Breathing Disturbances Research Articles

C10 Description Of The Breathing Phenotype In Two Mouse Models For Huntington's Disease

Aspiration pneumoniais a major cause of death in people with Huntington’s disease (HD). Furthermore, breathing irregularities and impaired swallowing in mid and late-stage HD are frequent clinical observations. These observations may berelated to impaired brain stem control of breathing and swallowing. Irregularbreathing patterns could also arise as a compensatory mechanism for decreased blood O 2 and increased CO 2 levels in the blood due to primary weakness of respiratory muscles or impaired O 2 uptake in the lungs. In order to develop clinical therapies for people with HD affected by breathing and swallowing difficulties, it is necessary to understand the underlying cause for this problems. An animal model would be an invaluable tool for the investigation of the pathophysiological condition leading to breathing and swallowing problems observed in people with HD. The aim of this study is to identify and characterise an animal model for HD that share some of the pathological features with respect to breathing and swallowing. In our study we will monitor the breathing pattern of Detloff HdhQ50 and HdhQ250 mice employing whole-body plethysmography on a monthly basis to test for the occurrence of breathing disturbances during disease progression. We also plan to analyse blood samples, respiratory muscles, and lung tissue to see if the breathing problems are caused by disturbances in these tissues and not by impaired brain stem control of breathing.

Postoperative Changes in Sleep-Disordered Breathing and Sleep Architecture in Patients With Obstructive Sleep Apnea

Background:Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these p

Cerebral impairment in heart failure.

Patients with heart failure (HF) exhibit a wide range of symptoms, including dyspnea, sleep-disordered breathing, autonomic abnormalities, cognitive dysfunction, and neuropsychological disturbances. These symptoms, which affect quality of life and morbidity and mortality in the condition, are largely related to structural and functional changes in the brain. There are increasing reports of brain abnormalities in HF, but often the linkages between brain injury and common HF clinical symptomatology are not clearly described. In this review, we will discuss the current evidence of brain injury and the associated clinical symptoms in HF, focusing on those brain regions that are commonly damaged in the condition. We will also provide a brief exploration of some potential mechanisms for brain injury in HF.

Impairment of nasal airway under intermittent hypoxia during growth period in rats

ObjectiveTo clarify the influences of intermittent hypoxia (IH) on the growth and development of the midfacial area, including the nasal cavity, in growing rats. DesignSeven-week-old male Sprague–Dawley rats were divided into two groups: the experimental group (n=5), which was exposed to IH for 8h during light periods at a rate of 20cycles/h (nadir, 4% O2 to peak, 21% O2 with 0% CO2), and the control group (n=5), which was exposed to room air. After 3 weeks, the maxillofacial structures in both groups were evaluated with respect to the height, width, length, surface area, cross-sectional area, and volume of the nasal cavity using soft X-ray and micro-CT. ResultsThe experimental group showed a significantly smaller cross-sectional area and volume than did the control group. The surface area exhibited no significant differences between the two groups, although it tended to be smaller in the experimental group than in the control group. The nasal volume divided by the length of the tibia (for comparison with whole-body growth) was significantly smaller in the experimental group than in the control group. ConclusionsThese data suggest that IH exposure suppresses growth and development of the nasal cavity and may result in nasal breathing disturbance.

Association between symptoms of sleep-disordered breathing and speech in children with craniofacial malformations.

Sleep-disordered breathing (SDB) and speech difficulties are common problems in children with craniofacial malformations (CFM). The present study was designed to investigate whether resonance issues identified during speech assessment are associated with parental report of SDB symptoms in children with CFM. Children aged 2-18 years with congenital CFM attending at the Craniofacial Anomalies Program from March 2007 to April 2011 were screened for SDB symptoms using the Sleep-Related Breathing Disturbance Scale of the Pediatric Sleep Questionnaire. Speech evaluation, based on the Pittsburgh Weighted Speech Scale score, was the tool used to investigate velopharyngeal dysfunction (VPD) based on speech perceptual assessment. A total of 488 children with congenital CFM were included. Overall 81% were Caucasian and 24% were overweight/obese. Twenty-four percent of children screened positive for SDB and 35% had VPD. Children with VPD were no more likely to screen positive for SDB than children without VPD (26% vs. 23%, p = 0.38). However, children with previous sphincter pharyngoplasty (SP) were more likely to have hyponasality (51% vs. 12%, p = 0.0001) and reduced or absent nasal emission (33% vs. 16%, p = 0.008). In a logistic regression, the adjusted odds ratio for SDB for those with hyponasality was 2.10 (95%CI 1.21-3.61, p = 0.008) and for those with reduced or absent nasal emission was 1.75 (95%CI 1.06-2.88, p = 0.028). Symptoms of sleep disordered breathing are common in children with craniofacial malformations especially if they have undergone sphincter pharyngoplasty; many of these children can be identified by measures of resonance on routine speech evaluation.

Factors associated with mouthguard use and discontinuation among rugby players in Malaysia.

To assess rugby players' preferences for using a mouthguard and to determine the factors contributing to the use and discontinuation of a mouthguard. A cross-sectional study was conducted in two rugby tournaments from 2009 to 2010. Samples were selected by convenience sampling. Participants were required to complete a self-administered questionnaire, which inquired about awareness and pattern of mouthguard use, as well as reasons if discontinued. Completed questionnaires were returned by 456 participants, with an estimated response rate of 77.8%. All participants were male (mean age = 22.73, SD = 3.98). Median duration of playing was 6 years, and median frequency was 6 h per week. Overall mouthguard use was low (31.1%, n = 142), especially for custom-fitted mouthguard (1.8%, n = 8), followed by stock mouthguard (7.7%, n = 35). Boil-and-bite type was most commonly used (21.1%, n = 96). Of those who wore a mouthguard before, only 28% continued using it. The discontinuation rate for each type was as follows: stock, 57.1% (P = 0.032); boil-and-bite, 80.2% (P = 0.002); and custom, 37.5% (P = 0.04). Age was a significant factor for mouthguard use (P = 0.007, OR = 1.10, 95% CI = 1.03-1.17). Breathing disturbance (OR = 3.36, 95% CI = 1.17-9.72) and general discomfort (OR = 3.71, 95% CI = 1.68-8.20) were significant factors in discontinuing mouthguard use. The use of mouthguard was low among rugby players. Custom-made was the least worn type, possibly due to limited availability. The use of mouthguard increased slightly with age but was discouraged by breathing interference and general discomfort. Therefore, preventive effort should focus on early education and reinforcement, as well as on the improvement of wearability and accessibility.

Short-term medroxyprogesterone acetate in postmenopausal women with sleep-disordered breathing

Menopause predisposes women to sleep-disordered breathing (SDB) and sleep disturbances. Progestin has a potential to stimulate breathing and to induce sleep. Our goal was to test these effects objectively and to compare them with the effects of nasal continuous positive airway pressure (CPAP), which is the standard treatment of SDB. In a placebo-controlled, double-blind, parallel-group trial, we investigated 34 postmenopausal women (17 in the placebo group and 17 in the medroxyprogesterone acetate [MPA] group) whose SDB had been treated with nasal CPAP for 6 months to 8 years prior to study entry. The 6-week trial included measurements with CPAP at baseline, after 14 days of placebo or MPA (60 mg daily), and after a 3-week washout. The participants discontinued their nasal CPAP therapy 1 week after baseline measurements and went on with study medication. Two weeks after discontinuation of CPAP therapy, nightly oxygen saturation was sustained higher (P = 0.004) and arterial carbon dioxide tension was lower (P < 0.001) with MPA than with placebo. Carbon dioxide was also lower than during CPAP (P < 0.001), and this effect was sustained beyond 3 weeks after the cessation of MPA (P < 0.001). However, the apnea-hypopnea index of CPAP increased and sleep deteriorated similarly on MPA and placebo after withdrawal of CPAP therapy. In postmenopausal women with SDB, MPA induces a long-lasting stimulatory effect on breathing without improving sleep quality or the apnea-hypopnea index.

English

Introduction: There is a need to more clearly understand the characteristics of breathing patterns in children with cleft palate in the first year of life, as there is little data available to guide current practice. Pierre Robin patients are known to have a higher incidence, however we hypothesised sleep breathing disturbance is not confined to

Symptoms of Sleep Disordered Breathing in Children with Craniofacial Malformations

The purpose of this study was to investigate the frequency of sleep disordered breathing (SDB) symptoms in a clinical sample of children with congenital craniofacial malformations (CFM) followed at a tertiary medical center and non-selected for sleep problems. Cross-sectional study of 575 children aged 2-18 years followed at the Craniofacial Anomalies Program between March 2007 and May 2011. The Sleep-Related Breathing Disturbance scale of the Pediatric Sleep Questionnaire was used to screen for SDB, snoring, and sleepiness. A cutoff value ≥ 0.33 of the total answered questions identified children with positive screening for SDB symptoms. Overall, 25% of children screened positive for SDB, 28% for snoring, and 20% for sleepiness. In children with non-syndromic CFM, those with Robin sequence had the highest frequency of SDB, snoring, and sleepiness (43%, 44%, and 38%, respectively). In children with syndromic CFM, velocardiofacial/ DiGeorge syndrome had the highest frequency of SDB and sleepiness (48% and 43%, respectively). Children with Treacher Collins had the highest frequency of snoring (83%). The presence of cleft palate was not associated with an increased frequency of SDB symptoms. Nevertheless, children with syndromic CFM, compared to those with non-syndromic CFM, had a higher SDB score (0.27 ± 0.21 vs.0.21 ± 0.19, p = 0.003) and were more likely to have sleepiness (26% vs. 18%, p = 0.05). Congenital craniofacial malformations in children are associated with high risk for SDB symptoms. Our findings should encourage a high index of suspicion for SDB in children with CFM, with a low threshold for further testing and close follow-up. Moraleda-Cibrián M; Edwards SP; Kasten SJ; Berger M; Buchman SR; O'Brien LM. Symptoms of sleep disordered breathing in children with craniofacial malformations.

Postoperative Changes in Sleep-disordered Breathing and Sleep Architecture in Patients with Obstructive Sleep Apnea

Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA. After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture. Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] >5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P < 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P < 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery. Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.

Adaptive Servoventilation in Central Sleep Apnea

Adaptive servoventilation (ASV) represents the most recent advancement in the treatment of Cheyne-Stokes respiration and other forms of central sleep apnea. ASV interferes with the pathophysiologic changes of hyperventilatory breathing disturbances, and has been proved to most efficiently treat central breathing disturbances in comparison with other positive airway pressure (PAP) options, oxygen, or drugs. However, ASV algorithms need to be refined to sufficiently address nonresponders. Because of its efficacy, ASV can be recommended for the treatment of most central breathing disturbances, especially hyperventilatory disorders, if a first trial of continuous PAP has failed.

The free radical scavenger Trolox dampens neuronal hyperexcitability, reinstates synaptic plasticity, and improves hypoxia tolerance in a mouse model of Rett syndrome

Rett syndrome (RS) causes severe cognitive impairment, loss of speech, epilepsy, and breathing disturbances with intermittent hypoxia. Also mitochondria are affected; a subunit of respiratory complex III is dysregulated, the inner mitochondrial membrane is leaking protons, and brain ATP levels seem reduced. Our recent assessment of mitochondrial function in MeCP2 (methyl-CpG-binding protein 2)-deficient mouse (Mecp2-/y) hippocampus confirmed early metabolic alterations, an increased oxidative burden, and a more vulnerable cellular redox balance. As these changes may contribute to the manifestation of symptoms and disease progression, we now evaluated whether free radical scavengers are capable of improving neuronal and mitochondrial function in RS. Acute hippocampal slices of adult mice were incubated with the vitamin E derivative Trolox for 3–5 h. In Mecp2-/y slices this treatment dampened neuronal hyperexcitability, improved synaptic short-term plasticity, and fully restored synaptic long-term potentiation (LTP). Furthermore, Trolox specifically attenuated the increased hypoxia susceptibility of Mecp2-/y slices. Also, the anticonvulsive effects of Trolox were assessed, but the severity of 4-aminopyridine provoked seizure-like discharges was not significantly affected. Adverse side effects of Trolox on mitochondria can be excluded, but clear indications for an improvement of mitochondrial function were not found. Since several ion-channels and neurotransmitter receptors are redox modulated, the mitochondrial alterations and the associated oxidative burden may contribute to the neuronal dysfunction in RS. We confirmed in Mecp2-/y hippocampus that Trolox dampens neuronal hyperexcitability, reinstates synaptic plasticity, and improves the hypoxia tolerance. Therefore, radical scavengers are promising compounds for the treatment of neuronal dysfunction in RS and deserve further detailed evaluation.

Parallel Development of Choroid Plexus Degeneration and Meningeal Inflammation in Subarachnoid Hemorrhage – Experimental Study

The choroid plexuses (CPs) are brain structures located in the brain ventricles, involved in the production and reabsorption of cerebrospinal fluid (CSF) components, cerebral immune surveillance, and various endocrine-enzymatic activities and acts as aCSF-blood barrier. This study investigated to determine if there is alink between ischemic CP injury and meningo-cerebral inflammation processes. This study was conducted on 18 rabbits. Four rabbits were used as the baseline group to examine the normal structures. Fourteen of the rabbits were used as the study group by injecting 1.00cc of homologous blood into their cisterna magna. The animals were followed by daily monitoring for ten days and then slaughtered. Apoptotic degeneration of the CP cells was determined and statistical analyses were carried out using normal and apoptotic CP cell numbers. Data analyses were comprised of Mann-Whitney Utests. Differences were considered to be significant if p<0.005. Five animals belonging to the study group died between the 5th and 8th days. Unconsciousness, neck stiffness, convulsion, fever, apnea, cardiac arrhythmia, and breathing disturbances were observed in all of the animals who subsequently died. Intraventricular blood leakage was detected in all the dead and three surviving animals. Choroidal artery spasm, choroidal ependymal cell injury, choroidal cell apoptosis, pia-arachnoid thickening, meningocortical adhesions and blood cell density in the subarachnoid spaces were more severe in the more CP degenerated animals than those of the others. There were significant differences between the apoptotic CP cell density and blood cell density in the subarachnoid spaces (p<0.005). Subarachnoid hemorrhage (SAH) extending to brain ventricles causes ischemic degeneration of the CP by way of triggered choroidal artery vasospasm. It should be emphasized that the prevention of CP function may be an important part of the protection of the brain in SAH.

The link between rhinitis and rapid-eye-movement sleep breathing disturbances in children with obstructive sleep apnea.

Rhinitis and obstructive sleep apnea (OSA) often coexist during childhood. To delineate this clinical association, we examined OSA severity and polysomnogram (PSG) features in children with rhinitis and OSA. Given that rapid-eye-movement (REM) sleep is characterized by nasal congestion, we hypothesized that children with rhinitis have more REM-related breathing abnormalities. We conducted a retrospective cross-sectional analysis of 145 children with PSG-diagnosed OSA. Outcomes included PSG parameters and obstructive apnea-hypopnea index (OAHI) during REM and non-REM. Linear multivariable models examined the joint effect of rhinitis and OSA parameters with control for potential confounders. Rhinitis was present in 43% of children with OSA (n = 63) but overall OAHI severity was unaffected by the presence of rhinitis. In contrast, OAHI during REM sleep in children with moderate-severe OSA was significantly increased in subjects with rhinitis and OSA (44.1/hr; SE = 6.4) compared with those with OSA alone (28.2/hr; SE = 3.8). Rhinitis is highly prevalent in children with OSA. Although OSA is not more severe in children with rhinitis, they do have a distinct OSA phenotype characterized by more REM-related OSA. Further research is needed to delineate the link between REM-sleep and the physiology of the nose during health and disease.

Envelope Analysis of the Airflow Signal To Improve Polysomnographic Assessment of Sleep Disordered Breathing

Given the detailed respiratory waveform signal provided by the nasal cannula in polysomnographic (PSG) studies, to quantify sleep breathing disturbances by extracting a continuous variable based on the coefficient of variation of the envelope of that signal. Application of an algorithm for envelope analysis to standard nasal cannula signal from actual polysomnographic studies. PSG recordings from a sleep disorders center were analyzed by an algorithm developed on the Igor scientific data analysis software. Recordings representative of different degrees of sleep disordered breathing (SDB) severity or illustrative of the covariation between breathing and particularly relevant factors and variables. The method calculated the coefficient of variation of the envelope for each 30-second epoch. The normalized version of that coefficient was defined as the respiratory disturbance variable (RDV). The method outcome was the all-night set of RDV values represented as a time series. RDV quantitatively reflected departure from normal sinusoidal breathing at each epoch, providing an intensity scale for disordered breathing. RDV dynamics configured itself in recognizable patterns for the airflow limitation (e.g., in UARS) and the apnea/hypopnea regimes. RDV reliably highlighted clinically meaningful associations with staging, body position, oximetry, or CPAP titration. Respiratory disturbance variable can assess sleep breathing disturbances as a gradual phenomenon while providing a comprehensible and detailed representation of its dynamics. It may thus improve clinical diagnosis and provide a revealing descriptive tool for mechanistic sleep disordered breathing modeling. Respiratory disturbance variable may contribute to attaining simplified screening methodologies, novel diagnostic criteria, and insightful research tools.

Velopharyngeal Anatomy in Patients With Obstructive Sleep Apnea Versus Normal Subjects

Obesity can cause disturbed breathing and is one of the most significant risk factors for obstructive sleep apnea (OSA). However, the anatomic basis of OSA and, specifically, the anatomic mechanisms leading from obesity to OSA are still unclear. We examined the anatomic features of the velopharynx in patients with OSA versus those without in correlation with the body mass index (BMI), age, history of snoring, and OSA severity and re-evaluated the contribution of adding a frontal view to the cephalometric analysis of patients with OSA. Lateral and frontal cephalometric measurements were taken to assess the velopharyngeal anatomic features of 306 men with various degrees of OSA and 64 men without OSA and without a history of snoring. The demographic, polysomnographic, and cephalometric features were compared. The patients with OSA had an increased pharyngeal length, thicker velum, a thicker posterior pharyngeal wall, a reduced pharyngeal width, and a consequent narrowing of the pharyngeal lumen. As the BMI increased, the OSA severity increased. Also, in parallel, the velum and posterior pharyngeal wall thickness increased and the pharyngeal width decreased. Three types of velopharyngeal narrowing, with an increased occurrence in severe degrees of OSA, were identified: bottle shape, hourglass shape, and tube shape. These aerodynamically unfavorable changes might cause increased upper airway resistance, explaining the development of both OSA and hypoventilation syndrome in obese patients. Velopharyngeal thickening and lumen narrowing were shown to be features of obese men with OSA. However, these features developed only above a threshold BMI value. The combination of frontal and lateral cephalometry is important for comprehensive evaluation of patients with OSA.

Can snoring be a cause of aggressive behaviour in children?

Snoring, as a first symptom of impaired breathing during sleep, seems to be an important risk factor for behavioural disturbances in children. The study was conducted to find out how sleep disordered breathing (SDB) in a population of first graders in one province of Poland influences their behaviour. A population single-stage cross-sectional study using a parent-reported questionnaire was applied. 1480 first graders were involved. We collected data about snoring, age, weight, height and parent-reported problems with child behaviour. The data were analysed in terms of BMI, breathing disturbances and aggressive behaviour. We’ve got completed 1107 (74.8%) of 1480 sent questionnaires. 560 girls and 547 boys were recruited. The mean age of the children was 7.31. There were 64.7% children considered non-snorers, and 35.3% snorers. 7.5% were considered habitual snorers. We also divided children into two subgroups: normal-weight and overweight. There was a linear association of aggressive behaviour with the increasing severity of snoring on a 5-point scale with highly significant differences ( p < 0.00001). In both the overweight and normal-weight subgroups, snorers showed statistically more aggressive behaviour ( p < 0,0019; p < 0,0098) than non-snorers. Snoring can drive to aggressive behaviour in population of first graders. The severity of breathing disturbances during sleep is associated with increasing aggressive behavioural problems, both in the subgroups of normal weight and overweight children. The Authors thank Wielka Orkiestra Swiatecznej Pomocy Foundation (The Great Orchestra of Christmas Charity) which supported the study.

Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630-2,590 m)?

Newcomers at high altitude (> 3,000 m) experience periodic breathing, sleep disturbances, and impaired cognitive performance. Whether similar adverse effects occur at lower elevations is uncertain, although numerous lowlanders travel to moderate altitude for professional or recreational activities. We evaluated the hypothesis that nocturnal breathing, sleep, and cognitive performance of lowlanders are impaired at moderate altitude. Randomized crossover trial. University hospital at 490 m, Swiss mountain villages at 1,630 m and 2,590 m. Fifty-one healthy men, median (quartiles) age 24 y (20-28 y), living below 800 m. Studies at Zurich (490 m) and during 4 consecutive days at 1,630 m and 2,590 m, respectively, 2 days each. The order of altitude exposure was randomized. Polysomnography, psychomotor vigilance tests (PVT), the number back test, several other tests of cognitive performance, and questionnaires were evaluated. The median (quartiles) apnea-hypopnea index at 490 m was 4.6/h (2.3; 7.9), values at 1,630 and 2,590 m, day 1 and 2, respectively, were 7.0/h (4.1; 12.6), 5.4/h (3.5; 10.5), 13.1/h (6.7; 32.1), and 8.0/h (4.4; 23.1); corresponding values of mean nocturnal oxygen saturation were 96% (95; 96), 94% (93; 95), 94% (93; 95), 90% (89; 91), 91% (90; 92), P < 0.05 versus 490 m, all instances. Slow wave sleep on the first night at 2,590 m was 21% (18; 25) versus 24% (20; 27) at 490 m (P < 0.05). Psychomotor vigilance and various other measures of cognitive performance did not change significantly. Healthy men acutely exposed during 4 days to hypoxemia at 1,630 m and 2,590 m reveal a considerable amount of periodic breathing and sleep disturbances. However, no significant effects on psychomotor reaction speed or cognitive performance were observed. Clinicaltrials.gov: NCT01130948.

Sleep, symptom-ratings and serum ferritin levels in children with ADHD

The present study was conducted to describe sleep problems in a sample of Egyptian children with ADHD and to examine the effect of low serum ferritin levels on their sleep and symptom-ratings. The parents of 41 ADHD children, aged 6–12 years, filled out the Children’s Sleep Habits Questionnaire (CSHQ) and Conners’ Parent Rating Scale-Revised: long version (CPRS-R:L) in Arabic. Serum ferritin levels of the children were determined with the enzyme-linked immunosorbent assay method. The parents of 62 normal control children filled out the CSHQ. The ADHD group had significantly higher scores on bedtime resistance, sleep anxiety, parasomnias, sleep-disordered breathing, daytime sleepiness and global sleep disturbance (CSHQ total score) than in the control group. Children with serum ferritin levels <30 ng/mL had more disturbed sleep than children with serum ferritin levels ⩾30 ng/mL. There were significant negative correlations between sleep duration subscale, total score of CSHQ, and serum ferritin levels (p<0.05). There were no significant differences in ADHD symptoms in regard to ferritin levels (p > 0.05). Sleep problems are common among this sample of children with ADHD. This study suggests an association between low serum ferritin levels and sleep disturbances among Egyptian children with ADHD. We would like to thank the parents and the children for participation in this study. Also, we would like to thank Janssen-Cilag pharmaceutical company that paid the cost of the CPRS-R:L questionnaire.

Excessive daytime sleepiness and the risk for obstructive sleep apnea in Georgian population

Excessive daytime sleepiness (EDS) is a common complaint in obstructive sleep apnea (OSA) patients. OSA, the most prevalent sleep breathing disturbance, is a risk-factor for various adverse health conditions. Epidemiological data on this subject in the Georgian population are scarce. The present study is aimed at investigating self-reported daytime sleepiness and the severity of sleep apnea risk in the population of the two largest cities of Georgia – Tbilisi and Kutaisi. 304 subjects from Tbilisi (mean age 37.07 + 10.73, 67.4% female) and 91 subjects from Kutaisi (39.4 + 10.8, 67.1% female) were surveyed. Participants completed Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Beck depression inventory, short form (BDI SF). The risk of sleep apnea was screened using STOP BANG questionnaire (low risk – 0–2 positive answers; intermediate risk – 3–4 positive answers; high risk – 5 or more positive answers). Socio-demographic data and self evaluation of the overall health status were also obtained. EDS was defined as an ESS score ⩾11. Pearson chi-square tests were used to examine associations between OSA risk and sleep, health and socio-demographic variables. Group comparisons were conducted with unpaired t-test. Mean ESS score in the Tbilisi sample was 6.9 ± 3.8, and 19.7% had an EDS. These parameters were lower in the Kutaisi sample – 5.64 ± 3.54, and 7.7%. The between group differences in ESS score was statistically significant (t393 = 2.8, p = 0.005). Poor sleep quality was observed in 46.1% of Tbilisi sample (mean score 5.56 ± 3.13), and 33% of Kutaisi sample (4.52 ± 2.7). The significant correlation between sleep quality and BDI score was found in both groups. 7.9% of the Tbilisi and 4.4% of the Kutaisi sample had a high risk for OSA. 26% of the Tbilisi and 25.3% of the Kutaisi sample had an intermediate risk for OSA. In the Tbilisi population EDS and OSA severity were significantly associated with health status, sleep quality, BMI, age, gender and with EDS for OSA. In the Kutaisi sample, EDS was associated with health status, sleep quality and gender, and OSA severity was associated with EDS, age and gender. However, when the number of positive answers were checked the significant association was detected also with BMI ( p = 0.14). The findings point to poor sleep quality and a high prevalence of OSA risk in the Georgian population. Further studies are needed to determine the target subpopulation for OSA treatment. Study supported by Swiss National Science Foundation, SCOPES, grant IZ74Z0_137415