Daytime Sleepiness Research Articles

Sex differences in the risk of excessive daytime sleepiness in mild and moderate ischaemic stroke patients: a retrospective database study

BackgroundExcessive daytime sleepiness (EDS) is a common complication of stroke that has a detrimental effect on patients’ daily life and functional recovery. The clinical characteristics and risk factors for poststroke EDS may differ between males and females.MethodsA retrospective study based on hospital medical records was conducted on patients with a diagnosis of stroke who participated in polysomnographic monitoring at the Affiliated Hospital of Yangzhou University from February 2022 to May 2024. Baseline data, laboratory test data, polysomnographic data, and related scale scores were retrospectively collected. The Epworth Sleepiness Scale (ESS) score was used to assess EDS after stroke. Binary logistic regression was used to determine the risk factors for daytime sleepiness. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed via IBM SPSS 26.0.ResultsESS scores were higher in males than in females, whereas females had higher Pittsburgh Sleep Quality Index (PSQI) scores and Hospital Anxiety and Depression Scale (HADS) scores. Male sex and higher depression scores were risk factors for EDS; among male patients, higher anxiety scores were a risk factor for EDS, whereas smoking was a protective factor. Depression, a higher arousal index and a reduced proportion of N3 sleep periods were risk factors for EDS in females.ConclusionsThe characteristics and influencing factors of EDS differ between the sexes in patients with mild and moderate ischaemic stroke. Our study may provide evidence and guidance for clinical diagnosis and treatment. Interventional studies are needed to assess the impact of treating these risk factors in the future.

A single-arm pilot study of a brief cognitive-behavioral therapy for insomnia intervention among Japanese occupational therapy and physical therapy university students with sleep disturbances

ObjectiveTo evaluate the feasibility of the Sleep Health through University Student Habits (SHUSH) program, a brief sleep improvement intervention based upon principles of cognitive-behavioral therapy for insomnia (CBT-I) developed for Japanese university students.MethodsPretest-posttest, single-arm pilot study design with 3-month follow up was used to evaluate the feasibility of SHUSH. We developed then offered a 90-min sleep education class based upon the two-process model of sleep regulation, sleep restriction, stimulus control, and sleep hygiene. We recommended individualized sleep prescriptions (e.g., prescribed time to bed and prescribed time out of bed) from 11 days of daily sleep diary data. We then offered 15 min of individualized follow-up meetings each week for three consecutive weeks in person or online in which we supported adherence to sleep prescriptions. Fifteen university students with self-reported sleep disturbance (Insomnia Severity Index; ISI score ≥ 9) completed the SHUSH program. Participants were on average age 19.7 years old; nine were women, and they were students in occupational therapy and physical therapy. We assessed validated Japanese versions of sleep-related (e.g., ISI, Sleep hygiene practice scale; SHPS), mental health-related (e.g., Generalized Anxiety Disorder Screener) patient-reported outcomes (PROs) and daily sleep diary variables (e.g., sleep onset latency and sleep efficiency).ResultsComparing baseline and posttest data, a statistically significant difference was observed in insomnia symptom severity, daytime sleepiness, sleep hygiene practices, eveningness to morningness, anxiety, depression, sleep diary improvements (e.g., sleep onset latency, total time in bed, and sleep efficiency). Comparing posttest and 3-mo follow up data (n = 10), a statistically significant difference wasn't observed for most PRO effects. However, there was a statistically significant difference in ineffective sleep behaviors (i.e., SHPS-J). We did observe a rebound effect for some SHPS-J items.ConclusionSHUSH was developed as a brief cognitive-behavioral intervention for insomnia. SHUSH participants showed improvements on sleep-related and mental health-related PROs after 4 weeks of intervention. At 3 months follow-up sleep quality and mental health gains were maintained. SHUSH was a feasible program. Randomized controlled trials are needed to test treatment efficacy on sleep related and mental health related PROs in the future.

Resistant Hypertension: A Brief Review of Pathophysiology.

A 52-year-old male comes to the internal medicine clinic for a follow-up for the management of hypertension. He was initially diagnosed with hypertension 5 years ago. His other past medical history includes obesity and hyperlipidemia. His current medications currently include losartan 100 mg daily, hydrochlorothiazide 25 mg, and amlodipine 10 mg. His physical exam is significant for an elevated in-office blood pressure of 160/105 mmHg, BMI 38, and neck circumference >40 cm. He also reports snoring at night and having significant daytime sleepiness despite getting over 8 hours of sleep each night. This patient meets the most recent diagnostic criteria per the American Heart Association for resistant hypertension. Resistant hypertension is an increasingly prevalent phenotype encountered in both primary care and subspecialty clinics. Multiple comorbidities, including obesity, sleep apnea, chronic kidney disease, heart failure, and diabetes mellitus, are associated with resistant hypertension. Our understanding of the potential etiologies for this condition continues to evolve rapidly. We used a narrative review to explore four research areas in the pathophysiology of resistant hypertension (the sympathetic nervous system, aldosterone excess, endothelial dysfunction, and inflammation) and explore the novel therapies currently in development.

Feature Contributions and Predictive Accuracy in Modeling Adolescent Daytime Sleepiness Using Machine Learning: The MeLiSA Study.

Background: Excessive daytime sleepiness (EDS) among adolescents poses significant risks to academic performance, mental health, and overall well-being. This study examines the prevalence and risk factors of EDS in adolescents in Bangladesh and utilizes machine learning approaches to predict the risk of EDS. Methods: A cross-sectional study was conducted among 1496 adolescents using a structured questionnaire. Data were collected through a two-stage stratified cluster sampling method. Chi-square tests and logistic regression analyses were performed using SPSS. Machine learning models, including Categorical Boosting (CatBoost), Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Random Forest (RF), K-Nearest Neighbors (KNN), and Gradient Boosting Machine (GBM), were employed to identify and predict EDS risk factors using Python and Google Colab. Results: The prevalence of EDS in the cohort was 11.6%. SHAP values from the CatBoost model identified self-rated health status, gender, and depression as the most significant predictors of EDS. Among the models, GBM achieved the highest accuracy (90.15%) and precision (88.81%), while CatBoost had comparable accuracy (89.48%) and the lowest log loss (0.25). ROC-AUC analysis showed that CatBoost and GBM performed robustly in distinguishing between EDS and non-EDS cases, with AUC scores of 0.86. Both models demonstrated the superior predictive performance for EDS compared to others. Conclusions: The study emphasizes the role of health and demographic factors in predicting EDS among adolescents in Bangladesh. Machine learning techniques offer valuable insights into the relative contribution of these factors, and can guide targeted interventions. Future research should include longitudinal and interventional studies in diverse settings to improve generalizability and develop effective strategies for managing EDS among adolescents.

Association of Insomnia with Functional Outcomes Relevant to Daily Behaviors and Sleep-Related Quality of Life among First Nations People in Two Communities in Saskatchewan, Canada.

Insomnia is a common sleep complaint in Canada and is associated with increased use of health care services and economic burden. This paper examines the association of insomnia with functional outcomes relevant to daily behaviors and sleep-related quality of life among First Nations participants using the Functional Outcomes of Sleep Questionnaire (FOSQ-10). The First Nations Sleep Health Project follow-up survey was conducted in partnership with two Cree First Nations in the summer of 2022, where 355 individuals participated. Statistical analysis was conducted using logistic regression models. The mean age of the participants was 40.76 ± 14.60 (SD) years, and 59.4% were females. The prevalence of chronic insomnia (Insomnia Severity Index score of ≥15) was 21.0%, with more females (26.1%) than males (13.8%) experiencing it among the 348 participants. Overall, the mean FOSQ-10 score was 17.27 ± 2.98 among the 350 participants, with those who had clinical insomnia reporting significantly lower scores than those without clinical insomnia (mean ± SD: 14.6 ± 3.9 vs. 18.0 ± 2.1; p < 0.001). The FOSQ-10 scores indicated sleep-related functional impairment (FOSQ-10 total score < 17.90) in 46.6% of participants. After adjusting for age, excessive daytime sleepiness, sex, and regular use of prescription medication, we found that clinical insomnia was significantly associated with functional impairments. In fact, a person with clinical insomnia was 3.5 times more likely to have functional impairments than those without clinical insomnia. This study highlights the significant association between insomnia and functional impairments related to daily behaviors and quality of life in two First Nation communities. Identifying this association can help healthcare providers to diagnose and treat patients with insomnia in these communities.

Does gaming keep subjects awake?: Subjective and objective sleep parameters following gaming in comparison to a passive control

ObjectivesGaming is a global phenomenon often associated with impaired health and sleep patterns. Although the research activities are growing, the evidence to date is rare due to the various gaming titles and inconsistent study designs. Thus, this study aimed to examine the impact of excessive gaming in the evening on subjective as well as objective sleep parameters by focusing on specific game titles and assessing several evenings/nights using a mixed-methods approach. MethodsA total of 33 experienced young male adults (23.00 ± 3.53 years old, ranked players in League of Legends or Counter-Strike: Global Offensive) took part. The individuals’ sleep parameters were assessed via diary and actigraphy. In randomized order, one week apart and for a duration of 120 min each, two study evenings were spent gaming, while the other two evenings were spent without digital media and gaming, but instead watching a nature documentary. ResultsNo significant difference between the conditions were found (p > 0.05) in either the sleep duration nor the sleep quality. Daytime sleepiness was significantly increased after watching the documentary movie, when compared to gaming (p < 0.001). ConclusionsThese results indicate that, one the one hand, the gaming activity leads to higher arousal and alertness as it requires concentration and dedication. On the other hand, this impact seems only short-term and does not necessarily affect sleep patterns. Future studies are needed to gain deeper insights, especially regarding the long-term health effects of gaming.

Excessive daytime sleepiness and associated factors in patients with type 2 diabetes mellitus: a cross-sectional study

Excessive daytime sleepiness and associated factors in patients with type 2 diabetes mellitus: a cross-sectional study

Factors Affecting Daily Functioning in Turkish Patients with Obstructive Sleep Apnea.

Background and Objectives: This study aims to examine the factors affecting the daily functioning of patients with obstructive sleep apnea (OSA). Materials and Methods: In addition to the polysomnography records of 361 patients, participants completed the Turkish FOSQ-10 (Functional Outcomes of Sleep-10), Medical Outcome Survey Short Form-12, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). First, the psychometrics properties of the Turkish FOSQ-10 were evaluated. Then, factors affecting daily functioning were examined through univariate and multivariate analyses. Results: Of all participants, 68.7% (n = 248) were male, and the average age was 47.94 ± 11.08. According to the OSA category, 23% (n = 83) were mild, 22.7% (n = 82) were moderate, 45.2% (n = 163) were severe, and 9.1% (n = 33) were OSA negative. The Turkish FOSQ-10 was found to be a valid and reliable scale through validity and reliability analyses. The moderate and severe OSA patients had different FOSQ-10 Total scores compared to the negative OSA group. Daily functioning was positively associated with overall quality of life while inversely associated with depression, being anxious, and daytime sleepiness in OSA patients. In a multiple regression model, BDI, mental component summary-12, physical component summary-12, and ESS scores were significantly related to the FOSQ-10 Total score in OSA patients (p < 0.05). Conclusions: The daily functioning of moderate and severe OSA patients was worse than that of the negative OSA group. Depression, quality of life, and daytime sleepiness were simultaneously important variables associated with daily functioning in OSA patients.

Bruxism and Sleep Disorders in Patients Diagnosed With Depressive Disorder and Anxiety Disorder UsingAntidepressants.

To investigate the frequency of bruxism, factors associated with bruxism and sleep disorders in patients diagnosed with depressive disorder and anxiety disorder who use antidepressants. A total of 273 patients diagnosed with anxiety disorder or depression who had been using antidepressants for at least 1 month were included, along with 273 healthy control groups. The patient and control groups completed a sociodemographic data form, Epworth Daytime Sleepiness Scale (EDSS), Pittsburgh Sleep Quality Index (PSQI) and a bruxism questionnaire. Additionally, the clinician confirmed the diagnosis of bruxism through a clinical interview. Bruxism was detected in 73.3% of the patient group and 28.2% of the control group (p < 0.001). The most commonly used antidepressants among patients were selective serotonin reuptake inhibitors (SSRIs) such as escitalopram and sertraline. Within the patient group, individuals with bruxism had higher family history rates of teeth grinding (p = 0.034), PSQI scores (p < 0.001) and EDSS scores (p < 0.001) compared to those without bruxism. Positive correlations were found between the presence of bruxism and PSQI (p < 0.001) scores as well as EDSS scores (p < 0.001) in both the patient group and all participants. Regression analysis conducted on the entire sample revealed that family history rates of teeth grinding (p < 0.001), antidepressant use (p < 0.001) and PSQI score (p = 0.004) were associated with bruxism. The findings from this study suggest that a majority of patients diagnosed with depressive or anxiety disorders may experience bruxism, particularly those using SSRI-type antidepressants. Furthermore, individuals with bruxism may have poor sleep quality and excessive daytime sleepiness tendencies.

Sex Differences in Elderly People’s Sleep: A Cross-Sectional Study

Background and Objectives: Sex differences are unclear in geriatric sleep medicine, and most evidence comes from inference from preclinical bases or clinical studies conducted on younger people. The aim of this study is to explore sex differences in sleep quality and daytime sleepiness in a cohort of elderly people. Materials and Methods: This cross-sectional study involved subjects aged 65 years or older undergoing multidimensional evaluation, including sleep quality and daytime sleepiness assessment with validated tools. Results: This study included 226 subjects (69.5% women), the majority of whom showed poor sleep quality (64.2%). A logistic regression model put one before the other sleep quality and gender. It initially showed that men were about half likely as women to have poor sleep quality (OR 0.48, 95%CI 0.27–0.86). Nonetheless, after adjusting for cognitive status and mood, the difference became smaller and insignificant (OR 0.72, 95%CI 0.38–1.38). Conclusions: Sex differences in elderly people’s sleep quality seem to not be independent, appearing to be affected by alterations in cognitive status and mood.

Pitolisant 40 mg for excessive daytime sleepiness in obstructive sleep apnea patients treated or not by CPAP: Randomised phase 3 study.

Obstructive sleep apnea (OSA) syndrome commonly leads to excessive daytime sleepiness (EDS). Pitolisant, a selective histamine-3 receptor antagonist, is efficacious at doses up to 20 mg once daily in OSA treated or not with continuous positive airway pressure (CPAP). We assessed the efficacy and safety of pitolisant at doses up to 40 mg once daily in patients with moderate to severe OSA treated or not with CPAP therapy. In this phase 3, multicentre, randomised, double-blind, placebo-controlled clinical trial, patients with OSA were assigned 2:1 to receive pitolisant (according to an individual up-titration scheme, 10, 20 or 40 mg once daily) or placebo for 12 weeks. The primary endpoint was a change in the Epworth Sleepiness Scale (ESS) score from baseline to week 12. Secondary endpoints included a change in reaction time using the Oxford Sleep Resistance test (OSleR), Clinical Global Impression of Change (CGI-C), and Patient's Global Opinion of the Effect (PGOE) of study treatment. Overall, 361 patients (mean age 52.4 years, 77.3% male; mean apnea-hypopnea index [AHI] 27.0 events/h) were randomised to receive pitolisant (n = 242; 50% received CPAP) or placebo (n = 119; 48.7% CPAP). After the dose-adjustment phase (week 3), 88.8% of patients received pitolisant 40 mg. Compared with placebo, pitolisant produced a significant reduction in the ESS score at week 12 (least square mean difference -2.6 (95% CI: -3.4; -1.8; p < 0.001)) irrespective of CPAP use; and improved the reaction time on OSleR, CGI-C, and PGOE at week 12. Pitolisant was well tolerated; no new safety signals were identified. In conclusion, pitolisant up to 40 mg once daily was an effective treatment for EDS in patients with moderate to severe OSA irrespective of CPAP use.

Prevalence of poststroke fatigue and its relationship with clinical characteristics among community-dwelling stroke survivors: A cross-sectional survey

Background and objectivePoststroke fatigue is widely overlooked due to a lack of awareness, definite cause, and cure. It is influenced by cultural variance in psychosocial factors and stroke epidemiology patterns across different countries. To date, the prevalence of poststroke fatigue has not been determined in the Indian setting. Hence our objective was to estimate the prevalence of fatigue among community-living late subacute and chronic stroke survivors. Additionally, we determined the association between poststroke fatigue and participants’ clinical and demographic data. MethodsA cross-sectional survey was conducted among first-time stroke survivors following discharge from two tertiary care hospitals. Medical records were screened and included if they met the criteria for age >18 years, able to follow a two-step command with no existing neurological or systemic conditions that would influence fatigue scores. Telephonic consent was obtained, and an interview was conducted to obtain the scores for fatigue, daytime sleepiness, depression, functional mobility, and disability. ResultsA total of 323 participants (mean age: 60.3 ± 12.6 years, mean stroke duration: 8.6 ± 4.4 months) completed the interview. Poststroke fatigue was reported in 11.8 % (n = 38) of the population. Occupational status (χ2 = 5.73), functional mobility (χ2 = 5.84), and disability scores (χ2 = 8.00) were significantly associated (p < 0.05) with fatigue scores. Individuals with disability exhibited five times (OR = 5.00, CI: 1.45–17.23, p = 0.01) higher odds of experiencing fatigue than those without disability. ConclusionOur study reported a relatively lower prevalence of fatigue among community-living late subacute and chronic stroke survivors. Implementing strategies to address these contributing factors could effectively ease fatigue in individuals recovering from stroke.

A case study on the exposure-response relationship of sleep disturbance due to road traffic noise - As a case in Japan in the 2020s

A socio-acoustic survey was conducted among residents living along major arterial roads in Kanagawa Prefecture, Japan, to examine the occurrence of sleep disturbances due to road traffic noise. Lnight noise maps was introduced for estimating ranges from 30 dB to 80 dB. We asked the frequency of "difficulty falling asleep," "nocturnal awakenings," "early morning awakenings", "feeling unrefreshed in the morning",and "daytime sleepiness" due to road traffic noise. Cases experiencing any of these items more than three times a week were defined as "highly sleep disturbed (HSD)", and that one or twice a week were defined as "sleep disturbed (SD)", respectively. The exposure response relationships between those and Lnight were examined with the independent variables of noise sensitivity, gender, and age. The results of multiple logistic regression analysis revealed that Lnight, and noise sensitivity had a significant effect on SD, while noise sensitivity significantly affected HSD. We show the results of this study in comparison with previous surveys on sleep disturbances conducted in Japan and other regions.

Clinical characteristics of obstructive sleep apnea patients with residual sleepiness

ObjectiveThis meta-analysis examines the clinical characteristics of CPAP-treated obstructive sleep apnea (OSA) patients with residual excessive sleepiness (RES).MethodWe conducted a search for articles published from inception to March 16, 2024, in PubMed, Embase, Cochrane Library, and Web of Science. Seven studies were included in this meta-analysis.ResultsThe meta-analysis revealed that continuous positive airway pressure (CPAP)-treated OSA patients with RES were characterized by higher Epworth Sleepiness Scale and Depression Scale scores, lower body mass index (BMI) and apnea-hypopnea index (AHI) before CPAP treatment. RES patients also exhibit poorer CPAP adherence. Being female was also associated with RES.ConclusionBeing female, having lower BMI and AHI, and more severe daytime sleepiness and depressive symptoms before CPAP treatment, and lower CPAP adherence were characteristics of OSA patients with RES. These factors may prove helpful in identifying CPAP-treated OSA patients who may need additional treatment to minimize RES.

The Dynamics of Heart Rate Asymmetry and Situational Sleepiness from Evening to Night: The Role of Daytime Sleepiness.

The relationship between daytime sleepiness and heart rate asymmetry (HRA) during the transition from evening to night is crucial for understanding autonomic regulation and its implications for alertness. This study aims to investigate how daytime sleepiness influences HRA dynamics from evening to night and how situational sleepiness correlates with HRA metrics. HRA metrics were calculated at 8 P.M., 9 P.M., and 10 P.M. in 50 participants, categorized into 'Lower Normal' and 'Higher Normal' daytime sleepiness groups based on Epworth Sleepiness Scale (ESS) scores. Situational sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) and Stanford Sleepiness Scale (SSS). The results demonstrated that individuals with 'Higher Normal' daytime sleepiness exhibited lower HRA metrics at 10 P.M. compared to those with 'Lower Normal' daytime sleepiness, supporting the suggestion that higher daytime sleepiness correlates with reduced parasympathetic activity and diminished autonomic responsiveness. Significant negative correlations between situational sleepiness and HRA metrics were observed in the 'Higher Normal' group, particularly with the SSS. Therefore, increased daytime sleepiness affects HRA dynamics by decreasing parasympathetic activity and altering autonomic regulation at the beginning of the biological night (10 P.M.). These findings suggest potential applications for enhancing drowsiness detection and managing fatigue in safety-critical environments.

Medication management: how medication review improves lives and reduces waste.

Ageing is associated with an increased risk of adverse drug reactions. This calls for great care and diligent follow up when prescribing medication to older patients. Yet, this is seldom the case and the proportion of older people taking five or more medications has quadrupled from 12% to 49% in the last 20 years. Certain medications are riskier than others. Those with anticholinergic effects are of particular concern. Adverse effects of anticholinergics include dry mouth, nausea, dizziness, fatigue, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment, such as confusion and agitation. Anticholinergic medication can cause daytime drowsiness and cognitive decline, while increasing the risk of fall and can lead to increased mortality. Although anticholinergic medication should be avoided in older people whenever possible, their use has almost doubled in the last 20 years, and those who are most vulnerable to its adverse effects had the greatest increase in use. This article examines why older people are at increased risk of adverse drug reactions and how medication review can enable older persons to take medications regularly, improve quality of life and minimise medication waste.

Impact of comorbid sleep-disordered breathing on escitalopram treatment in patients newly diagnosed with generalized anxiety disorder: A 12-week prospective observational study

We aimed to evaluate the presence of sleep-disordered breathing (SDB) in generalized anxiety disorder (GAD) patients and its impacts after 12-week of escitalopram treatment. In this prospective observational study, GAD patients were followed up to determine whether comorbid SDB affects their treatment response. They underwent a home sleep apnea test (HSAT), and oxygen desaturation index ≥5 was considered indicative of SDB. All participants were treated with escitalopram 5 mg in the first 2 weeks and 10 mg in the remaining 10 weeks. They underwent assessments of heart rate variability and completed questionnaires for sleep, mood, attention, and daytime sleepiness on the day of enrollment, and 2 weeks, 4 weeks, and 12 weeks later. A total of 45 GAD participants (mean age, 56.2 years) were included in the study. Of these, 53.3% had comorbid SDB. Participants with GAD and SDB had higher baseline Beck Anxiety Inventory (BAI) and STOP-BANG scores. Both groups of participants with GAD showed overall improvement in anxiety, depression, and insomnia symptoms after 12 weeks of escitalopram treatment. Additionally, there were no statistically significant differences in the changes in BAI, Beck Depression Inventory, and Epworth Sleepiness Scale scores between the two groups at the Week 2, Week 4, and Week 12 assessments compared to baseline. However, the GAD group with comorbid SDB seemed to have a lower tendency for improvement in depressive symptoms than the group with non-comorbid SDB. Compared with the GAD group without comorbid SDB, the GAD group with comorbid SDB exhibited more severe anxiety symptoms at baseline and tended to show less improvement in depressive symptoms after 12 weeks of escitalopram treatment.

Sleep, Sleep Apnea, and Fatigue in People Living With HIV

Background: People living with HIV (PLWH) often report fatigue even when viral load is suppressed. Obstructive sleep apnea (OSA), which is often associated with fatigue, is common in PLWH, but whether OSA explains fatigue in this population is unknown. Setting: Academic university-affiliated HIV and Sleep Medicine Clinics. Methods: PLWH, aged 18–65 years, with a body mass index of 20–35 kg/m2 and viral suppression (RNA &lt;200 copies per mL), were recruited to undergo daytime questionnaires, including the Functional Assessment of Chronic Illness Therapy Fatigue Scale and Epworth Sleepiness Scale, 7 days of actigraphy (to determine daily sleep duration and activity amplitude and rhythms), and an in-laboratory polysomnography to assess for the presence and severity of OSA. Results: Of 120 subjects with evaluable data, 90 (75%) had OSA using the American Academy of Sleep Medicine 3% desaturation or arousal criteria, with an apnea–hypopnea index &gt;5/h. There was no difference in Functional Assessment of Chronic Illness Therapy scores between those with and without OSA, although those with OSA did report more daytime sleepiness as measured using the Epworth Sleepiness Scale. In a multivariable model, predictors of fatigue included more variable daily sleep durations and decreased mean activity counts. Sleepiness was predicted by the presence of OSA. Conclusion: OSA was very common in our cohort of PLWH, with those with OSA reporting more sleepiness but not more fatigue. Variability in sleep duration was associated with increased fatigue. Further study is needed to determine if treatment of OSA, or an emphasis on sleep consistency and timing, improves symptoms of fatigue in PLWH.

Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome

Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA. Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram. OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers. A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.

Distinction of papillary and adamantinomatous craniopharyngioma: Clinical features, surgical nuances and hypothalamic outcomes

ObjectiveUnderstanding the differences of suprasellar papillary and adamantinomatous craniopharyngiomas (PCPs/ACPs) is pivotal for target therapy, surgical strategy or postoperative management. Here, the clinical features, surgical nuances and postoperative hypothalamic outcomes of PCPs were systematically recapitulated. Methods24 PCPs and 52 ACPs underwent initial surgery were retrospectively reviewed. Clinical data, quantified third ventricle (3rd V) occupation and optic chiasm distortion were compared, as well as intra-operative findings, operating notes and prognosis. Moreover, analysis of tumor/3rd V relationship and hypothalamic outcomes were also performed. ResultsTumors were more likely to occupies the 3rd V cavity in PCPs. Chiasm distortion of “compressed forward” was the most common pattern (45.8 %) in PCPs, whereas “stretched forward” pattern accounted the highest (42.5 %) in ACPs. Besides, round-shaped with less calcification, duct-like recess, solid consistency, rare subdiaphragmatic invasion, visible lower stalk and improved postoperative visual outcome were more frequently observed in PCPs. The basal membranes of the tumor epithelium and the reactive gliosis were separated by a layer of collagen fibers in most PCPs, which differs from ACPs in the morphological examination of tumor/3rd V floor interface. In daytime sleepiness and memory difficulty, the PCPs showed significantly better outcomes than the ACPs groups, and PCPs suffered less postoperative weight gain (p < 0.05) than ACPs among adult-onset cases. ConclusionPCPs are different from ACPs regards the clinical features, operative techniques and outcomes. If necessary, PCPs are suggested more amenable to total removal since its less invasiveness to the 3rd V floor and better hypothalamic outcomes.