Epworth Sleepiness Scale Research Articles

The deficiencies of epworth sleepiness scale in the evaluation of excessive daytime sleepiness in obstructive sleep apnea and related factors.

Epworth Sleepiness Scale(ESS) is widely used in the assessment of excessive daytime sleepiness (EDS) despite certain deficiencies. It was aimed to evaluate the factors associated with low ESS scores in subjects investigated for OSA. In this cross sectional study, we recorded the ESS and Pittsburg sleep quality index (PSQI) scores of patients undergoing polysomnography in our sleep center between November 2022-January 2023. Additional questions regarding literacy, vehicle use, driver licence and travelling habits were asked. Sleep indices of patients with AHI ≥ 5 were recorded following PSG. 96 patients with mean age 51 ± 12, 68% male, median AHI 34.6 (7-105), ESS 7 (0-22), PSQI 9 (2-15) were included. Among moderate-severe OSA patients without EDS; 10% were illiterate, 67% performed reading only from cellular phone, 88% did not attend the social settings, 53% did not travel frequently and 40% did not use any vehicle. The listed factors were also associated with low ESS (p < 0.001). The sleep indices and PSQI scores of patient groups with and without EDS were similar. There was a correlation between ESS and total PSQI score (β = 0.31, p = 0.002) and subjective sleep quality (β = 0.21, p = 0.04), sleep disturbances (β = 0.29, p = 0.004) and daytime dysfunction (β = 0.49, p < 0.001) domains. ESS may be inadequate in the assessment of the demographical features and daily habits of patients from different sociocultural settings. Clinicians should be aware that the patients may have severe OSA and poor sleep quality despite low ESS scores and should evaluate each patient individually.

Clinical study of two mandibular advancement devices in the treatment of Obstructive Sleep Apnea: a pilot randomized controlled trial

ObjectiveA preliminary clinical evaluation of the efficacy, comfort, and adverse reactions of two mandibular advancement devices (MADs) in the treatment of Obstructive Sleep Apnea (OSA).MethodsForty patients with mild-to-severe OSA were recruited and randomly divided into two groups. They were treated with Shark-fin or Silensor MAD, respectively. Treatment efficacy was evaluated by home sleep apnea tests, the snoring scale, Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A comfort scale questionnaire was applied. Cone beam computed tomography (CBCT), cephalometric radiography, and intraoral scanning were made before and after 3-month treatment to detect temporomandibular joints (TMJ), dental and skeletal changes. All data were assessed as normal distributed and analyzed by t test. The significance level was defined as α = 0.05.ResultsThe effective rate, defined as a decrease in Respiratory Event Index (REI) to less than 5 events per hour or a decrease of more than 50%, was 70% in the Shark-fin MAD group and 50% in the Silensor MAD group. REI, lowest oxygen saturation and maximum apnea and hypoventilation time were significantly improved in Shark-fin MAD group (P < 0.01), and the proportion of non-rapid eye movement (REM) sleep stage 3 was higher than before use (P < 0.05), while only REI and lowest oxygen saturation were significantly improved in Silensor MAD group (P < 0.05). The loudness of snoring was significantly decreased after one day using Shark-fin MAD (P < 0.05), and further decreased after one month (P < 0.01). Conversely, Silensor MAD exhibited inferior efficacy in mitigating snoring compared to Shark-fin MAD. Upon wearing the Shark-fin MAD, ESS were significantly improved after one month and three months (P < 0.05), and PSQI improved after three months (P < 0.05). Additionally, the Shark-fin MAD group had a significantly better comfort score compared to the Silensor MAD group (P < 0.05). There was no significant difference in TMJ, dental and skeletal structures in the two groups before and after treatment (P > 0.05).ConclusionBoth two MADs were effective in reducing REI and increasing lowest oxygen saturation on OSA patients, and Shark-fin MAD has better improvement effect and faster onset of action. In addition, Shark-fin MAD was superior to Silensor MAD in improving snoring loudness, daytime sleepiness, sleep quality and wearing comfort. There were no significant dental or skeletal changes, and no alterations in occlusion or temporomandibular joint function in the short term.Trial registrationClinical Trials.gov Registration ID ChiCTR2400086628. Registered 08/07/ 2024-Retrospectively registered, https://register.clinicaltrials.gov.

Are We Missing Obstructive Sleep Apnea in Patients With Non-traumatic Subglottic Stenosis?

To investigate the association between subglottic stenosis (SGS) and obstructive sleep apnea (OSA). This is a cross-sectional pilot cohort study conducted at a single tertiary academic center from 2022 to 2023. Subjects with non-traumatic SGS were recruited for enrollment. All subjects completed a peak expiratory flow (PEF) measurement, validated sleep questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and a 1-night home sleep test (HST). Demographic data were summarized. Prevalence was calculated and descriptively compared to a matched population. Partial correlation analysis evaluated the relationship of PEF% and Meyer-Cotton grading, in addition to PEF% and apnea-hypopnea index (AHI). Sleep quality was compared in subjects with and without OSA via a Mann-Whitney U test. Twenty subjects participated; all were Caucasian females with a mean age of 48.4 (10.4) years and a body mass index (BMI) of 24.1 (3.8). The majority (80%) had idiopathic SGS, and a mean PEF 288 (71) L/min. OSA was present in 40% of subjects, of which 15% had moderate OSA. PEF% did not correlate to AHI (P > .05). Poor sleep quality (PSQI ≥ 5) was present in 70% of subjects and 20% had excessive daytime sleepiness (ESS > 9). PSQI and ESS did not differ between subjects with and without OSA (P > .05). OSA prevalence is elevated in a cohort of subjects with SGS. Further study of airway dilation's impact on OSA is necessary. Screening and surveillance for OSA in patients with subglottic stenosis may need to be considered based on this study's findings.Level of Evidence: Level 3.

Patient centered outcomes of transoral robotic surgery for obstructive sleep apnea: a retrospective analysis.

Obstructive Sleep Apnea (OSA) is usually caused by collapse of the base of tongue (BOT) and impacts patients' overall health. Despite current conventional therapies, some patients do not achieve satisfactory results. Reduction of BOT using Trans Oral Robotic Surgery (TORS) emerges as a promising treatment. We evaluated the patient reported and clinical outcomes of TORS for OSA. We performed a retrospective cohort study of patients treated from 2018 to 2021 in a non-academic general hospital. Patients were eligible for TORS when apnea hypopnea index (AHI) was >5 in combination with obstruction at BOT level. Patients were included when 1-year follow up respiratory polygraphy was available. Changes in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-35), MD Anderson Dysphagia Inventory (MDADI) scores and postoperative complications were evaluated. Surgical success rates were obtained. Out of 56 patients, 28 patients of which 22 (78.6%) males and 6 (21.4%) females, with OSA severity ranging from mild to severe and mean age of 49 (SD 11.8) with a median BMI of 28.1 (IQR 26.9-32.1) were included. ESS score declined from mean 5.9 (SD 3.8) to 2.2 (SD 2.0) (p<0.00). FOSQ-35 scores were all declined (p<0.05). MDADI scores were in normal range (80-100) and remained stable (p = 0.44). In 23 (82.1%) patients no postoperative complications were observed. Surgical success rates were 86%. TORS demonstrate to be effective and safe in OSA patients, and it can be used in both patients who are unresponsive to conventional therapies or as a primary therapy.

Association between iron intake and excessive daytime sleepiness in the community-dwelling Japanese: the Toon Health Study.

Brain iron deficiency is known to cause dopaminergic dysfunction in people with restless legs syndrome. Considering the role that dopamine plays in the wake-promoting system, we speculated that iron deficiency may contribute to the development of excessive daytime sleepiness (EDS). Therefore, we conducted the present study to examine the association between iron intake and EDS in the general population. We collected data from the participants of the Toon Health Study from 2009 to 2017 (N = 2405) and conducted a cross-sectional analysis. EDS was defined as an Epworth Sleepiness Scale score ≥ 11. Participants were divided into four groups according to quartiles of estimated iron intake from their responses to the Food Frequency Questionnaire. We used sex, age, body mass index, and sleep duration as adjustment variables. The mean age of the participants was 57.9 years, and 64.2% were women. Compared to the highest quartile of iron intake, the multivariable-adjusted odds ratio for EDS of the lowest quartile was 1.38 (95% confidence interval [CI]: 1.04-1.83, p for trend = 0.03). When the analysis was restricted to participants with a Pittsburgh Sleep Quality Index (PSQI) score < 6, the odds ratio was 1.57 (95% CI: 1.06-2.31, p for trend = 0.04). Significant inverse associations were observed between iron intake and EDS. This tendency was also observed in participants without substantial subjective sleep disturbance (i.e., PSQI score < 6), suggesting that iron deficiency may play a role in the wake-promoting system independently of sleep disturbances.

Occupational Stress and Sleep of Military Police Officers From Rio de Janeiro, Brazil.

Military Police officers of Rio de Janeiro's State have been considered the most lethal security forces in Brazil, corresponding to 52.35% of deaths in policing actions. The main aim of this study was to identify occupational stress among military police officers in Rio de Janeiro State and its relationship with the psychosocial environment, sleep quality, and daytime sleepiness. Two hundred and forty-two military policemen, divided into two groups (elite and non-elite), were evaluated occupational stress by the Lipp's Stress Symptoms Inventory (LSSI), daytime sleepiness (DS) by the Epworth Sleepiness Scale and sleep quality (SQ) by the Pitsburgh Sleep Quality Index. Military police officers (entire sample) showed dissatisfaction related to psychological support from the military institution (p = 0.004), about the inefficiency of the judicial system (p < 0.001) and their low popularity towards society (p = 0.009). The group of elite police officers slept significantly less (p = 0.026) and, in general, suffered more from severe daytime sleepiness, had poorer SQ and showed lower levels of occupational stress than their peers. It was possible to identify that stress can be detected, developed, and intensified in military police officers as a result of the environment in which they are exposed and this interferes significantly in sleep and daytime sleepiness (p < 0.05). Through this study, it is hoped that measures can be implemented to enhance the work environment and thereby improve the quality of life for this military population. Furthermore, it is intended to stimulate more comprehensive and longitudinal studies, particularly inclusive of female military personnel.

Sleep quality and risk of obstructive sleep apnea among breast cancer survivors with and without lymphedema.

Breast cancer survivors (BCSs) tend to have sleep disturbances such as obstructive sleep apnea (OSA). However, limited evidence exists on the role of breast cancer-related lymphedema (BCRL) in sleep disturbances and OSA. Therefore, this study aimed to investigate the quality of sleep (QoS) and OSA risk among women with and without BCRL. The quality of life (QoL) was evaluated using the SF-12 and EORTC-QLQ C-30 questionnaires, while their sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The STOP-bang questionnaire (SBQ) was utilized to quantify OSA risk. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Also, neck and waist circumference and the excessive volume in the affected limb were measured using a tape measure. The statistical analyses were performed using the SPSS 21.0 software. Seventy-one women with BCRL and 84 BCS without lymphedema were included. The comparison of PSQI, SBQ, ESS, SF-12, and EORTC QLQ-C30 questionnaires exhibited no significant difference between these two groups. The overnight snoring and average neck circumference were significantly higher in the BCRL group than in the control. The BCRL stage significantly correlated with neck circumference and SBQ total score. Additionally, the mean volume difference indicated a significant correlation with the ESS total score and both physical and mental summary components of the SF-12 questionnaire. The prevalence of sleep disturbances among BCSs with and without BCRL is high. Women with advanced stages of BCRL might be at high risk for OSA. Therefore clinical evaluation of BMI, neck circumference, and, snoring overnight should be emphasized among this population.

Standardized List Evaluating Apnea (SLEAP): A Comprehensive Survey to Define the Quality of Life in OSA.

To develop and validate a patient-reported outcome measure (PROM) to evaluate the quality of life (QoL) among patients with obstructive sleep apnea (OSA). A prospective cohort study. Tertiary referral center. We developed a 15-item English questionnaire that was administered to 176 adults with OSA and 22 adult controls without symptoms of OSA in a tertiary sleep surgery clinic between June 2021 and December 2021. The internal consistency and test-retest reliability were measured using the Cronbach's α and the intraclass correlation coefficient, respectively. The 2-sample Wilcoxon rank-sum (Mann-Whitney) test was applied to compare the 2 groups. Convergent validity of the test scores of the questionnaire was compared to previously validated outcome measures and objective sleep study outcomes using the Spearman correlation coefficient. Of the 198 respondents (176 cases and 22 controls); 71% were men and 29% were women. The internal consistency was excellent with the α of .92 (lower 95% confidence limit of 0.90). All the test-retest correlations were positive, significant, and strong ranging from 0.50 to 0.90. The differences between cases and controls were statistically significant for all the items and for the total score. The total score of the questionnaire with the Epworth Sleepiness Scale and objective OSA measures was moderate to strong. The new tool provides a validated PROM to evaluate the QoL among OSA patients specifically, with excellent internal consistency, reasonable test-retest reliability, discriminant validity, and construct validity. Level 4.

MELATONIN ON SLEEP IN PARKINSON’S DISEASE: A RANDOMIZED DOUBLE BLIND PLACEBO CONTROLLED TRIAL

BackgroundSleep disturbances are one of the most common non-motor symptoms in Idiopathic Parkinson’s Disease (IPD) patients. However, the effect of melatonin on sleep problems in Parkinson's disease patients is unclear. Aims and objectivesTo study the effect of melatonin on sleep in IPD patients through subjective and objective assessment. MethodsBetween August 2023 to February 2024, we conducted a randomized, double-blind, placebo-controlled trial on IPD patients. We randomized eligible subjects to melatonin (3mg) (n=43) or placebo (n=43) for 8 weeks. The primary endpoint was sleep quality assessed through the Pittsburgh sleep quality index and daytime sleepiness using Epworth sleepiness scale. Secondary endpoints were polysomnographic sleep parameters, quality of life, motor and non-motor symptoms. Assessments were done at baseline and at the end of 8 weeks. ResultsWe screened 107 IPD patients and 86 patients were included in the study. Seventy three patients (melatonin, 35 and placebo, 38) completed the study. The mean change in Pittsburgh Sleep Quality Index (PSQI) score between the two groups was 1.87 (95% CI: 1.5–2.1; p = 0.001) and Epworth Sleepiness Scale (ESS) score was 1.25 (95% CI: 0.80-1.71; p = 0.001) favoring melatonin. The mean difference between the two groups for Non-Motor Symptoms Scale (NMSS) was 6.11 (95% CI 5.27-6.92; p = 0.001), Parkinson's Disease Questionnaire (PDQ 39) 8.12 (95% CI 6.97-9.50; p = 0.001) & Polysomnography (PSG) parameters [sleep latency 8.36 (95% CI 4.38-12.34; p = 0.001) and total sleep time 14.51 (95% CI 5.00-24.41; p = 0.005)] favoring melatonin. Side effects attributable to melatonin were minimal. ConclusionMelatonin is an effective and safe treatment option for sleep problems in PD patients, and beneficial effects on sleep quality are associated with improved non-motor symptoms and quality of life. We need to emphasize the fact that though we had statistically significant changes in our outcomes, it is not clear whether such changes would have real-life impact (meaningfulness) that would be relevant to licensing authorities or management as patients in our study are young, have short disease duration, have high use of anticholinergics and on modest levodopa equivalent dose. So, we are doubtful if this could be generalized to the typical PD population who are older, have longer disease duration and are on potentially sedating medications or not.

The Impact of Alpha-s1 Casein Hydrolysate On Chronic Insomnia: A Randomized, Double-Blind Controlled Trial

BackgroundAlpha-s1 casein hydrolysate (ACH; Lactium®) is recognized as a supplementary treatment to enhance sleep quality. However, limited studies utilizing objective sleep assessment tools have resulted in a lack of substantial validation. This study aimed to assess the effects of ACH on both subjective sleep assessments and objective polysomnography (PSG) recordings in a hospital-based cohort of Taiwanese individuals with chronic insomnia. MethodsIn this 4-week randomized, double-blind, placebo-controlled trial, 36 participants diagnosed with chronic insomnia were enrolled and randomly assigned to either the ACH or placebo groups. Initially, participants in the ACH group received 600 mg of ACH daily, which was reduced to 300 mg for the latter two weeks; the placebo group received maltodextrin capsules throughout the study. The study utilized polysomnography (PSG), along with detailed sleep questionnaires including the Insomnia Severity Index (ISI), Global Sleep Disorders Score (GSDS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Hospital Anxiety and Depression Scale (HADS), to assess improvements in sleep quality and related health markers. The efficacy of the intervention was assessed through measures of sleep efficiency, stage distribution, and psychological well-being, comparing results from before to after the treatment phase. ResultsThe study demonstrated that ACH treatment notably enhanced sleep quality, evidenced by significant improvements in ISI, GSDS, PSQI, ESS, and HADS scores at both week 2 and 4 (all p-values < 0.05) compared with baseline scores. When compared to the placebo group, the ACH group experienced a marked reduction in GSDS scores over time (p = 0.045). Furthermore, PSG data revealed a significant decrease in sleep onset latency from baseline in the ACH group compared to the placebo group (p = 0.012; -7.7 ± 16.0 minutes vs. 6.1 ± 17.7 minutes for ACH and placebo groups, respectively). These results indicate that ACH treatment effectively improved sleep initiation and overall sleep quality. ConclusionACH Supplementation significantly improved sleep quality, particularly by reducing GSDS scores and sleep onset latency, demonstrating its potential as an effective intervention for chronic insomnia. Future studies with larger samples and exploration of long-term effects are needed to confirm these results.

Samelisant (SUVN-G3031), A Histamine 3 Receptor Inverse Agonist: Results from The Phase 2 Double-Blind Randomized Placebo-Controlled Study for The Treatment of Excessive Daytime Sleepiness in Adult Patients with Narcolepsy

Narcolepsy is a rare, chronic neurological disorder characterized by a dysregulated sleep-wake cycle, with core clinical features including excessive daytime sleepiness (EDS), cataplexy, hypnopompic/hypnagogic hallucinations, and sleep paralysis. Several treatment options are available for the symptomatic management of narcolepsy, but they have limitations. Comorbidities of narcolepsy further limit the treatment choices. Blocking of histamine 3 (H3) receptors has been demonstrated to be a viable approach for the management of symptoms of narcolepsy. Samelisant (SUVN-G3031) is a new H3 receptor inverse agonist. The efficacy, safety, tolerability, and pharmacokinetics of Samelisant in narcolepsy patients were evaluated in a phase 2, double-blind, placebo-controlled study (ClinicalTrials.gov identifier: NCT04072380). Patients diagnosed with narcolepsy according to the International Classification of Sleep Disorders criteria and having an Epworth Sleepiness Scale (ESS) score of ≥12 and a mean Maintenance of Wakefulness Test (MWT) time of <12min across the 4 sessions at baseline were enrolled. The total study duration was up to 7 weeks, which included a screening period of 4 weeks, a treatment period of 2 weeks, and a safety follow-up 1 week after the last study drug administration. The primary efficacy measure was the change in total ESS score compared to placebo. Secondary and exploratory assessments included the Clinical Global Impression of Severity, MWT, Clinical Global Impression of Change, Patient Global Impression of Change and cataplexy rate. Safety assessments included monitoring adverse events (AEs) and laboratory assessments. Of the 426 patients screened, 190 were randomized. The safety and intention-to-treat population included 188 and 164 patients, respectively. A statistically significant treatment effect of Samelisant was observed on the primary endpoint, indicating improvements in EDS. The treatment's impact on EDS was also evident on the other patients' and clinicians' perspectives scales. The AEs reported in ≥5% patients in any treatment groups were insomnia, abnormal dreams, nausea, and hot flush. Global phase 3 studies and long-term safety and efficacy assessments of Samelisant are planned to reaffirm the current findings.

Effectiveness Of Oropharyngeal Exercises For Obstructive Sleep Apnea In Sedentary 45-Year-Old Adult: A Case Report

Background: Obstructive sleep apnea (OSA) is a common condition characterized by repeated episodes of airway obstruction during sleep. Traditional treatments include CPAP and lifestyle modifications. This case report explores the effectiveness of Oropharyngeal exercises in a sedentary 45-year-old adult with OSA. Case Presentation: A 45-year-old sedentary male with moderate OSA underwent a regimen of Oropharyngeal exercises over a 12-week period. Intervention: The patient performed daily Oropharyngeal exercises designed to strengthen the upper airway muscles. Outcome Measures: Improvement was assessed using the Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and subjective sleep quality. Results: After 12 weeks, there was a significant reduction in AHI, improvement in ESS scores, and enhanced subjective sleep quality. Conclusion: Oropharyngeal exercises may be a viable adjunctive treatment for OSA, particularly in sedentary individuals. Further research with larger samples is needed to confirm these findings

Clinical Efficacy of a Position-Responding Mandibular Advancement Device in Patients With Obstructive Sleep Apnea.

Although mandibular advancement device (MAD) treatment is effective for obstructive sleep apnea (OSA), some concerns remain regarding its potential therapeutic impact and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. We conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Fourteen patients diagnosed with OSA participated in this study. Polysomnography (PSG) was performed at the beginning of the clinical trial, and after 3 months of treatment, PSG with AMAD in situ was conducted. The mean scores for the Epworth Sleepiness Scale (ESS) and STOP-Bang were 8.21±4.21 and 5.00±1.00, respectively. After 3 months of AMAD treatment, the STOP-Bang scores improved to 3.75±1.06; however, the ESS scores did not show a significant change. Additionally, we observed statistically significant improvements in several respiratory parameters in the PSG data following AMAD treatment. These included reductions in the apnea-hypopnea index (AHI) (from 32.85±21.71 to 12.93±10.70), supine AHI (from 45.91±23.58 to 15.59±12.76), and lateral AHI (from 13.94±10.95 to 5.49±7.40). Improvements were also noted in the lowest O2 saturation (from 79.71±6.22 to 84.00± 5.71), total arousal number (from 191.14±112.07 to 86.57±48.80), and arousal index (from 33.76±21.00 to 15.05± 8.42). However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, no major side effects were observed during treatment, specifically related to tooth or jaw pain. Our clinical trial found that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.

Interrater reliability of different scoring systems for drug-induced sleep endoscopy

PurposeTo explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.MethodsDISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss’ kappa for categorical data and linearly weighted kappa for ordinal data.ResultsIn total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.ConclusionThe interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.

Diagnostic utility of obstructive sleep apnea screening questionnaires: a comprehensive meta-analysis.

The main objective of this meta-analysis was to assess the accuracy of the Sleep-Related Breathing Disorder (SRBD) Scale in the diagnosis of obstructive sleep apnea syndrome (OSAS). A comprehensive review and meta-analysis of observational studies evaluating the diagnostic utility of OSA screening questionnaires were performed. Analyses determined the summary receiver operator characteristic area under the curve (SROC), the pooled sensitivity (Se), and the specificity (Sp). Subgroup analysis investigated and compared the summary sensitivity, specificity, and diagnostic odds ratio (DOR) among the BQ, STOP, and ESS according to the severity of OSA. 34 studies were included. The Berlin questionnaire had a sensitivity of 0.80 and a specificity of 0.48, while the Epworth sleepiness scale had a sensitivity of 0.48 and a specificity of 0.73. The STOP-BANG scale had a sensitivity and specificity of 0.89 and 0.40, respectively. The diagnostic accuracy of BQ, ESS, NoSAS, and STOP was evaluated based on OSA severity. BQ and STOP had higher sensitivity and specificity, while ESS had lower specificity. The current meta-analysis indicates that the SRBD scale has acceptable accuracy in detecting patients with OSAS. We propose that the STOP questionnaire could be used as an easy-to-use and accurate screening tool for the identification of patients at risk for OSAS in the general population. ESS had higher specificity, allowing healthcare professionals to prioritize interventions and tailor treatment plans based on OSA severity.

Психологические особенности проявления посттравматического стрессового расстройства у мирного населения региона, подвергшегося локальным военным действиям (на примере г. Мариуполь)

&lt;p&gt;The work aims to study the relationship between the level of risk of PTSD, coping strategies, psychological defense mechanisms and other manifestations of personality traits. Materials from an empirical study conducted on a sample of students at the Mariupol State University named after A.M. Kuindzhi are presented. &lt;strong&gt;Sample.&lt;/strong&gt; The study involved 99 respondents aged 18&amp;ndash;35 years, with data from a female subgroup of 90 individuals, averaging 21.09 years old. &lt;strong&gt;Methods&lt;/strong&gt; used included the Trauma Screening Questionnaire for screening post-traumatic stress disorder, the Ways of Coping Questionnaire (WCQ) adapted in Russian by L.I. Wasserman and the Self-Report of Defense Styles questionnaire by M. Bond, adapted in Russian by E.E. Tunik. Additionally, the Scale of Reactive and Personal Anxiety by C.D Spielberger was used in its Russian-language adaptation by Y.L. Hanin, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Questionnaire for Determining the Sleep Quality Index (Pittsburgh Sleep Quality Index, PSQI), Spiegel Scale of Subjective Sleep Characteristics (Medical Outcomes Study Sleep Scale, MOS-SS), Epworth Sleepiness Scale author&amp;rsquo;s questionnaire. &lt;strong&gt;Results.&lt;/strong&gt; The results obtained allow us to say that a high risk of PTSD development is related to the coping strategy &amp;ldquo;escape&amp;ndash;avoidance&amp;rdquo;, maladaptive personality defenses, and subjective sleep disorders, such as nightmares and insomnia.&lt;/p&gt;

Performance of questionnaires to predict sleep-disordered breathing in acute stroke patients.

Sleep-disordered breathing is common in stroke and may negatively affect its outcome. Screening for sleep-disordered breathing in this setting is of interest but poorly studied. We aimed to evaluate the performance of eight obstructive sleep apnea screening questionnaires to predict sleep-disordered breathing in acute stroke or transient ischaemic attack patients, and to assess the impact of stroke/transient ischaemic attack-specific factors on sleep-disordered breathing prediction. We analysed acute stroke/transient ischaemic attack patients (N = 195) from a prospective cohort ("Sleep Deficiency and Stroke Outcome study"). Assessments included anthropometrics, stroke-specific parameters, sleep history, an in-hospital respiratory polygraphy within the first week after stroke, and obstructive sleep apnea screening questionnaires (Berlin Questionnaire, Epworth Sleepiness Scale, STOP-BANG, NoSAS, Sleep Apnea Clinical Score, No-Apnea, Sleep Obstructive apnea score optimized for Stroke, SLEEP-IN). In a binary classification task for respiratory event index ≥ 15 per hr, we evaluated the performance of the above-mentioned questionnaires. We used logistic regression to identify predictors for sleep-disordered breathing in this cohort. The areas under the curve for respiratory event index ≥ 15 per hr were: Berlin Questionnaire 0.60; STOP-BANG 0.72; NoSAS 0.69; No-Apnea 0.69; Sleep Apnea Clinical Score 0.75; Epworth Sleepiness Scale 0.50; Sleep Obstructive apnea score optimized for Stroke 0.58; and SLEEP-IN 0.67. The No-Apnea had the lowest false omission rate (0.13), a sensitivity of 0.97 and a specificity of 0.12. In multiple logistic regression analysis (respiratory event index ≥ 15 per hr), age, neck circumference, National Institutes of Health Stroke Scale at admission, prior stroke, cardioembolic stroke aetiology and observed apneas were associated with sleep-disordered breathing. The logistic regression model performed similar (area under the curve 0.80) to Sleep Apnea Clinical Score (p = 0.402) and STOP-BANG (p = 0.127), but outperformed the other questionnaires. Neither existing questionnaires nor our statistical model are sufficient to accurately diagnose sleep-disordered breathing after stroke, thus requiring sleep study evaluation. The No-Apnea questionnaire may help to identify patients amenable to sleep testing.

Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?

Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence. Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2-6months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis.Adherence data was downloaded from the UAS device. 327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (β = 3.7, CI [1.3, 7.4], p = 0.038) and increased age (β = 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence. UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.

The impact of sleep deprivation on the functional connectivity of visual-related brain regions

BackgroundSleep deprivation(SD) is known to impair cognitive function and emotional regulation, however, its specific effects on the functional connectivity of visual-related brain regions remain unclear. ObjectivesThis study aimed to investigate the impact of 36-h acute sleep deprivation on functional connectivity in visual neural circuits and its relationship with cognitive and emotional changes. MethodsSixty healthy male participants were assessed before and after 36 h of sleep deprivation using resting-state fMRI, the Psychomotor Vigilance Task (PVT), the Epworth Sleepiness Scale (ESS), and the Profile of Mood States (POMS). Functional connectivity changes were analyzed using paired t-tests and False Discovery Rate (FDR) correction. Key resultsSleep deprivation significantly altered functional connectivity between the prefrontal cortex, hippocampus, and visual processing regions. These changes correlated with slower PVT reaction times, increased subjective sleepiness (ESS), and emotional disturbances (POMS), including heightened tension and reduced self-esteem. ConclusionsThe findings suggest that acute sleep deprivation impairs cognitive performance and emotional regulation by changing functional connectivity in key brain regions. These results may strengthen our understanding of neurobiology of SD and its potential negative effects.

Hyperbaric oxygen therapy improves motor symptoms, sleep, and cognitive dysfunctions in Parkinson's disease.

To systematically analyze the therapeutic effectiveness of hyperbaric oxygen therapy compared with conventional drug therapy in patients with Parkinson's disease. PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Database, searched to the end of March 2023. Two authors independently screened and abstracted data from each trial. The primary outcome measures included the efficacy rate and the Unified Parkinson's Disease Rating Scale III (UPDRS III). Secondary outcome measures included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Depression Scale (HAMD), Minimum Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Hoehn-Yahr staging. Thirteen studies with a total of 958 participants were included in the meta-analysis. After intervention, the experimental group exhibited a higher treatment efficacy rate compared to the control group [OR=3.18, 95%CI (1.60, 6.33), P<0.01], a lower UPDRS III score [MD=-2.96, 95%CI (-4.31, -1.61), P<0.01], and lower Hoehn-Yahr staging [MD=-0.14, 95%CI (-0.26, -0.02), P<0.01]. The experimental group also outperformed the control group in non-motor symptoms, with higher scores in MoCA, PSQI, and ESS [SMD=0.65, 95%CI (0.45, 0.85), P<0.01], [MD=-2.52, 95%CI (-2.85, -2.18), P<0.01], and [MD=-3.30, 95%CI (-3.77, -2.83), P<0.01], respectively. Hyperbaric oxygen therapy improves motor function, relieves the severity of the disease, ameliorates cognitive function, and improves sleep quality while alleviating excessive daytime sleepiness in patients with Parkinson's disease. The therapeutic mechanism of hyperbaric oxygen therapy may be related to increased cerebral tissue oxygen content, which contributes to anti-hypoxic, anti-inflammatory, anti-apoptotic, and antioxidant stress.