and nighttime REM sleep. As this attitude may be reversed by some recall training before MSLT, collecting wider amounts of DE reports after NREM naps would cast light on both the across-stage continuity in the functioning of cognitive processes underlying DE and the difference in content and structural organization of SOREM-DEs preceded by N1 or also N2 sleep.

Surgical management in a severe OSA patient diagnosed with Stickler syndrome

Stickler syndrome is a genetic disorder of connective tissue. One of the major symptoms associated with this disorder is an oro-facial malformation, which may cause a submucous cleft or a complete cleft of the hard palate. A 32-year-old man diagnosed with Stickler syndrome and a submucosal cleft palate (SMCP) visited our hospital with a chief complaint of excessive daytime sleepiness. The patient was diagnosed with severe obstructive sleep apnea (OSA), and administration of a polysomnography test revealed an apnea-hypopnea index (AHI) of 30.9 events/hour (h). Auto-titrating continuous positive airway pressure was initiated to control the OSA symptoms and subsequently the patient showed some improvement. However, due to continuous velopharyngeal insufficiency symptoms, intravelar veloplasty was performed. Three months after surgery, the AHI had decreased to 12.4 events/h. Recent studies have described a greater risk for OSA in individuals with cleft palate, than in the general population. The present case demonstrates surgical success in a patient with OSA and SMCP, suggesting that palatal surgery may be considered an optional surgical treatment for OSA patients with SMCP.

Excessive daytime sleepiness in adolescents: current treatment strategies.

The complaints of excessive daytime sleepiness are very common among adolescents. In addition, in this particular subpopulation, the presence of excessive daytime sleepiness is associated with negative impact on school performances, interpersonal difficulties (school friends or family), extracurricular activities, health and driving. In adolescents with complaints of excessive daytime sleepiness, it is important to perform a complete clinical assessment including systematic clinical interview, physical examination, sleep diaries, use of specific questionnaires and possible confirmatory tests. In adolescents, the main causes of excessive daytime sleepiness are sleep deprivation, inadequate sleep hygiene, insomnia disorders, circadian rhythm disorders, chronic somatic pathologies, psychiatric disorders, movement disorders related to sleep, respiratory disorders related to sleep, parasomnias, hypersomnia disorders and use of drugs or medications. Given the multiple aetiologies of excessive daytime sleepiness in adolescents, the implementation of targeted therapeutic strategies is essential in order to allow optimal management of this symptom and better prevention of its negative consequences. The aim of this review is therefore to provide health care professionals caring for adolescents with excessive daytime sleepiness complaints the currently recommended therapeutic strategies for the main aetiologies of excessive daytime sleepiness in this particular subpopulation.

Excessive daytime sleepiness, metabolic syndrome, and obstructive sleep apnea: two independent large cross-sectional studies and one interventional study

BackgroundObstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) were considered to contribute to MetS. This study was performed to assess the association between MetS and EDS in two independent large-scale populations, and in subjects who underwent upper-airway surgery.MethodsA total of 6312 patients without self-reported depression and 3578 suspected OSA patients were consecutively recruited, during health screening examinations and from our sleep center, respectively. A total of 57 subjects with OSA who underwent upper-airway surgery were also included. Demographic, anthropometric, biochemical, and polysomnographic data were obtained.ResultsIn the health screening examination group, 233 (9.23%) women and 350 (10.93%) men had complaints of EDS. A total of 229 (7.04%) women and 1182 (36.88%) men met the criteria for MetS. In the OSA group, 147 (21.18%) women and 1058 (36.69%) men reported EDS. In addition, 93 (13.4%) women and 1368 (47.43%) men reported MetS. In the health screening examination group, EDS did not contribute significantly to MetS (OR = 1.125, 95% CI: 0.907–1.395; p = 0.283). In the OSA group, EDS significantly contributed to MetS (OR = 1.249, 95% CI: 1.063–1.468; p = 0.007); however, the results were not significant after adjusting for sleep variables (OR = 1.071, 95% CI: 0.905–1.268; p = 0.423). Upper-airway surgery did not affect cardio-metabolic variables in OSA patients with or without EDS.ConclusionsEDS was not associated with MetS in two independent large-scale cohorts. In addition, upper-airway surgery did not affect components of MetS in OSA patients with and without EDS.

Psychomotor Vigilance Test and Its Association With Daytime Sleepiness and Inflammation in Sleep Apnea: Clinical Implications.

Excessive daytime sleepiness (EDS) is a key symptom of obstructive sleep apnea (OSA). The Psychomotor Vigilance Task (PVT) has been suggested as an objective easy-to-use, inexpensive alternative to the Multiple Sleep Latency Test (MSLT) to measure EDS. In patients with OSA, physiological sleepiness, but not subjective EDS (Epworth Sleepiness Scale [ESS]), has been associated with increased levels of the sleep- inducing proinflammatory cytokine interleukin-6 (IL-6). The goal of this study was to assess the association of PVT with objectively measured sleepiness (MSLT) and subjectively measured sleepiness (ESS) and IL-6 levels in patients with OSA. We studied 58 untreated patients with OSA who underwent an 8-hour in-laboratory polysomnography for 4 consecutive nights. MSLT, PVT, and 24-hour serial profiles of IL-6 were assessed on the fourth day. PVT variables included number of lapses, mean reciprocal of the fastest 10% and slowest 10% reaction times, and median of 1/reaction time. ESS was assessed on day 1 of the study. Higher ESS scores were significantly associated with greater number of lapses (β = .34, P = .02) and lower values of 1/RT (β = -.36, P = .01) and slowest 10% RTs (β = -.30, P = .04). No significant association was observed between PVT and MSLT, nor PVT and IL-6 levels. Our findings suggest that PVT is associated with subjectively assessed daytime sleepiness, but not with physiological sleepiness nor IL-6 levels in patients with OSA. It appears that ESS and PVT may be useful in predicting risks associated with impaired performance, such as traffic accidents, in patients with OSA.

Tratamiento del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) con presión positiva en la vía aérea (PAP)

Para el tratamiento de cualquier enfermedad es necesario un adecuado manejo multidisciplinar e involucrar al paciente en la mejor opción que se requiera a largo plazo; la falta de tratamiento de los pacientes implica una enorme carga para el sistema sanitario y la sociedad. En la actualidad, existen diferentes tratamientos para los pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS); el de mayor elección, después de descartar anomalías anatómicas susceptibles de cirugía, es el PAP (presión positiva en vía aérea). Las indicaciones para terapia con PAP incluyen pacientes con índice de apnea-hipopnea (IAH) ≥15 eventos/hora o ≥5 y ≤14 eventos/hora y quejas de somnolencia diurna excesiva, deterioro cognitivo, trastorno del afecto o insomnio, hipertensión arterial documentada, enfermedad arterial coronaria o historia de evento cerebrovascular. Es importante recordar que el IAH debe basarse en sueño ≥2 horas de registro polisomnográfico. Hay diferentes modalidades de tratamiento con PAP y se debe intervenir para buscar mejorar la adherencia al dispositivo, principal limitante para alcanzar la eficacia en el tratamiento. El impacto del tratamiento del SAHOS ha sido investigado, pero la mayoría de los estudios reportados son de carácter observacional.

Validation of a modified Hindi version of the Epworth Sleepiness Scale among a North Indian population.

Background:Since a majority of population in India does not drive automobiles, one item on the Epworth Sleepiness Scale (ESS) requires modification and validation. In addition, data collected by us indicated that a majority of rural and urban Indians regularly spend time in prayer/spiritual activity. The main purpose of this study was to develop a cross-cultural adaptation of the ESS for a North Indian population, in Hindi language (ESS-I). The study also provides evidence of reliability and validity of the modified version.Methodology:The subjects included were normal volunteers aged 18–75 years (Group 1) (n = 70), compared with patients with complaints of excessive daytime sleepiness, who had undergone polysomnography (Group 2) (n = 22) and patients who had undergone multiple sleep latency test (Group 3) (n = 10). The study was carried out in four phases: Translation and retranslation of the original scale with modification of item 8 (mainly addition of option of question on “while offering prayers or in spiritual activity”); reliability (test–retest) (n = 30); internal consistency (using Cronbach's alpha index) (n = 102); and sensitivity to change (n = 8).Results:Group 1 showed spiritual activity as a significantly more commonly practiced activity than driving. The Cronbach's alpha for the modified version was 0.892 (excellent), and this was not improved by removing the modified item. The alpha value for Group 1 versus Groups 2 and 3 was 0.667 and 0.892, respectively. The scale was reliable over time (test–retest), and it was sensitive to sleepiness change in patients with obstructive sleep apnea during treatment.Conclusion:The ESS-I, is comparable to the original scale. It is reliable, valid, and change-sensitive. It is proposed that the modified version can be very useful for detecting sleepiness among Indian population, especially those who do not drive their own vehicles.

Prevalence of hypothyroidism in obstructive sleep apnea

Background: Patients with OSA usually present with complaints of excessive daytime sleepiness, un-refreshing sleep, fatigue or insomnia. Earlier studies have suggested an influence on hypothyroidism whose incidence differed in different geographical areas and between races. This study was conducted to identify the prevalence of hypothyroidism in obstructive sleep apnea in our area. Methods: Polysomnography was conducted on all patients referred for sleep apnea test after performing the regular clinical and physical examination. Blood tests were done to diagnose hypothyroidism. AHI and the Epworth Sleepiness scale was done for assessment for daytime sleep patterns. BMI was calculated for all patients. Results: There was a predominance of males with OSA than females, though the incidence of hypothyroid was greater in females. 36 patients were found to be hypothyroid of which, 27 were previously detected cases and on medication. Only 9 patients (2.4%) were newly diagnosed cases. Male patients with hypothyroid were heavier in weight than the females or men without hypothyroid, had higher ESS, AHI and desaturation Index and low sleep efficiency and arousal index Conclusions: There were more males than females having sleep apnea although the hypothyroidism was more common in females than in males. The prevalence of hypothyroidism was not significant than the normal population. Therefore, the detection of TSH in sleep apnea cases should be considered only if there are other risk factors and indications like obesity, persistent sleepiness despite therapy.

Risky drug use and effects on sleep quality and daytime sleepiness.

Sleep problems are commonly reported following alcohol and cannabis abuse, but our understanding of sleep in non-clinical drug using populations is limited. The present study examined the sleep characteristics of alcohol and cannabis users recruited from the wider community. Two hundred forty-eight self-identified alcohol and/or cannabis users (131 women and 117 men) with a mean age of 26.41 years completed an online study that was advertised via online forums, print media and flyers. As part of the study, participants completed validated sleep scales assessing sleep quality (Pittsburgh Sleep Quality Index) and excessive daytime sleepiness (Epworth Sleepiness Scale) in addition to validated drug scales assessing alcohol (Alcohol Use Disorders Identification Test) and cannabis (Marijuana Screening Inventory) use. Problems with sleep quality were more commonly reported than were complaints of excessive daytime sleepiness. Clinically significant poor sleep quality was associated with comorbid problem alcohol and cannabis use. Women reporting problem alcohol and cannabis use had poorer sleep outcomes than men. Social drug users who report risky alcohol and cannabis use also report poor sleep. Poor sleep quality likely exacerbates any drug-associated problems in non-clinical populations.

Excessive Daytime Sleepiness in Patients with Depressive Symptoms in a Nigerian Family Practice Setting

Objectives: Clinically significant Excessive Daytime Sleepiness (EDS) is frequently encountered among patients with depressive symptoms, and a significant association was observed between depression, body mass index and EDS. Incidentally this sleep disorder is often overlooked. The aim of this study was to examine the association between excessive daytime sleepiness, depressive symptoms, body mass index and blood pressure in a Nigerian family practice setting. Methods: This was a hospital based cross sectional study. Systematic sampling method was used in recruiting the patients. The PHQ-9 was administered to the respondents to screen for depressive symptoms. EDS was evaluated using the Epworth Sleepiness Scale (ESS). The international classification of BMI was used. Classification of hypertension was made according to (JNC 7). Results: One hundred and seventy eight (44.5%) were found to have one form of depression or the other. There was female preponderance. Depression was prominent in the age group 51-60 years, more among the married than the single, as well as those with low socio economic status. There was strong statistical association between age, sex, marital status, level of education, occupation and monthly income (p-values 0.008, 0.000, 0.000, 0.003, 0.000 and 0.001 respectively). Forty five (25.3%) were hypertensive. Fifty nine (33.1%) scored 10 or more on the ESS which was clinically significant sleepiness. Forty seven (26.4%) were obese constituting (23.7%) of the poor sleepers. Ninety three (52.2%) were poor sleepers, sleeping less than the normal 7 hours. Conclusion: In this study, significant EDS was found with patients with depressive disorders and higher body mass index. Therefore patients with a complaint of EDS should be thoroughly assessed for depression and obesity.

Validation of a modified hindi version of the Epworth Sleepiness Scale in a north Indian population

Since a majority of Indians do not drive automobiles, one item on the Epworth Sleepiness Scale requires modification and validation. In addition, data collected by us, indicated that a vast majority of rural and urban Indians regularly spend time in prayer/spiritual activity. The main purpose of this study was to develop a cross-cultural adaptation of the Epworth Sleepiness Scale for a north-Indian population (ESS-I). The study also provides evidence of reliability and validity of the modified version. The subjects included were normal volunteers aged 18–75 years (group 1) ( n = 100), compared with patients with complaints of excessive daytime sleepiness, who had undergone polysomnography (group 2) ( n = 22) and patients who had undergone MSLT (group 3)( n = 10). The study was carried out in four phases: translation and retranslation of the original scale with modification of item8 (mainly addition of option of question on ‘while offering prayers or in spiritual activity’); reliability (test–retest) ( n = 30); internal consistency (using Cronbach’s alpha index) ( n = 102); and sensitivity to change ( n = 8). Group 1 showed spiritual activity as significantly more common activity than driving. The Cronbach’s á for the modified version, was 0.892, and this was not improved by removing the modified item. The á value for group 1 versus group 2&3 was 0.667 and 0.892, respectively. The scale was reliable over time (test–retest) and it was sensitive to sleepiness change in patients with obstructive sleep apnea during treatment. The ESS-I, is comparable to the original scale, It is reliable, valid, and change-sensitive. It is proposed that the modified version can be very useful for detecting sleepiness among Indian population, especially those who do not drive their own vehicles. I am highly greatful to Jyoti Katoch, Shivani, Bharat Singh, Umesh Kumar, Nikhil at the Sleep disorders clinic and lab, Department of Neurology, AIIMS, New Delhi, India and my family specially my mother for their constant support.

Comparison of sleep diary and actigraphy to evaluate total sleep time in hypersomnia patients

A sleep diary is often employed for diagnosing and treating hypersomnia. However, its reliability needs to be evaluated because overlooked chronic sleep insufficiency could be misdiagnosed as narcolepsy. In this study, we compared simultaneous sleep measurements using a sleep diary and by actigraphy in patients visiting our sleep clinic for the first time with complaints of excessive daytime sleepiness. Of the 28 patients enrolled, 24 complied with both these requirements. In this population, the results obtained using a sleep diary tended to estimate a statistically significant earlier sleep onset time and longer total sleep time than those via actigraphy. For total sleep time, this tendency was more prominent in patients with a higher Epworth Sleepiness Scale score. In 5 of the 24 (20.8%) patients, the sleep diary records indicated >6 h of total sleep time while the actigraphy records indicated 1 h. These results suggested that sleep insufficiency in hypersomnia patients may be overlooked when their sleep time is assessed using only a sleep diary in the initial phase of the diagnostic procedure, and the simultaneous use of actigraphy may be preferable in this assessment.

Nocturnal frontal lobe epilepsy presenting as excessive daytime sleepiness

Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE.

대학생의 수면양상과 주간졸음증에 영향을 미치는 요인

Purpose: The purpose of this study was to investigate sleep patterns and predictors of excessive daytime sleepiness (EDS) in university students. Methods: Participants were 120 university students who were attending two universities in S-city and C-city. Data were collected from May 20 to June 15, 2012 using self-report questionnaires which included Johns' Epworth Sleepiness Scale, Yi's Sleep Quality Scale, and Beck Depression Inventory. Data were digitalized and analyzed using frequency, percentages, means and standard deviations, Wilcoxon rank sum test, Chi-square test, Fisher's exact test, and multiple logistic regression with SAS 9.0. Results: Mean total sleep time was 6.6 hours on weekdays, 8.1 hours on weekends. Mean sleep latency was 19.1 minutes and the score for mean sleep quality was 22.6. Prevalence of EDS was 12.5%. Depression was significantly different between EDS and Non-EDS students (t=2.17, p=.030). Multiple logistic regression showed that the only factor associated with EDS was depression (adjusted odds ratio of depression=5.33, 95% Confidence Interval=1.49-19.04). Conclusion: Results of this study indicate that university students experience short sleep time, low sleep quality, and common EDS with depression, suggesting that students with complaints of EDS should be completely assessed for depression as well as sleep problems.

Positional central apnea and vascular medullary compression

A 66-year-old man with hypertension presented with complaints of excessive daytime sleepiness (Epworth Sleepiness Score 14/24), dyspnea upon exertion, and episodes of noninjurious dream-enacting behavior. He reported tongue biting when sleeping in the right lateral decubitus position. Medications included atenolol 12.5 mg, lovastatin 20 mg, doxazosin 2 mg, amlodipine 5 mg, isosorbide mononitrate 60 mg, and aspirin 81 mg. He denied headaches, visual changes, dysarthria, dysphagia, or localized weakness. He denied use of alcohol, tobacco, or drugs.