Epworth Sleepiness Scale Score Research Articles

Treatment of Obstructive Sleep Apnea and Simple Snoring: Efficacy of a New Mandibular Advancement Device

The following prospective study has the aim of evaluating the efficiency of the F22 MAD (mandibular advancement device), a new oral device for the treatment of OSAS (Obstructive Sleep Apnea Syndrome) and snoring. Methods: AHI (apnea-hypopnea index), ODI (Oxygen Desaturation Index), snoring percentage, time spent in the supine position, and Epworth Sleepiness Scale score were evaluated in 19 patients with snoring, mild to moderate OSAS, or severe OSAS who declined CPAP (Continuous Positive Air Pressure) treatment, before and after the application of the F22 MAD. Results: The median value of AHI varied from 15.6 ± 10.7 to 5.7 ± 5.7; the median value of ODI varied from 13.4 ± 8.8 to 6.2 ± 5.2; the median value of the percentage of snoring varied from 30.7 ± 7 to 7.5 ± 10.8, except for the patient who has severe OSAS who increased their value. The value obtained by the self-completion of the ESS questionnaire (Epworth Sleepiness Scale) underwent a statistically significant variation, while clinically significant for 13\19 patients who obtained a reduction of the value >/= of 2 points. Conclusions: It is possible to conclude that the F22 MAD is effective in the treatment of patients with mild and moderate OSAS or simple snoring, reducing the polysomnographic outcomes with statistically and clinically significant results in terms of reduction of AHI, ODI and percentage of snoring.

Clinical characteristics of non-sleepy obstructive sleep apnea patients: a study in a tertiary care sleep clinic in India.

Obstructive sleep apnea (OSA) encompasses a diverse population, manifesting with or without symptoms of excessive daytime sleepiness. There is contention surrounding the significance of non-sleepy OSA within clinical contexts and whether routine treatment is warranted. This study aims to evaluate epidemiological and clinical distinctions between sleepy and non-sleepy OSA patients. A retrospective analysis was conducted on consecutive patients undergoing polysomnography for OSA assessment at tertiary care hospitals between 2018 and 2023. For 176 of 250 patients, complete polysomnography records with OSA diagnoses were available. Non-sleepy OSA was defined when a patient had an Epworth sleepiness scale score <10 and polysomnography demonstrated an apnea hypopnea index ≥5/hour. Non-sleepy OSA patients were matched with sleepy OSA patients in terms of age and gender distribution (mean age 51.24±13.25 years versus 50.9±10.87 years, male 70.4% versus 73.3%). The sensitivity of STOP-BANG≥3 for the non-sleepy OSA group was 87.7%, 89.3%, and 95.2% for any OSA severity, moderate to severe OSA, and severe OSA, respectively, while the corresponding sensitivity for the sleepy OSA group was 96.5%, 98.6%, and 100% for any OSA severity, moderate to severe OSA, and severe OSA, respectively. A novel symptom scoring tool, HASSUN (hypertension, nocturnal apneas, snoring, sleep disturbance, unrefreshing sleep, and nocturia), demonstrated a sensitivity of over 90% for all severity categories of OSA in both non-sleepy and sleepy OSA groups. The prevalence of cardiovascular and metabolic comorbidities did not significantly differ between non-sleepy and sleepy OSA patients. The physiological parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, arterial partial pressure of oxygen, and bicarbonate at baseline, were comparable between the two groups. To conclude, non-sleepy OSA patients are less obese, exhibit fewer symptoms, and have less severe OSA in comparison to sleepy OSA. Non-sleepy OSA patients display a similar likelihood of cardiovascular and metabolic comorbidities compared to sleepy OSA patients. Further investigations are warranted to elucidate the mechanisms underlying cardiovascular metabolic comorbidities in non-sleepy OSA patients. The proposed HASSUN scoring tool for non-sleepy OSA screening necessitates validation in future studies.

Assessing sleep-related breathing disorders among newly diagnosed rheumatoid and psoriatic arthritis patients: a cross-sectional study.

This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to develop a screening algorithm for early detection. We evaluated newly diagnosed RA or PsA patients using the Epworth Sleepiness Scale (ESS) questionnaire, cardiorespiratory polygraphy (RPG), and clinical and laboratory assessments. Sleep apnea syndrome (SAS) was diagnosed based on pathological RPG findings excessive daytime sleepiness, defined as ESS score above 10. The study included 39 patients (22 RA, 17 PsA) and 23 controls. In RPG, SRBD was identified in 38.5% of arthritis patients compared to 39.1% of controls (p = 1.00), with male gender (p = .004) and age (p < .001) identified as risk factors. Excessive daytime sleepiness was noted in 36.4% of RA patients, 17.6% of PsA patients, and 21.7% of controls. Of the 24 patients diagnosed with SRBD, 41.6% met the criteria for SAS. SAS prevalence was 31.8% among RA patients, 0% in PsA patients, and 13% in controls. A significant association was observed between excessive daytime sleepiness and SRBD (p = .036). Our findings reveal a high prevalence of SRBD in newly diagnosed, untreated RA and PsA patients in ESS and RPG, with excessive daytime sleepiness being a reliable predictor of SRBD. Patients with RA exhibited a higher predisposition to SAS. We therefore suggest incorporating ESS and RPG as screening tools in RA or PsA for early detection and management of SRBD.

Shift schedules and circadian preferences: the association with sleep and mood

ObjectWe explored the circadian preferences of non-shift workers (non-SWs) and various types of shift workers (SWs), and the associations of these preferences with sleep and mood.MethodsIn total, 4,561 SWs (2,419 women and 2,142 men aged 37.00 ± 9.80 years) and 2,093 non-SWs (1,094 women and 999 men aged 37.80 ± 9.73 years) completed an online survey. Of all SWs, 2,415 (1,079 women and 1,336 men aged 37.77 ± 9.96 years) reported regularly rotating or fixed schedules (“regular SWs”), and 2,146 (1,340 women and 806 men aged 36.12 ± 9.64 years) had irregular schedules (“irregular SWs”). Of the regular SWs, 2,040 had regularly rotating schedules, 212 had fixed evening schedules, and 163 had fixed night schedules. All participants completed the Morningness-Eveningness Questionnaire (MEQ) exploring circadian preferences, the short form of the Center for Epidemiological Studies-Depression Scale (CES-D) evaluating depression, the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS).ResultsCompared to non-SWs, SWs had lower MEQ scores, i.e., more eveningness, after controlling for age, gender, income, occupation, and weekly work hours (F = 87.97, p &amp;lt; 0.001). Irregular SWs had lower MEQ scores than regular SWs (F = 50.89, p &amp;lt; 0.001). Among regular SWs, the MEQ scores of fixed evening and fixed night SWs were lower than those of regularly rotating SWs (F = 22.42, p &amp;lt; 0.001). An association between the MEQ and ESS scores was apparent in non-SWs (r = −0.85, p &amp;lt; 0.001) but not in SWs (r = 0.001, p = 0.92).ConclusionSWs exhibited more eveningness than non-SWs; eveningness was particularly prominent in SWs with irregular or fixed evening/night shifts. Eveningness was associated with sleepiness only in non-SWs, but not in SWs.

Existence and pattern of sleep-related breathing disorders in patients diagnosed with bronchial asthma.

Asthma and obstructive sleep apnea (OSA) are commonly prevalent diseases, and both can co-exist to result in an alternate overlap syndrome, where a bidirectional relationship can adversely affect each other. This study aimed to determine the existence and pattern of sleep-related breathing disorders in subjects with bronchial asthma. It was prospectively conducted at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi, in diagnosed cases of bronchial asthma. A subjective assessment of sleepiness was done using the Epworth sleepiness scale (ESS). All subjects underwent overnight polysomnography (PSG) in the Sleep Laboratory of the Institute. A total of 70 subjects were screened, and among them, finally, 30 were enrolled. The mean age of the subjects was 37.53±11.21 years, the mean body mass index (BMI) was 26.4±5.58 kg/m2, the mean ESS score was 3.1, and 80% of the subjects were male. After PSG, OSA (apnea hypopnea index >5/hour) was found in 63% (19/30) of the patients, of whom 43% had mild OSA, 10% had moderate OSA, and 10% had severe OSA. 10% (3/30) had nocturnal oxygen desaturation, while none had sleep hypoventilation. Patients with OSA compared to those without OSA had a higher BMI, more co-morbid allergic rhinitis, severe bronchial asthma, and a worse percentage of predicted forced expiratory volume in the first second. The study showed high detection rates of OSA in bronchial asthma patients. Hence, asthma patients should be evaluated for OSA.

Effectiveness and optimization of low-sodium oxybate in participants with narcolepsy switching from a high-sodium oxybate: data from the SEGUE study.

Low-sodium oxybate (LXB; calcium, magnesium, potassium, and sodium oxybates; Xywav) contains the same active moiety as high-sodium oxybates (sodium oxybate [SXB; Xyrem] and fixed-dose sodium oxybate [Lumryz]), with 92% less sodium, and is approved in the US for treatment of cataplexy or excessive daytime sleepiness in patients 7 years of age and older with narcolepsy, and idiopathic hypersomnia in adults. Patients with narcolepsy have increased cardiovascular risk relative to people without narcolepsy. LXB's lower sodium content is recognized by the US FDA in the narcolepsy population as clinically meaningful in reducing cardiovascular morbidity compared with high-sodium oxybates. The Substitution of Equal Grams of Uninterrupted Xyrem to Xywav (SEGUE) study (NCT04794491) examined the transition experience of patients with narcolepsy switching from SXB to LXB. Eligible participants were aged 18 to 80 years with narcolepsy type 1 or 2 on a stable SXB dose/regimen. After 2 weeks, participants transitioned gram-per-gram to LXB for 6 weeks, with opportunity for subsequent titration. Assessments included the Epworth Sleepiness Scale (ESS), Patient Global Impression of Change (PGIc), ease of switching medication scale (EOSMS), and forced preference questionnaire (FPQ). The study enrolled 62 participants at baseline; 60 transitioned to LXB and 54 completed the study. At baseline and end of the LXB intervention/early discontinuation, respectively, mean total doses were 8.0 and 8.0 g/night; mean ESS scores were 9.4 and 8.8. Most participants reported improvement (45%) or no change (48%) in narcolepsy symptoms on the PGIc, reported the transition to LXB was "easy" (easy, extremely easy, not difficult at all; 93%) on the EOSMS, and preferred LXB compared with SXB (79%) on the FPQ, most commonly due to the lower sodium content. Most participants switched from SXB to LXB with minimal modifications of dose/regimen and reported the transition process was easy. Effectiveness of oxybate treatment was maintained on LXB, and most participants preferred LXB to SXB. No new safety or tolerability issues were identified. Registry: ClinicalTrials.gov; Name: An Interventional Safety Switch Study (Segue Study) of XYWAV in Narcolepsy; URL: https://classic.clinicaltrials.gov/ct2/show/NCT04794491; Identifier: NCT04794491.

Eating habits, sleep quality, and lifestyle changes during the COVID-19 crisis: a national survey from Palestine

BackgroundThe COVID-19 pandemic and the consequences of safety measures, such as lockdowns, have impacted not only the physical health of individuals but also their lifestyle, psychosocial health, and mental health. In this analysis, we aimed to explore the effect of the COVID-19 pandemic on lifestyle, eating habits, and sleep quality in the Palestinian population. Furthermore, the current study aimed to determine the factors associated with poor sleep.MethodsThe study was carried out between November 2021 and February 2022 after a long lockdown. We adopted a cross-sectional design to achieve the objectives of this study. The questionnaire included information on sociodemographic characteristics and other characteristics. In addition, questions related to lifestyle changes and items related to changes in the consumption of certain types of food were included. Furthermore, in the present study, two scales were used to assess sleep quality: the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI).ResultsA total of 978 participants were included in this study; 508 (51.9%) were women, and 465 (47.5%) were aged between 17 and 30 years. 41% of the participants added one meal or more, and almost 43% skipped one meal or more. A total of 39.2% believed that their habits worsened as a result of the COVID-19 pandemic. A significant portion of the population increased their vitamin intake by 62.5%. In general, nuts, fast food, fried food, coffee, snacks, cans, and homemade baked foods were consumed at higher rates overall. The median ESS score, which measures general levels of daytime drowsiness, was 20.00 (18.00–22.00). Residency (p = 0.008), living status (p < 0.001), salary (p < 0.001), education level (p = 0.002), job status (p = 0.015), and vitamin intake (p < 0.001) were significantly associated with the ESS score. The PSQI score, which evaluates adult sleep patterns and quality, has a median value of 5.00. (4.00–7.00). Living status (p < 0.001), salary (p = 0.006), job status (p = 0.002), smoking status (p = 0.030), chronic diseases (p = 0.002), and vitamin use (p < 0.001) were significantly associated with the PSQI score. Only taking multivitamins was a predictor of having a lower score on both the ESS (p = 0.001) and PSQI (p < 0.001).ConclusionsOur findings clearly showed that the COVID-19 pandemic has substantially affected the Palestinian population in different aspects of life. We recommend that health authorities and healthcare providers continually share knowledge and awareness about good eating habits, sleep quality, and other aspects of lifestyles.

Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation.

In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes. Observational. Multicenter registry. We included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea-Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction. No relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Amongall patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery. In ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.

Clinical Outcomes and Tau Pathology in Retired Football Players: Associations With Diagnosed and Witnessed Sleep Apnea.

Obstructive sleep apnea (SA) is common in older men and a contributor to negative cognitive, psychiatric, and brain health outcomes. Little is known about SA in those who played contact sports and are at increased risk of neurodegenerative disease(s) and other neuropathologies associated with repetitive head impacts (RHI). In this study, we investigated the frequency of diagnosed and witnessed SA and its contribution to clinical symptoms and tau pathology using PET imaging among male former college and former professional American football players. The sample included 120 former National Football League (NFL) players, 60 former college players, and 60 asymptomatic men without exposure to RHI (i.e., controls). Diagnosed SA was self-reported, and all participants completed the Mayo Sleep Questionnaire (MSQ, informant version), the Epworth Sleepiness Scale (ESS), neuropsychological testing, and tau (flortaucipir) PET imaging. Associations between sleep indices (diagnosed SA, MSQ items, and the ESS) and derived neuropsychological factor scores, self-reported depression (Beck Depression Inventory-II [BDI-II]), informant-reported neurobehavioral dysregulation (Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A] Behavioral Regulation Index [BRI]), and tau PET uptake, were tested. Approximately 36.7% of NFL players had diagnosed SA compared with 30% of the former college football players and 16.7% of the controls. Former NFL players and college football players also had higher ESS scores compared with the controls. Years of football play was not associated with any of the sleep metrics. Among the former NFL players, diagnosed SA was associated with worse Executive Function and Psychomotor Speed factor scores, greater BDI-II scores, and higher flortaucipir PET standard uptake value ratios, independent of age, race, body mass index, and APOE ε4 gene carrier status. Higher ESS scores correlated with higher BDI-II and BRIEF-A BRI scores. Continuous positive airway pressure use mitigated all of the abovementioned associations. Among the former college football players, witnessed apnea and higher ESS scores were associated with higher BRIEF-A BRI and BDI-II scores, respectively. No other associations were observed in this subgroup. Former elite American football players are at risk of SA. Our findings suggest that SA might contribute to cognitive, neuropsychiatric, and tau outcomes in this population. Like all neurodegenerative diseases, this study emphasizes the multifactorial contributions to negative brain health outcomes and the importance of sleep for optimal brain health.

Anterior palatoplasty as a treatment for mild and moderate obstructive sleep apnea: our experience

Abstract BACKGROUND. Obstructive sleep apnea (OSA) is characterized by frequent episodes of breathing cessation during sleep, resulting in low oxygen and high carbon dioxide levels, leading to daytime sleepnes, cognitive issues, and increased cardiovascular risk. The objective of this study was to assess the effectiveness of the anterior palatoplasty (AP) procedure in the treatment of patients with mild and moderate obstructive sleep apnea. MATERIAL AND METHODS. Sixteen patients diagnosed with mild and moderate OSA underwent AP in our clinic between 2021-2023. All patients were &gt; 18 years old, body mass index &lt; 30, with an apnea-hypopnea index (AHI) from 10 to 40 and disfunction of the velopharyngeal or of the retropalatal space. Patients underwent a one-night polysomnography examination prior to the surgical procedure, as well as six months after the procedure. Additionally, patients were asked to complete the Epworth Sleepiness Scale (ESS) both prior to and six months following the surgery. The procedure was done under general anaesthesia and involved AP surgery with or without reducing of the uvula. RESULTS. The average of total AHI values decreased from 28.89 per hour prior to surgery to 11.14 per hour six months after surgery. The oxygen desaturation index decreased after surgery with 2.57%. ESS scores of patients also decreased from 10.40 to 7.80 and all patients felt less tired. CONCLUSION. We believe that AP is an effective technique in the treatment of mild and moderate OSA caused by a disfunction of the velopharyngeal or retropalatal space. Additionally, we consider that AP is linked with a lower incidence of post-surgical complications compared to other surgical options.

Assessment of the Epworth Sleepiness Scale, Pediatric Sleep Questionnaire, and Mallampati Score in Children With Obstructive Sleep Apnea: An Observational Study

Background and Objective Individuals diagnosed with obstructive sleep apnea (OSA) experience recurrent episodes of breathing cessation due to blockage of the upper airway during sleep. This study aimed to assess the Pediatric Sleep Questionnaire (PSQ) scores, Epworth Sleepiness Scale (ESS) scores, and Mallampati score in pediatric patients with OSA, compared with non-OSA.Methods An observational study was conducted on 100 pediatric female patients aged 9-13 years with retrognathic mandible. The participants were subjected to PSQ, ESS, and Mallampati score to assess the size and shape of the patient’s tongue and esophageal airway. Finally, polysomnographic examination was carried out for all the participants and they were divided into two groups: Group 1 (50 patients) who were diagnosed with OSA by polysomnography and Group 2 (50 patients) consisting of non-OSA patients. Chi-square and Mann–Whitney U test were applied to compare scores between the two groups.Results The mean PSQ, ESS, and Mallampati scores of participants were 0.78 ± 0.45, 9.86 ± 2.47, and 2.27 ± 0.98, respectively in Group 1 and 0.24 ± 0.03, 7.27 ± 2.39, and 1.32 ± 0.57, respectively in Group 2, and this difference was statistically significant (p &lt; 0.05). PSQ, ESS, and Mallampati scores had specificity of 100%, 95.5%, and 72.7%, respectively, whereas the sensitivity was 45.5%, 22.7%, and 63.6%, respectively. ESS scores ≥ 10, PSQ scores ≥ 0.3, and Mallampati scores ≥ 2 were indicative of OSA.Conclusions Patients with OSA having retrognathic mandible had higher PSQ, ESS, and Mallampati scores compared to healthy individuals without OSA. Mallampati score can be satisfactorily used for screening OSA patients.

A Comparative Study of Architecture and Quality of Sleep among Juvenile Myoclonic Epilepsy Patients and Healthy Individuals Attending Tertiary Care Hospital in Central India

&#x0D; &#x0D; &#x0D; &#x0D; Background and Objective: Primary sleep disorders are common in patients with epilepsy. Seizures, epileptiform discharges, and antiepileptic drugs alter the sleep architecture of patients with juvenile myoclonic epilepsy (JME). We evaluated sleep architecture and its quality in these patients.&#x0D; Materials and Methods: Thirty patients with JME (11 men and 19 women with mean age of 21.10 ± 4.55 years) and 30 healthy controls underwent overnight polysomnography (PSG). Sleep quality and daytime sleepiness were assessed using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively.&#x0D; Results: Myoclonus and generalized tonic-clonic seizures (GTCS) were present in all patients with JME, while absence seizures were in 13.3%. Sleep deprivation was the most frequent precipitating factor for seizures (56.6%) followed by fatigue, sound, and photic stimulation. Patients with JME reported a statistically significant drop in sleep efficiency (P&lt;0.001) with prolonged sleep onset latency (P&lt;0.001). There was prolongation in the N1 stage of non-rapid eye movement (NREM) sleep (P=0.002), and reduction in the N2 stage of NREM (P&lt;0.001) and rapid eye movement (REM) sleep (P&lt;0.001). The median PSQI score was higher in patients with JME, suggesting poor sleep quality (P&lt;0.001), and the daytime sleepiness was not different as indicated by the similar median ESS score (P=0.033).&#x0D; Conclusion: Our results suggest a significant alteration in the sleep architecture of patients with JME with reduced sleep efficiency and poor sleep quality. The possible role of the disease itself is suggested for these alterations as a simi- lar trend was also observed in drug naïve patients.&#x0D; &#x0D; &#x0D; &#x0D;

Internet Addiction and Its Effect on Sleep Quality Among Medical Students

Aim: This study was carried out to determine the prevalence of internet addiction in medical school students, and to examine the relationship between internet addiction and sleep quality, sleepiness and psychological resilience. Method: The study was conducted with 213 participants studying at Bolu Abant Izzet Baysal University Faculty of Medicine. A sociodemographic questionnaire, Young Internet Addiction Test-Short Form, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Brief Psychological Resilience Scale were applied to all participants, and the results were statistically evaluated. Results: The average age of the participants was found as 21.25±2.00. 65.3% (n=139) of the participants were women and 27.2% (n=58) were first-year students. The average score of Young's internet addiction was 27.15±7.35; the average Pittsburgh Sleep Quality Index score was 5.49±2.47. 60% of them were evaluated as having poor sleep quality. Average Epworth Sleepiness Scale scores were 6.62±4.22; average scores of the Psychological Resilience Scale were 19.35±5.04. There was a positive and significant relationship between Young Internet Addiction and Pittsburgh Sleep Quality. As internet addiction increased, sleep quality decreased. A negative significant relationship was found between Young's Internet Addiction and the Brief Psychological Resilience Scale. As internet addiction increased, psychological resilience decreased. Conclusion: In our study, it was determined that as internet addiction increased, sleep quality and psychological resilience decreased, and daytime sleepiness increased. We can improve sleep quality by preventing internet addiction, and increase participation in daily activities and psychological resilience by reducing daytime sleepiness. Keywords: internet addiction disorder, sleeplessness, resiliency, psychological

Longitudinal evolution and plasma biomarkers for excessive daytime sleepiness in Parkinson's disease.

Excessive daytime sleepiness (EDS) is one of the most frequent non-motor symptoms in Parkinson's disease (PD); however, the pathogenesis of EDS is unclear, and there is a lack of information on plasma biomarkers for EDS in PD. We aimed to investigate the plasma biomarkers of EDS in a large PD cohort. A total of 159 PD patients were included in the prospective cohort study and followed up annually for three years. Plasma biomarkers including glial fibrillary acidic protein, amyloid-beta, p-tau181, and neurofilament light chain (NfL), were measured using an ultrasensitive single-molecule array (SimoaTM) technology at each visit. EDS was evaluated using the Epworth Sleepiness Scale (ESS). The frequency of EDS in PD increased from 15.1% at baseline to 25.0% after three years. The mean ESS scores increased from 5.1 [Standard Deviation (SD): 4.8] at baseline to 6.1 [SD: 5.5] at the third year of follow-up. At baseline, compared with patients with PD without EDS, those with EDS were more likely to be male, had poorer cognitive performance, and more severe motor and non-motor symptoms. The adjusted generalized estimating equations models showed that higher plasma NfL levels (OR 1.047 [1.002-1.094], p = 0.042) were associated with EDS during follow-ups. The adjusted linear mixed-effects model showed that higher plasma NfL levels (β 0.097 [0.012-0.183], p = 0.026) were associated with ESS scores during follow-ups. Higher plasma NfL levels were associated with EDS in PD, indicating an association between neuro-axonal degeneration and EDS in PD.

Sleepiness and Vitamin D Levels in Patients with Obstructive Sleep Apnea.

The aim of this cross-sectional study is to explore the association between serum 25-hydroxyvitamin D [25(OH)D] levels, a marker of Vitamin D status, and excessive daytime sleepiness (EDS), expressed as increased scores of the Epworth Sleepiness Scale (ESS), in a group of prospectively enrolled patients with obstructive sleep apnea (OSA). Newly diagnosed patients with OSA, divided into two groups, those with EDS (ESS > 10) and those without EDS (ESS < 10). All patients underwent night polysomnography. Measurement of serum 25(OH)D vitamin was performed using a radioimmunoassay. In total, 217 patients with OSA (197 males and 20 females) were included. Patients with EDS had higher AHI (p < 0.001) values and lower mean serum 25(OH)D levels, compared with those of non-somnolent patients [17.4 (12.2-25.7) versus 21.1 (15.3-28.8) ng/mL, respectively, p = 0.005]. In patients with EDS, serum 25(OH)D levels correlated with average oxyhemoglobin saturation during sleep (r = 0.194, p = 0.043), and negatively with ESS score (r = -0.285, p = 0.003), AHΙ (r = -0.197, p = 0.040) and arousal index (r = -0.256, p = 0.019). Binary regression analysis identified Vit D serum levels (β = -0.045, OR: 0.956, 95% CI: 0.916-0.997, p = 0.035), total sleep time (β = 0.011, OR: 1.011, 95% CI: 1.002-1.021, p = 0.016) and AHI (β = 0.022, OR: 1.022, 95% CI: 1.003-1.043, p = 0.026) as independent predictors of EDS in patients with OSA. In patients with EDS, multiple regression analysis indicated that ESS score was negatively associated with Vit D serum levels (β = -0.135, p = 0.014) and minimum oxyhemoglobin saturation during sleep (β = -0.137, p = 0.043). In the present study, EDS in patients with OSA is associated with low levels of Vitamin D, while sleep hypoxia may play a role in this process.

Restless legs syndrome in patients with obstructive sleep apnea: Association between apnea severity and symptoms of depression, insomnia, and daytime sleepiness

ObjectiveTo determine if the prevalence and severity of restless legs syndrome (RLS) varies with apnea severity and analyze differences between the sexes in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness in patients with obstructive sleep apnea (OSA). MethodsSymptoms of depression, insomnia, and daytime sleepiness were defined as Patient Health Questionnaire–9 score ≥10, Insomnia Severity Index score ≥15, and Epworth Sleepiness Scale score ≥11. Multivariate logistic and linear regression analyses were conducted. ResultsIn 707 adults with OSA (85.1% males), 16.1% (n = 114) had comorbid RLS. The prevalence of RLS was markedly lower in those with moderate and severe OSA than in those with mild OSA. Similarly, the odds of RLS significantly decreased with increasing apnea-hypopnea index. After controlling for age and sex, in patients with comorbid RLS, the International RLS Study Group Rating Scale scores were negatively correlated with apnea-hypopnea index and a nadir peripheral oxygen saturation during sleep. The presence of RLS was more likely to be associated with symptoms of depression, insomnia, and daytime sleepiness after controlling for confounding variables, but only in men. ConclusionsRLS is frequently noted in combination with OSA, with a female preponderance. The severities of OSA and RLS may be negatively associated. In patients with OSA, sex-related differences in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness warrant further investigations.

Effect of shift work on excessive daytime sleepiness in female nurses: results from the Japan nurses' health study.

We investigated the relationship between shift work and excessive daytime sleepiness (EDS) among participants in the Japan Nurses' Health Study (JNHS). Responses of 9,728 female nurses to the 6th follow-up questionnaire were cross-sectionally analyzed. EDS was defined as an Epworth Sleepiness Scale score ≥11. EDS-associated factors were evaluated using Poisson regression analysis after adjustment for multiple confounders. Of the participants (mean age, 52.2 ± 8.0 yr), 28.7% were engaged in shift work, and the overall prevalence of EDS was 24.6%. EDS-associated factors were investigated separately in women aged <40 yr (n=250), 40-59 yr (n=7,467), and ≥60 yr (n=2,011). Current engagement in shift work (prevalence ratio: 1.92 [95% confidence interval: 1.20-3.06], compared with no experience of shift work) and obesity (2.08 [1.11-3.88] for BMI ≥30 and 1.39 [1.02-1.90] for BMI of 25.0-30.0, compared with BMI of 18.5-25.0) showed an independent association with EDS in women aged ≥60 yr. The effect of shift work on EDS in female nurses differed by age, as shift work and obesity contributed to EDS only in older participants. Shift work should be assigned after full consideration of age, sleep, and health status to minimize medical errors.

Comparison of Epworth Sleepiness Scale and OSA-18 Scores With Polysomnography in Children.

Our goal is to determine if there is a correlation between Modified Epworth Sleepiness Scale (M-ESS) scores, obstructive sleep apnea (OSA)-18 scores, and polysomnography (PSG) outcomes in children. Retrospective chart review. Pediatric otolaryngology clinic. Charts of consecutive children presenting from July 2021 to July 2023 were reviewed. Demographics, body mass index (BMI), BMI Z score, M-ESS score, OSA-18 score, PSG results, and sleep apnea severity were included. One-way analysis of variance and Pearson/Spearman correlation coefficients were calculated. Three hundred sixty-seven children were included, 162 (44.1%) girls and 205 (55.9%) boys. Mean patient age was 7.8 (95% confidence interval [CI]: 7.3-8.3) years. M-ESS score was 6.3 (n = 348, 95% CI: 5.8-6.8), mean OSA-18 score was 56.2 (n = 129, 95% CI: 53.0-59.4). Mean apnea-hypopnea index (AHI) was 10.1 (95% CI: 8.7-11.4) events/h, obstructive AHI 9.3 (95% CI: 8.0-12.7) events/h, respiratory distress index 14.6 (95% CI: 8.4-20.8) events/h, and oxygen saturation nadir 89.8% (95% CI: 89.1-90.4). Sixty-two children (17.2%) had mild, 192 (53.5%) moderate, and 105 (29.2%) severe sleep apnea. M-ESS score correlated weakly to AHI (r = .19, P = <.001), and OSA-18 score to oxygen saturation nadir (r = -.16, P = .002). After logistic regression adjusted for age and BMI, neither clinical scores were independently associated with AHI. M-ESS and OSA-18 scores have a weak correlation with OSA severity in children. More reliable, age-appropriate screening tools are needed in pediatric sleep apnea.

Real-world impact of continuous positive airway pressure on sleepiness in patients with obstructive sleep apnea in a national registry

ObjectiveExcessive daytime sleepiness (EDS) persists in some patients with obstructive sleep apnea (OSA) despite continuous positive airway pressure (CPAP) treatment. This study characterized response to CPAP and factors associated with residual EDS. MethodsDanish National Patient Registry data were analyzed. Patients with OSA diagnosis (1994–2016), Epworth Sleepiness Scale (ESS) scores and apnea-hypopnea index recorded before beginning CPAP (baseline) and after 1–13 months of CPAP use, and CPAP adherence were included. Odds ratios (OR) for residual EDS after CPAP treatment were estimated using multivariate logistic regression. ResultsOf 1174 patients (mean age, 57 years; 75.5% male), 41.1% had baseline EDS (mild, 13.2%; moderate, 14.0%; severe, 13.9%); 58.9% did not. After CPAP treatment, follow-up mean ESS scores were normal (≤10) for all baseline EDS subgroups; however, 15.6% (n = 183) of patients had residual EDS (mild, 6.7%; moderate, 5.5%; severe, 3.4%). Odds of residual EDS were higher for patients with mild (OR, 5.2; 95% confidence interval [CI], 3.2–8.6), moderate (OR, 4.5; 95% CI, 2.7–7.4), and severe (OR, 13.0; 95% CI, 8.0–21.2) EDS at baseline compared with those with normal daytime sleepiness at baseline. Patients’ adherent with CPAP use were 38.2% less likely to have residual EDS compared with nonadherent patients (OR, 0.62; 95% CI, 0.43–0.88). ConclusionsEDS was common in this cohort of Danish patients with OSA. Baseline EDS severity predicted higher odds of residual EDS. After CPAP treatment, adherence was associated with reduced odds of residual EDS, but EDS persisted in a subgroup of patients.

Screening for Sleep Disordered Breathing in Three Distinct Neurological Diseases in the Bulgarian Population

Sleep disordered breathing (SDB) is a common medical problem in the general population. Neurological disorders such as ischemic stroke (IS), myasthenia gravis (MG), or multiple sclerosis (MS) seem to be of higher risk of SDB. Nevertheless, the implementation of screening for SDB in such disorders has not been well studied. Therefore, the aim of this study was to explore screening parameters for SDB in IS, MG and MS, in our region. We included prospectively patients with diagnosed IS, MG and MS. Psychometric tools such as the Epworth Sleepiness Scale (ESS), the STOP-BANG, and the Berlin questionnaire were implemented. For the respiratory screening portable recording device was used. Seventy-two patients, 25 with IS (mean age 66.3 years), 24 with MG (mean age 47.9 years), and 23 with MS (mean age 40.1 years) were enrolled. Basic anthropometric parameters such as BMI, neck and waist circumference were higher in IS than in MG and MS ($$p&lt;0.001$$). The ESS scores were 5.5±3.2 for IS, 5.6±3.3 for MG, and 5.9±4.5 for MS, but without significant difference between the groups. Contrariwise, STOP-BANG scores in IS were 4.8±1.3, significantly higher ($$p&lt;0.0001$$) than both MG (2.1±1.4) and MS (1.2±0.9). A high risk for OSA in BQ was calculated in 68% of IS, much higher ($$p&lt;0.0001$$) than in MG (33.3%) and in MS (13%). In the respiratory screening, the mean apnea-hypopnea index in the IS group (20±18.3) was statistically higher than in MG (8.1±12.7, $$p&lt;0.005$$), and in MS patients (2.3±4.9, $$p&lt;0.001$$). Oxygen desaturation index in IS (19.3±19) differed statistically from the one in MG (8.1±12.9, $$p&lt;0.005$$), and in MS (2.6±5.5, $$p&lt;0.001$$). The oxygen saturation (SO2) showed difference only between IS and MS in all three measured values – baseline SO2 ($$p&lt;0.001$$), median SO2 ($$p&lt;0.05$$) and lowest SO2 ($$p&lt;0.05$$). IS, MG and MS, as distinct neurological entities, show different clinical profiles with respect to screening for SDB. These should be taken into consideration in the individual evaluation for sleep disordered breathing.