Epworth Sleepiness Scale Questionnaire Research Articles

Application of screening test for obstructive sleep apnoea detection in systemic hypertensive patients

Obstructive sleep apnoea (OSA) is prevalent in patients with hypertension (HTN). There is a lack of OSA screening in patients with HTN. Diagnosis and treatment of OSA in patients with HTN may improve blood pressure control and avoid complications of undiagnosed and untreated OSA. Hence, this study was conducted with the aim to screen OSA suspects in high risk groups of patients with hypertension using Stop Bang Questionnaire and Epworth sleepiness Scale (ESS). This was a cross sectional study carried out in OPD and IPD in Department of Respiratory Medicine, Lata Mangeshkar hospital, Hingna after obtaining approval from institutional ethics committee. Total 100 patients fulfilling the inclusion criteria were included after taking informed consent. The patients were screened according to ESS and Stop Bang Questionnaire. Out of 100, 53% of hypertensive patients were overweight / obese with mean BMI of 25.49 ± 5.43 kg/m2. According to Stop bang questionnaire, 56% and 34% of patients had high risk and intermediate risk of OSA respectively with mean score of 4.69 ± 1.68. According to ESS, 61% patients had low probability of OSA, 15% patient on borderline and 24% abnormal patients with mean score of 8.38 ± 4.688. BMI along with stop bang score showed high probability of OSA which was statistically significant. Screening with Stop bang questionnaire and ESS is helpful for diagnosing OSA in case of strong clinical suspicion with high BMI. This will avoid complications of undiagnosed OSA in patients with hypertension. Keywords: Obstructive sleep apnoea, Stop Bang Questionnaire, Systemic hypertension.

The Influence of Functional Endoscopic Sinus Surgery on Sleep Related Outcomes in Patients with Chronic Rhinosinusitis.

Purpose Chronic rhinosinusitis (CRS) patients often complain of nasal obstruction, which may cause sleep impairment for them. The goal of this study was to investigate the influence of functional endoscopic sinus surgery (FESS) on sleep related outcomes in CRS patients. Materials and Methods CRS patients who received FESS were included in this study. Prior to FESS and 3 months after surgery the patients were asked about the severity of nasal obstruction and completed the 20-item Sinonasal Outcome Test (SNOT-20), along with the Epworth Sleepiness Scale (ESS) questionnaire. Endoscopic examination, acoustic rhinometry, and polysomnography were performed in all patients. They were divided into four groups according to their preoperative apnea hypopnea index (AHI) scores: nonobstructive sleep apnea syndrome (non-OSAS), mild OSAS, moderate OSAS, and severe OSAS. Results A total of 96 subjects completed the study. The scores of the sleep domain of the SNOT-20 and ESS decreased in all of the AHI groups, with the exception of the severe OSAS group, after FESS. A reduction in the AHI of less than 5 was achieved in 9 patients (13.2%) after FESS. Conclusions Our results showed that FESS improved sleep quality in CRS patients, except those with severe OSAS, and a preoperative lower AHI was the only significant predictor of post-FESS OSAS outcome.

Scoring of Hypersomnolence and Fatigue in Patients With Obstructive Sleep Apnea Treated With a Titratable Custom-Made Mandibular Advancement Device.

The objective of this study was to measure fatigue and hypersomnolence in patients with obstructive sleep apnea (OSA) treated with a mandibular advancement device (MAD), using Epworth Sleepiness Scale (ESS) for hypersomnolence and Checklist Individual Strength questionnaire (CIS20R) for fatigue. This was a single-center, prospective cohort study. A total of 58 patients with OSA filled out ESS and CIS20R questionnaires at baseline and after 3 months of MAD treatment. A total of 39 full datasets were collected. Statistical analysis for reliability of the questionnaires, comparison between baseline and 3-month follow-up, correlation between the changes in the values of the two questionnaires, and changes in apnea-hypopnea index (AHI) were performed. CIS20R showed excellent reliability in this patient group at baseline and 3-month follow-up (Cronbach α = .97), ESS showed a marginally good reliability (Cronbach α = .82). The CIS20R (82/140) expressed high levels of fatigue at baseline, and ESS showed a normal level of daytime sleepiness. AHI, ESS, and CIS20R were significantly reduced under MAD treatment. A significant correlation between ESS and CIS20R was observed. No significant correlation between any of the questionnaires and the change in AHI was found. The CIS20R questionnaire results showed a high level of fatigue in the patients with OSA, and the questionnaire can be used to evaluate changes in fatigue due to MAD treatment after 3 months. The ESS failed to show similar characteristics. Therefore, a combination of ESS for hypersomnolence with CIS20R for fatigue is proposed for the follow-up of patients with OSA treated with MAD.

Altered irisin/BDNF axis parallels excessive daytime sleepiness in obstructive sleep apnea patients

Study objectivesObstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep-related breathing disorder, characterized by excessive daytime sleepiness (EDS), paralleled by intermittent collapse of the upper airway. EDS may be the symptom of OSAHS per se but may also be due to the alteration of central circadian regulation. Irisin is a putative myokine and has been shown to induce BDNF expression in several sites of the brain. BDNF is a key factor regulating photic entrainment and consequent circadian alignment and adaptation to the environment. Therefore, we hypothesized that EDS accompanying OSAHS is reflected by alteration of irisin/BDNF axis.MethodsCase history, routine laboratory parameters, serum irisin and BDNF levels, polysomnographic measures and Epworth Sleepiness Scale questionnaire (ESS) were performed in a cohort of OSAHS patients (n = 69). Simple and then multiple linear regression was used to evaluate data.ResultsWe found that EDS reflected by the ESS is associated with higher serum irisin and BDNF levels; β: 1.53; CI: 0.35, 6.15; p = 0.012 and β: 0.014; CI: 0.0.005, 0.023; p = 0.02, respectively. Furthermore, influence of irisin and BDNF was significant even if the model accounted for their interaction (p = 0.006 for the terms serum irisin, serum BDNF and their interaction). Furthermore, a concentration-dependent effect of both serum irisin and BDNF was evidenced with respect to their influence on the ESS.ConclusionsThese results suggest that the irisin-BDNF axis influences subjective daytime sleepiness in OSAS patients reflected by the ESS. These results further imply the possible disruption of the circadian regulation in OSAHS. Future interventional studies are needed to confirm this observation.

The relationship between anxiety, depression, daytime sleepiness in the REM-related mild OSAS and the NREM-related mild OSAS.

Obstructive sleep apnea syndrome (OSAS) is a common form of sleep-related respiratory disease characterized by recurrent blockages in the upper airway. Rapid eye movement (REM)-related OSAS is a condition in which apneas and hypopneas are more common during REM sleep. We investigated whether there was any difference between REM-related mild OSAS group and NREM-related mild OSAS group in terms of anxiety, depression, and daytime sleepiness. A total of 166 patients with mild OSAS (72 patients with REM-related and 94 NREM-related OSAS) participated in the study. Hospital Anxiety-Depression Scale (HADS) and Epworth Sleepiness Scale (ESS) questionnaires were completed by both groups. Anxiety and depression scores were significantly higher in patients with REM-related OSAS in comparison to the NREM-related OSAS group (p = 0.01, p = 0.02 respectively). There was no statistically significant difference between the two groups in terms of ESS scores (p = 0.60). The results of our study suggest that patients with REM-related OSAS have higher rates of depression and anxiety compared to non-REM-related OSAS patients and this may adversely affect quality of life. It may be possible to prevent psychiatric complications, such as depression and anxiety, by administering treatments that reduce REM sleep duration and intensity in patients with REM-related OSAS.

Construct Validation and Reliability Assessment of Tamil Version of Epworth Sleepiness Scale to Evaluate Daytime Sleepiness among Adolescents in Rural Puducherry, South India.

Background:Epworth sleepiness scale (ESS) has been used widely in the assessment of daytime sleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India.Materials and Methods:Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil-speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient.Results:Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two-factor model assessed by confirmatory factor method found Chi-square value of 215.57 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach's alpha) for complete ESS was 0.81. Factor-based analysis showed that the Cronbach's reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively.Conclusion:Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil-speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool.

M32 - PER3 POLYMORPHISMS, MORNINGNESS-EVENINGNESS AND DEPRESSION: PRELIMINARY EVIDENCE IN A BRAZILIAN FAMILY-BASED COHORT, THE BAEPENDI HEART STUDY

Background There is a significant interest in the contribution of the circadian timing system to individual differences in a wider range of behaviour. This is in part because sleep complaints and disturbances of the circadian timing system are common in psychiatric disorders. Based on diurnal preference, people can be divided into chronotypes with demonstrated differences in sleep-wake patterns and a variety of circadian rhythms, behavioral rhythms, and diurnal variation in mood. Specifically, greater eveningness has been related to greater depression. The human PER3 gene contains a variable number tandem repeat (VNTR) which is associated with diurnal preference: the longer allele (five tandem repeats) has been reported to associate with greater morningness, and the shorter allele (four tandem repeats) with greater eveningness. We have investigated the PER3 polymorphism and its relationship to sleep, circadian and depression characteristics in a Brazilian family-based cohort. Methods Baependi is a small rural town in Brazil that provides a window of opportunity to study the influence of sleep circadian patterns in a highly admixed rural population with a conservative lifestyle. Here, we studied 786 subjects (mean age±SD 46.5±16.2, 42% female). Blood samples were collected from all participants. The Per3 length polymorphism was genotyped using PCR followed by gel electrophoresis. We tested for associations between the PER3 polymorphism and sleep characteristics, daytime sleepiness, and chronotype using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire, respectively. Depressive symptoms were assessed using the Beck Depression Inventory [BDI-II]). Results Our genotyping data showed that 36% of the subjects were homozygous for the shorter allele (4/4), 51% of the participants were heterozygous (4/5) and 12% of the subjects were homozygous for the longer allele (5/5). Allele frequency was 0.62 for the 4-repeat and a 0.38 for the 5-repeat. The percentages of the chronotypes Morning type (M-type), Neither type (N-type) and Evening type (E-type) were 5%, 46% and 7%, respectively. We observed an increase of the depression symptoms in evening types [F(2, 1014)=4.8, p=0.007]. On the other hand, no such associations were observed the PER3 genotype. There were no significant differences in the MEQ score [F(2, 317)=0.46, p=0.63], daytime sleepiness [(F(2, 317)=0.23, p=0.79)], sleep efficiency [(F(2, 317)=2.59, p=0.07)] and sleep characteristics [(F(2, 317)=1.92, p=0.14)] between the PER3 genotypes. Discussion We observed an association between eveningness and depression. Identifying factors contributing to individual differences in sleep and to describe how these factors are associated with physiological and psychological profiles may aid our understanding of the role of sleep and the circadian system in mental health. On the other hand, we were not able to replicate the association between the PER3 VNTR polymorphism and chronotype, which has been confirmed independently in multiple populations worldwide (including in Brazil). Neither did we observe any association with depression. CNPq – PVE 400791/2014-5.

Use of positional therapy when incorporated into a diagnosis-treatment algorithm for obstructive sleep apnea.

Purpose Positional obstructive sleep apnea (OSA) is prevalent. We hypothesized that by incorporating positional therapy into a diagnosis-treatment algorithm for OSA it would frequently be prescribed as an appropriate first-line therapy.Methods Fifty-nine members (45 males, 49±9 yrs, BMI 35.2±5.6 kg/m2) of the Law Enforcement Health Benefits (LEHB), Inc. of Philadelphia with clinically suspected OSA were evaluated. Patients completed an Epworth Sleepiness Scale (ESS) questionnaire and a home sleep test (HST). Patients diagnosed with positional OSA (non-supine apnea-hypopnea index [AHI] < 5 events/hr) were offered positional therapy. A cost comparison to continuous positive airway pressure (CPAP) therapy was performed.Results Fifty-four (92%) of the patients (43 males, 49±9 yrs, BMI 35.2±5.3 kg/m2) had OSA on their HST (AHI 24.2±20.1 events/hr). Sixteen (30%) patients had positional OSA. Compared to non-positional patients, patients with positional OSA were less heavy (32.4±5.1 vs. 36.4±5.1 kg/m2, respectively [p=0.009]), less sleepy (ESS 8±5 vs. 12±5, respectively [p=0.009]), and had less severe OSA (AHI 10.4±4.3 vs. 30.0±21.3 events/hr, respectively [p<0.001]). Thirteen of the 16 patients with positional OSA agreed to positional therapy and 31 non-positional OSA patients agreed to CPAP therapy. Based on initial costs, incorporating positional therapy ($189.95/device compared to CPAP therapy at $962.49/device) into the treatment algorithm resulted in a 24% cost savings compared to if all the patients were initiated on CPAP therapy.Conclusion With the high prevalence of positional OSA, using a diagnosis-treatment algorithm that incorporates positional therapy allows it to be more frequently considered as a cost effective first-line therapy for OSA.

The relationship between obstructive sleep apnoea and quality of life in women with polycystic ovary syndrome: a cross-sectional study

Background: Obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS) are associated with significant comorbidities and commonly coexist. The primary aim of this study was to examine the relationship between OSA and quality of life (QoL) in women with PCOS. Methods: We conducted an observational cross-sectional study. PCOS was diagnosed according to the Rotterdam criteria. Women with increased risk of OSA, based on the Berlin questionnaire or the Epworth Sleepiness Scale (ESS), had home-based polysomnography performed (ALICE PDx). Participants were divided into two groups: (a) PCOS only: women with normal ESS and low-risk Berlin questionnaire (no sleep studies performed), or women with normal sleep studies [oxygen desaturation index (ODI) < 5 events/hour]; and (b) PCOS+OSA: women with PCOS and OSA ODI ⩾ 5. QoL was assessed using the World Health Organization QoL questionnaire (WHOQOL-BREF) and the PCOS health-related quality of life questionnaire (PCOSQ). Results: A total of 39 women were included; age (mean ± SD) was 32.2 ± 8.9 years, weight 92.5 ± 23.7 kg and body mass index (BMI) 34.1 ± 7.9 kg/m2; 38.5% (n = 15) had OSA. Compared with women with PCOS only, women with PCOS+OSA had higher BMI, HbA1c, C-reactive protein and low-density lipoprotein. ODI was independently associated with impaired QoL. Excessive daytime sleepiness (EDS) was independently associated with anxiety, depression and impaired QoL. Conclusions: OSA is highly prevalent and is associated with impaired QoL and worse metabolic profile in women with PCOS. Interventional studies are needed to examine the impact of OSA in women with PCOS.

Assessment of diurnal melatonin, cortisol, activity, and sleep−wake cycle in patients with and without diabetic retinopathy

ObjectiveTo assess the diurnal melatonin, cortisol, and activity/rest levels, as well as sleep quality, in patients with and without nonproliferative diabetic retinopathy (DR). MethodsWe included 25 diabetic patients with DR and 29 without DR. A total of 21 healthy subjects constituted the control group. We assessed the circadian rhythm by actigraphy and diurnal salivary melatonin and cortisol measurements. Sleep quality was evaluated by actigraphy and the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. Light exposure was quantified by actigraphy. The primary outcome was peak salivary melatonin level. Secondary outcomes were mean melatonin and cortisol levels during dark hours, activity−rest rhythm, sleep quality, as well as level of white, red, green, and blue light exposure. ResultsPeak melatonin concentration at 04:00 and mean nocturnal melatonin level were significantly reduced in all diabetic patients, regardless of retinopathy stage (p < 0.001). Levels of light exposures during dark hours were not significantly different in patients with and without DR and healthy controls. Only patients with DR showed increased intradaily variability in their activity−rest interval, indicating circadian misalignment (p = 0.04). Neither the objective actigraphic sleep quality parameters nor the subjective PSQI or ESS scores were significantly different between healthy controls and diabetic patients. ConclusionsReduced nocturnal melatonin concentration and increased fragmentation of activity−rest intervals revealed circadian rhythm disturbance in diabetic patients with DR.

Medical and Law Graduates and their sleep disorders: Daytime oversleep and Risk Factors

Backgroud: The exogenous factors such as family dynamics, psychosocial stress, academic hours and lifestyle can alter the quality of sleep and affect the people’s physical, occupational, cognitive and social functioning. Objectives: evaluate the epidemiological profile, excessive daytime sleepiness, risk factors and the quality of sleep among university students. Method: Cross-sectional study with 701 Medical and Law students from a private Brazilian Northeastern College. The Sociodemographic profile, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires have been applied. The data were submitted to simple and percentage frequency as well as bivariate and multivariate analysis. Significance level: 5%. Results: The sample was with 659 students, 243(37%) of Medicine and 416(63%) of Law. Age group 18-24 years, predominance of females, age group 18-24 years, female 393 (60%); they self-declared being white 282 (42.7%) and brown 303 (45.9%), said they were single 604(92%) and alcohol consumers more than 60%. Poor sleep quality and sleep disturbance were found in 169(70%) medical students and 221(54%) in law ones, being statistically significant (p &lt;0.001) for the medical students. In this comparison, The Law students presented a higher risk (RR 1.34 (1.15-1.56), p &lt;0.001) for disturbance and poor sleep quality. The risk of excessive daytime sleepiness versus drug use represented 71% (RR 1.71, 95% CI 1.18-2.49) for law students. General concerns, studies, anxiety and insomnia were the most frequent risk factors. Conclusion: Risk factors which are part of Medical and Law students’ daily routine affect their sleep quality and increase the risks of excessive daytime sleepiness.

The Predictors of Obstructive Sleep Apnea at A High Altitude: Results of a Population-based Study in the Western region of Saudi Arabia

Background: The sleep disturbances are common at high altitudes. This study aimed to determine the prevalence and predictors of obstructive sleep apnea at high altitudes. Methods: This cross-sectional observational study was conducted from March 2018 to June 2018 to assess the predictors of obstructive sleep apnea based on Berlin, Stop-Bang and Epworth sleepiness scale questionnaire from adult population of Taif City at an altitude of 1879 m from sea level in Saudi Arabia. Results: Of 1002 participants, the majority (614 participants, 61.3%) was males and the mean± SD age of participants was 30.6± 10.3 years (Range 11 - 67 years). In this study 24.9% participants were found to be at a high risk of having sleep apnea. Male gender, older age and smoking were found to be significantly associated with higher risk of sleep apnea according to Berlin, Stop-Bang and Epworth sleepiness scale questionnaire. Diseases found to be associated with a high risk of developing sleep apnea included hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes (p<0.001), psychological disorders (p<0.001) and asthma (p<0.001) .On the other hand, cardiac disorders were found to have an insignificant effect on sleep apnea (p=0.076) in this study. Almost one-third of the participants (34.9%; 95% CI= 32.0% to 37.9%) were found to have an abnormal level of daytime sleepiness according to Epworth Sleepiness Scale (ESS). These results were comparable to the previous studies at low altitude. Conclusions: Our study demonstrated that the predictors of OSA at high altitudes are comparable to those at low altitudes.

The Predictors of Obstructive Sleep Apnea at A High Altitude: Results of a Population-based Study in the Western region of Saudi Arabia

Background: The sleep disturbances are common at high altitudes. This study aimed to determine the prevalence and predictors of obstructive sleep apnea at high altitudes. Methods: This cross-sectional observational study was conducted from March 2018 to June 2018 to assess the predictors of obstructive sleep apnea based on Berlin, Stop-Bang and Epworth sleepiness scale questionnaire from adult population of Taif City at an altitude of 1879 m from sea level in Saudi Arabia. Results: Of 1002 participants, the majority (614 participants, 61.3%) was males and the mean± SD age of participants was 30.6± 10.3 years (Range 11 - 67 years). In this study 24.9% participants were found to be at a high risk of having sleep apnea. Male gender, older age and smoking were found to be significantly associated with higher risk of sleep apnea according to Berlin, Stop-Bang and Epworth sleepiness scale questionnaire. Diseases found to be associated with a high risk of developing sleep apnea included hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes (p<0.001), psychological disorders (p<0.001) and asthma (p<0.001) .On the other hand, cardiac disorders were found to have an insignificant effect on sleep apnea (p=0.076) in this study. Almost one-third of the participants (34.9%; 95% CI= 32.0% to 37.9%) were found to have an abnormal level of daytime sleepiness according to Epworth Sleepiness Scale (ESS). These results were comparable to the previous studies at low altitude. Conclusions: Our study demonstrated that the predictors of OSA at high altitudes are comparable to those at low altitudes.

SHORT-TERM IMPACT OF AN INTEGRATED MULTIDISCIPLINARY PATIENT-CENTERED COORDINATED CARE TREATMENT IN OSA

SESSION TITLE: Sleep Disorders SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Obstructive sleep apnea (OSA) is a common chronic condition with public health consequences which is characterized by breathing cessation and impaired oxygenation during sleep resulting in sleep fragmentation and impaired daytime activities; and is associated with cardio-metabolic diseases and mortality. Its treatment is multi-disciplinary. However, its current mode of care delivery is often fragmented with various disciplines operating in isolation. We aim to determine the impact of a novel integrated outpatient OSA care model using a care pathway which incorporates evidence-based management guidelines involving a multi-disciplinary team of healthcare professionals. We hypothesize that the integrated care model will be associated with improved outcomes as compared to current routine care. METHODS: This is a prospective randomized controlled trial comparing a new integrated model of care for OSA with routine practice in patient-reported outcomes, CPAP adherence and waiting time to receiving definitive OSA treatment. In the integrated care model, providers from various key disciplines (sleep medicine, otolaryngology and dentistry) convene to assess the patient and develop the best preferred treatment plan based on shared decision making with the patient using a common care pathway in a multidisciplinary clinic; compared to the conventional model where patients are cross-referred and seen by each discipline in isolation. RESULTS: The trial enrolled 220 patients. About three-quarters were males (73%) and were Chinese (72%). Mean age was 47.6 ± 14.4 years and mean body mass index (BMI) was 31.1 ± 7.4 kgm-2. Mean Epworth Sleepiness Scale (ESS) and Functional Outcome Sleep Questionnaire (FOSQ) score were 11.2 ± 4.9 and 15.4 ± 4.0 respectively. Median AHI was 36.6 ± 39.7 h-1 and 82% had moderate to severe OSA. Vast majority (84%) opted and received CPAP treatment. There was no difference in the proportions of patients receiving CPAP in both arms (62% vs. 57%, p=0.83). At 1 month post treatment, there was an improvement in FOSQ scores in the integrated care arm compared to the routine care arm (-1.5 ± 5.1 vs. -0.60 ± 4.7, p=0.01). However, there was no significant change in the ESS scales (-2.0 ± 4 vs. -0.5 ± 3.1, p=0.32) and difference in the median hours of CPAP use per used day between the 2 groups (4.65 ± 2.58 vs. 4.30 ± 1.60, p=0.82). The average waiting time between undergoing sleep study procedure and receiving definitive OSA treatment in the integrated care arm was significantly lower than in the routine care arm (13.1 vs 27.3 days, p=0.03). CONCLUSIONS: At short term follow-up, an integrated multidisciplinary OSA management care model in the outpatient clinic achieved better sleep functional outcomes and shorter clinic appointment waiting time than routine care among OSA patients. CLINICAL IMPLICATIONS: This may pave way for a new model of care delivery in the outpatient clinic setting for OSA. DISCLOSURES: No relevant relationships by Munirah Abd Gani, source=Web Response No relevant relationships by Shaffinaz Abd Rahman, source=Web Response No relevant relationships by Ai-Ping Chua, source=Web Response No relevant relationships by WENJIA GUO, source=Web Response no disclosure on file for Tun-Oo Han; no disclosure on file for yin maw hsann; no disclosure on file for Esther Hui–Ting Koh; No relevant relationships by Maria Victoria Jane Parot, source=Web Response No relevant relationships by Sue Rene Soon, source=Web Response No relevant relationships by Sridhar Venkateswaran, source=Web Response No relevant relationships by Adrian Yap, source=Web Response

Comparison of Predictor of Desaturation Disorders and Daytime Sleepiness Based On Epworth Sleepiness Scale and STOP-BANG Questionnaires in Mild to Moderate Obstructive Sleep Apnea Patients.

BACKGROUND:Obstructive sleep apnea (OSA) is characterised by recurrence in upper airway obstruction during sleep.AIM:This study aimed to compare the predictive values of the Epworth Sleepiness Scale (ESS) and STOP-BANG in the desaturation of patients with mild to moderate obstructive apnea based on the apnea-hypopnea index (AHI) scale.METHODS:A group of 79 patients (43 male and 36 female) were selected. The suspected patients were introduced to the sleep clinic, and the ESS and STOP-BANG questionnaires were filled up, then subjected to polysomnography test, and the scores of the disease were also determined based on an apnoea-hypopnoea index (AHI). Finally, the desaturation rate (SO2 < 3% based on the baseline) and desaturation index were determined in patients. Consequently, the finding was compared with the results of the questionnaires.RESULTS:Patients with STOP-BANG score above 3 had significantly higher weight, oxygen desaturation index (ODI) index and average desatu, while peripheral capillary oxygen saturation (SpO2) base and average SpO2 were lower than those with scores below 3 (P < 0.05). However, there was no significant difference between the patients with the ESS questionnaire score above 10 and below 10 (P > 0.05).CONCLUSION:The results of these two questionnaires reflect the unsaturated oxygen index in the blood, and can be considered for the evaluation of the severity of the disease.

Evaluation of Epworth Sleepiness Scale to Predict Obstructive Sleep Apnea in Morbidly Obese Patients and Increasing Its Utility.

Studies have shown that Epworth sleepiness scale (ESS) is not a good tool to predict obstructive sleep apnea (OSA). However, data regarding the accuracy of ESS in the prediction of OSA among morbidly obese patients are scarce. The study involved a retrospective review of the charts of the consecutive patients who underwent bariatric surgery at a tertiary care teaching hospital. All the patients underwent polysomnography (PSG) and undertook the ESS questionnaire. The sensitivity and specificity of ESS were calculated based on its correlation with the PSG findings. Furthermore, a new score was devised to improve the utility of ESS to predict OSA. A total of 232 consecutive patients from January 2014 to July 2017 were included in the study. The mean age and body mass index (BMI) were 40.5 ± 11.8 years and 47.6 ± 7.3 kg/m2, respectively. Among the 162 patients who had an ESS <10, 57.4% had moderate-to-severe OSA. The sensitivity of ESS to predict moderate-to-severe OSA was found to be 38.8% and the positive predictive value was 84.2% (positive likelihood ratio 2.82, 95% confidence interval = 1.57-5.06). A predictive score was identified as 0.031Age (years) +0.039BMI (kg/m2) + 0.038ESS + Gender (1 for male, 0 for female). The score had a sensitivity of 80% at a cutoff of 3.3. Among the morbidly obese, ESS is a poor predictor of OSA. Its utility as a tool for prediction of moderate-to-severe OSA can be improved by use of a new formula incorporating age, gender, and BMI beside ESS.

Forced expiratory volume in one second: A novel predictor of work disability in subjects with suspected obstructive sleep apnea

Whether the association of work disability with obstructive sleep apnea (OSA) is mainly due to the disease, i.e. the number and frequency of apneas-hypoapneas, or to coexisting factors independent from the disease, is not well-established. In this study, we aim to evaluate work ability in a group of subjects undergoing OSA workup and to identify the major contributors of impaired work ability. In a cross-sectional study, we enrolled 146 consecutive subjects who have been working for the last five years and referred to the sleep disorders outpatients’ clinic of the University-Hospital of Ferrara, Italy, with suspected OSA. After completing an interview in which the Work Ability Index (WAI) and the Epworth Sleepiness Scale (ESS) questionnaires were administered to assess work ability and excessive daytime sleepiness, respectively, subjects underwent overnight polysomnography for OSA diagnosing and spirometry. Of the 146 subjects, 140 (96%) completed the tests and questionnaires and, of these, 66 exhibited work disability (WAI < 37). OSA was diagnosed (apnea-hypopnea index ≥ 5) in 45 (68%) of the 66 subjects. After controlling for confounders, a lower level of forced expiratory volume at 1 second (FEV1), [odds ratio 0.97 (95% CI 0.95–1.00)], older age [1.09 (95% CI 1.03–1.15)], excessive daytime sleepiness [3.16 (95% CI 1.20–8.34)] and a worse quality of life [0.96 (95% CI 0.94–1.00)], but not OSA [1.04 (95% CI 0.41–2.62)], were associated with work disability. Patients with a higher number of diseases, in which OSA was not included, and a lower quality of life had an increased probability of absenteeism in the previous 12 months. In subjects with suspected OSA, FEV1 can be an important predictor of work disability.

Comparison of Epworth Sleepiness Scale and STOP-BANG Questionnaire for Diagnosing Obstructive Sleep Apnea at a Tertiary Care Centre in North India: A Retrospective Study

Comparison of Epworth Sleepiness Scale and STOP-BANG Questionnaire for Diagnosing Obstructive Sleep Apnea at a Tertiary Care Centre in North India: A Retrospective Study

Use of blood biomarkers to screen for obstructive sleep apnea.

PurposeObstructive sleep apnea (OSA) is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study.Patients and methodsThis multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c), C-reactive protein (CRP), uric acid, erythropoietin (EPO), and interleukin-6 (IL-6).ResultsThe study enrolled 264 subjects. The combination of HbA1c+CRP+EPO (area under the curve 0.78) was superior to the Epworth Sleepiness Scale (ESS; 0.53) and STOP-Bang (0.70) questionnaires. In non-obese subjects, the combination of biomarkers (0.75) was superior to body mass index (BMI; 0.61). Sensitivity and specificity results, respectively, were: HbA1c+CRP+EPO (81% and 60%), ESS (78% and 19%), STOP-Bang (75% and 52%), BMI (81% and 56%), and BMI in non-obese patients (81% and 38%).ConclusionWe verify our hypothesis and replicate our prior feasibility findings that OSA is associated with a characteristic signature cluster of biomarker changes in men. Concurrent elevations of HbA1c, CRP, and EPO levels should generate a high suspicion of OSA and may have utility as an OSA screening tool. Biomarker combinations correlate with OSA severity and, therefore, may assist sleep centers in identifying and triaging higher risk patients for sleep study diagnosis and treatment.

Sleep-disordered breathing in patients with cardiovascular diseases cannot be detected by ESS, STOP-BANG, and Berlin questionnaires

Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular diseases (CVD) and associated with poor outcome. At least 50% of heart failure (HF) patients present with SDB, equally divided in obstructive sleep apnea (OSA) and central sleep apnea (CSA). CVD patients with SDB do not always present with typical SDB symptoms. Therefore, we asked whether established questionnaires allow for the reliable detection of SDB. In this prospective cohort study, 89 CVD patients (54 male, 59 ± 15 years, BMI 30 ± 6kg/m2) in stable clinical state underwent an ambulatory polygraphy. SDB was defined as an apnea-hypopnea index (AHI) ≥ 15/h. We evaluated the Epworth Sleepiness Scale (ESS), STOP-BANG and Berlin questionnaires as well as anthropometric data and comorbidities regarding their ability to predict SDB. The ESS showed no correlation with SDB. The sensitivity of the Berlin Questionnaire to detect SDB was 73%, specificity was 42%. The STOP-BANG questionnaire showed a sensitivity of 97% while specificity was 13%. Coronary heart disease and/or history of myocardial infarction, hyperuricemia and age significantly contributed to a logistic regression model predicting presence of SDB. However, our regression model explains only 36% of the variance regarding the presence or absence of SDB. The approach to find variables, which would allow an early and reliable differentiation between patients with CVD and coexistence or absence of SDB, failed. Thus, as CVD patients show a high SDB prevalence and poor outcome, only a systematic screening based on measures of respiration-related parameters (i.e., respiratory flow, blood oxygen saturation, etc.) allows for a reliable SDB assessment.