Subjective Excessive Daytime Sleepiness Research Articles

Validation and performance of the sleep inertia questionnaire in central disorders of hypersomnolence

BackgroundOptimal measurement tools for problematic sleep inertia, common in some central disorders of hypersomnolence (CDH), have not yet been determined. We evaluated the performance of the Sleep Inertia Questionnaire (SIQ) in CDH, and how well it distinguished hypersomnolent groups from controls, and IH (idiopathic hypersomnia) from narcolepsy type 1 (NT1). MethodsThis prospective, bi-centric study included 63 control, 84 IH, 16 NT1, 18 narcolepsy type 2 (NT2), and 88 subjective excessive daytime sleepiness (sEDS) participants, using ICSD-3 criteria. 126 (47.2 %) participants were on any medication at the time of SIQ completion. We assessed construct validity of SIQ scores, and sleep inertia duration (SID), and compared them across diagnoses, controlling for age and center. We derived cutpoints to distinguish hypersomnolent patients from controls and IH from NT1. Sensitivity analyses for depression, chronotype, and medication were performed. ResultsThe SIQ sum and composite score were significantly lower in controls than in other groups (p < 0.0001), demonstrating outstanding ability to distinguish patients from controls (AUCs 0.92), without differences among hypersomnolent groups. SID (AUC 0.76) was significantly shorter in controls than in all hypersomnolent groups except NT1, and was shorter in NT1 than in IH or sEDS. Optimal SIQ sum cutpoint was 42 (J = 0.71) for patients versus controls. Optimal SID cutpoint in distinguishing IH from NT1 was 25 min (J = 0.39). ConclusionThe SIQ has excellent ability to distinguish hypersomnolent patients from healthy controls, after controlling for depression, eveningness, and medication. SID is best at distinguishing IH from NT1.

Evaluation of the Relationship Between Subjective Excessive Daytime Sleepiness and Polysomnographic Respiratory Variables in Adult Obstructive Sleep Apnea Syndrome

Evaluation of the Relationship Between Subjective Excessive Daytime Sleepiness and Polysomnographic Respiratory Variables in Adult Obstructive Sleep Apnea Syndrome

The Epworth sleepiness scale may have more advantages than the multiple sleep latency test in assessing sleepiness in patients with obstructive sleep apnea.

This study aimed to analyze the brain function of severe obstructive sleep apnea patients with various sleepiness assessment methods and explore the brain imaging basis for the differences between these methods. This study included 30 severe obstructive sleep apnea patients and 19 healthy controls. Obstructive sleep apnea patients were divided into a subjective excessive daytime sleepiness group and a subjective non-excessive daytime sleepiness group according to the Epworth sleepiness scale. Moreover, they were divided into an objective excessive daytime sleepiness group and an objective non-excessive daytime sleepiness group according to the multiple sleep latency test. The fractional amplitude of low-frequency fluctuation was used to assess the features of brain function. Compared with healthy controls, participants in the subjective excessive daytime sleepiness group exhibited higher fractional amplitude of low-frequency fluctuation signals in the right thalamus, left cerebellar lobe 6, left putamen, and pallidum. Participants in the objective excessive daytime sleepiness group showed higher fractional amplitude of low-frequency fluctuation signals in the right thalamus and lower fractional amplitude of low-frequency fluctuation signals in the right superior frontal gyrus, the dorsolateral and superior frontal gyrus, and the medial orbital. We concluded that the thalamus may be involved in subjective and objective sleepiness regulation. Functional abnormalities in the putamen and pallidum may be involved in subjective sleepiness, whereas the frontal lobe may be involved in objective sleepiness.

Role of Daytime Continuous Polysomnography in the Diagnosis of Pediatric Narcolepsy Type 1.

Narcolepsy type 1 (NT1) is still largely underdiagnosed or diagnosed too late in children. Difficulties in obtaining rapid and reliable diagnostic evaluations of the condition in clinical practice partially explain this problem. Predictors of NT1 include cataplexy and sleep-onset REM periods (SOREMPs), documented during nocturnal polysomnography (N-PSG) or through the multiple sleep latency test (MSLT), although low CSF hypocretin-1 (CSF hcrt-1) is the definitive biological disease marker. Obtaining reliable MSLT results is not always feasible in children; therefore, this study aimed to validate daytime continuous polysomnography (D-PSG) as an alternative diagnostic tool. Two hundred consecutive patients aged younger than 18 years (112 with NT1; 25 with other hypersomnias, including narcolepsy type 2 and idiopathic hypersomnia; and 63 with subjective excessive daytime sleepiness) were randomly split into 2 groups: group 1 (n = 133) for the identification of diagnostic markers and group 2 (n = 67) for the validation of the detected markers. The D-PSG data collected included the number of spontaneous naps, total sleep time, and the number of daytime SOREMPs (d-SOREMP). D-PSG data were tested against CSF hcrt-1 deficiency (NT1 diagnosis) as the gold standard using receiver operating characteristic (ROC) curve analysis in group 1. ROC diagnostic performances of single and combined D-PSG parameters were tested in group 1 and validated in group 2. In group 1, the areas under the ROC curve (AUCs) were 0.91 (95% CI 0.86-0.96) for d-SOREMPs, 0.81 (95% CI 0.74-0.89) for the number of spontaneous naps, and 0.70 (95% CI 0.60-0.79) for total sleep time. A d-SOREMP count ≥1 (sensitivity of 95% and specificity of 72%), coupled with a diurnal total sleep time above 60 minutes (sensitivity of 89% and specificity of 91%), identified NT1 in group 1 with high reliability (area under the ROC curve of 0.93, 95% CI 0.88-0.97). These results were confirmed in the validation group with an AUC of 0.88 (95% CI 0.79-0.97). D-PSG recording is an easily performed, cost-effective, and reliable tool for identifying NT1 in children. Further studies should confirm its validity with home D-PSG monitoring. These alternative procedures could be used to confirm NT1 diagnosis and curtail diagnostic delay.

Challenging subjective excessive daytime sleepiness as an insomnia symptom: a retrospective study.

Diagnostic manuals describe insomnia disorder (ID) characterised by fatigue and sleepiness as diurnal consequences of nocturnal symptoms. However, patients with ID do not frequently report sleepiness in the clinical setting. The present study aimed to investigate subjective sleepiness in ID measured through the Epworth Sleepiness Scale (ESS) and its independence towards daytime functioning and fatigue, and to evaluate cognitive behavioural therapy for insomnia (CBT-I) improvement in daytime consequences and their relationship to sleepiness and fatigue. We retrospectively collected the ESS evaluation in a large sample of 105 healthy controls (HCs), 671 patients with ID, and 602 patients with sleep disorders characterised by excessive daytime sleepiness (EDS). Moreover, we conducted a pre-post evaluation of the ESS in a sub-sample of patients with ID who underwent CBT-I. Component 2 of the Insomnia Severity Index and Profile of Mood States-Fatigue Inertia Scale was used to evaluate daytime functioning and fatigue. Patients with ID reported ESS levels comparable to that observed in HCs and significantly lower than the EDS group. No significant correlation arose between ESS and the diurnal impact of the disorder, suggesting the independence between daytime functioning and sleepiness in ID. Contrarily, insomnia severity and diurnal impact significantly correlated with fatigue. Data showed a statistically significant increase in sleepiness after CBT-I, despite significantly improving daytime consequences and fatigue. Although diagnostic manuals report sleepiness and fatigue as daytime consequences of sleep symptoms in patients with ID, these retrospective data indicate a dissociation between these entities. This evidence aligns with the core feature of ID: the hyperarousal status that pervades patients also during wakefulness.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study.

Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.

Early- and late-onset narcolepsy: possibly two distinct clinical phenotypes.

To investigate the clinical characteristics and the risk factors associated with excessive daytime sleepiness (EDS) in patients with early- and late-onset narcolepsy. Patients with narcolepsy were consecutively recruited. All patients were separated into early- and late-onset groups according to the onset age of disease ≤ 15 and > 15years, respectively. Demographic, clinical, and sleep parameters were compared between the two groups. Linear regressions were performed to examine the risk factors of subjective and objective EDS in patients with early- and late-onset narcolepsy. A total of 101 patients with narcolepsy (median age at recruitment = 18.0 years) were classified into anearly-onset group(67 patients withmedian age at onset = 12.0years) and alate-onset group (34 patients withmedian age at onset = 28.5years). Compared with early-onset group, late-onset group scored significantly higher on Epworth Sleepiness Scale (ESS), Ullanlinna Narcolepsy Scale (UNS), sleep paralysis, rapid eye movement (REM) sleep behavior disorder (RBD) questionnaire-Hong Kong (all P < 0.050). UNS-cataplexy and sleep paralysis had significantly positive associations with subjective EDS, and N1%, arousal index, and periodic limb movements index were positively associated with objective EDS in the early-onset group (all P < 0.050). However, these associations were not observed in late-onset narcolepsy. Late onset narcolepsy had more severe self-reported narcolepsy symptoms. REM sleep related symptoms and disrupted nighttime sleep were associated with EDS in early-onset narcolepsy. These findings suggest that early- and late-onset narcolepsy may represent two distinct phenotypes.

Differentiation of central disorders of hypersomnolence with manual and artificial-intelligence-derived polysomnographic measures.

Differentiation of central disorders of hypersomnolence (DOH) is challenging but important for patient care. This study aimed to investigate whether biomarkers derived from sleep structure evaluated both by manual scoring as well as with artificial intelligence (AI) algorithms allow distinction of patients with different DOH. We included video-polysomnography data of 40 narcolepsy type 1 (NT1), 26 narcolepsy type 2 (NT2), 23 patients with idiopathic hypersomnia (IH) and 54 participants with subjective excessive daytime sleepiness (sEDS). Sleep experts manually scored sleep stages. A previously validated AI algorithm was employed to obtain automatic hypnograms and hypnodensity graphs (where each epoch is represented as a mixture of sleep stage probabilities). One-thousand-three features describing sleep architecture and instability were extracted from manual/automatic hypnogram and hypnodensity graphs. After feature selection, random forest classifiers were trained and tested in a 5-fold-cross-validation scheme to distinguish groups pairwise (NT1-vs-NT2, NT1-vs-IH, …) and single groups from the pooled remaining ones (NT1-vs-rest, NT2-vs-rest,…). The accuracy/F1-score values obtained in the test sets were: 0.74 ± 0.04/0.79 ± 0.05 (NT1-vs-NT2), 0.89 ± 0.09/0.91 ± 0.08 (NT1-vs-IH), 0.93 ± 0.06/0.91 ± 0.07 (NT1-vs-sEDS), 0.88 ± 0.04/0.80 ± 0.07 (NT1-vs-rest), 0.65 ± 0.10/0.70 ± 0.09 (NT2-vs-IH), 0.72 ± 0.12/0.60 ± 0.10 (NT2-vs-sEDS), 0.54 ± 0.19/0.38 ± 0.13 (NT2-vs-rest), 0.57 ± 0.11/0.35 ± 0.18 (IH-vs-sEDS), 0.71 ± 0.08/0.35 ± 0.10 (IH-vs-rest) and 0.76 ± 0.08/0.71 ± 0.13 (sEDS-vs-rest). The results confirm previous findings on sleep instability in patients with NT1 and show that combining manual and automatic AI-based sleep analysis could be useful for better distinction of NT2 from IH, but no precise sleep biomarker of NT2 or IH could be identified. Validation in a larger and multi-centric cohort is needed to confirm these findings.

Associations between common sleep disturbances and cardiovascular risk in patients with obstructive sleep apnea: A large-scale cross-sectional study.

Studies have shown that obstructive sleep apnea (OSA) is inextricably linked with cardiovascular diseases (CVD). However, the roles of certain common sleep disturbances, such as low slow-wave sleep, excessive daytime sleepiness and short sleep duration, in the pathogenesis and progression of CVD in patients with OSA have not been determined. Therefore, we conducted a large cross-sectional study to explore the effect of low slow-wave sleep, excessive daytime sleepiness and short sleep duration on the risk of CVD in patients with OSA. Subjects were consecutively enrolled to participate in the sleep center of Shanghai Jiao Tong University Affiliated Sixth People's Hospital. All OSA patients were diagnosed by standard polysomnography, while controls were all simple snorers. A total of 4,475 participants were strictly recruited. The Framingham Risk Score were employed to assess the 10-year risk of CVD, and logistic regression was used to measure the association between sleep disturbances and the moderate-to-high CVD risk. In the whole cohort, OSA, excessive daytime sleepiness, and low slow-wave sleep were all risk factors for the moderate-to-high 10-year CVD risk (odds ratio [OR] = 3.012, 95% confidence interval [CI] 2.418-3.751; OR = 1.407, 95% CI: 1.228-1.613, and OR = 0.973,95% CI: 0.967-0.980), but sleep duration did not contribute significantly to that risk. Whether in patients with OSA and controls, low SWS (<12.8%) could increase the risk of CVD. Subjective excessive daytime sleepiness would significantly increase the risk of CVD only in patients with severe OSA. It is important to pay more attention to the impact of sleep on cardiovascular health. Patients with sleep disturbances should adopt a healthy lifestyle and undergo regular follow-up of cardiovascular indicators to prevent cardiovascular complications. [http://www.chictr.org.cn/showproj.aspx?proj=43057], identifier [ChiCTr1900025714].

Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view.

Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe.

Excessive daytime sleepiness in sleep apnea: any role of testosterone or vitamin D?

Recent studies reported association of sleep-disordered breathing (SDB) with testosterone and vitamin D deficiency. Low testosterone and vitamin D levels have been linked to fatigue and excessive daytime sleepiness (EDS). However, the impact of testosterone and vitamin D deficiency on EDS in subjects with SDB remains unknown. The aim of this study was to explore the predictors of EDS in habitual snorers. Role of testosterone, and vitamin D was studied in detail. We also looked for associations between testosterone, vitamin D, and sleep-related indices. We prospectively enrolled 291 consecutive male patients with habitual snoring. Baseline clinical characteristics were recorded on admission. Standard overnight polysomnography was performed to detect SDB, and Epworth Sleepiness Scale (ESS) was used to assess EDS. Blood samples were obtained in a fasting condition in the morning after polysomnography to determine levels of testosterone and vitamin D. Respiratory disturbance index (RDI) (95 % CI: 1.004-1.024, p=0.005) and the use of antihistamines (95 % CI: 1.083-11.901, p=0.037) were the only independent variables significantly associated with EDS in binary logistic regression analysis. In linear multiple regression analysis, body mass index (BMI) (Beta=-0.282, p<0.001) and oxygen desaturation index (Beta=-0.150, p=0.043) were the only independent variables significantly associated with testosterone levels, and BMI (Beta=-0.142, p=0.016) was the only independent variable significantly associated with vitamin D. We failed to find any independent association of testosterone and vitamin D with subjectively rated EDS among habitual snorers. Our results suggest an independent association between the magnitude of nocturnal desaturation and testosterone levels.

Atopic Dermatitis and Excessive Daytime Sleepiness: Analysis of Data from 8362 Adult Subjects in a Sub-Saharan Africa Country

Sleep disorders in patients with atopic dermatitis (AD) are common and can have a negative impact on the quality of life of the affected subjects. Very little data are available on the association between AD and excessive daytime sleepiness (EDS) in adults. The objective of this study was to compare the prevalence of EDS in subjects with AD and those without AD, and to investigate the determinants of EDS in adults with AD. In this cross-sectional population-based study conducted from 2015 to 2018 in Cameroon, adult subjects aged at least 19 years were included by multi-level stratified random sampling. AD was defined as the presence of a chronic itchy dermatitis evolving intermittently over a period of at least 6 months and electively affecting certain areas (fronts of the elbows, back of the knees, front of the ankles, under the buttocks, around the neck, around the eyes or ears) during the last 12 months preceding the survey. EDS was defined by an Epworth score≥10. Logistic regression was used to investigate the independent association between EDS and AD. A difference was considered significant if p&lt;0.05. A total of 8362 subjects (55.2% women) with median age (25th-75th percentiles) of 39 (27-54) years were included. There were 217 subjects (2.6%) with AD and 1022 subjects (12.2%) with EDS. The prevalence of EDS was higher in subjects with AD than in those without AD (22.1% vs. 12%, p&lt;0.001). In multivariate analysis integrating potential confounders (area of recruitment, age, education level, body mass index, association with other allergic diseases), AD remained independently associated with EDS with an adjusted odds ratio (95% CI) of 2.18 (1.54-3.08). No independent associated factors to EDS were found in subjects with AD. There is an independent association between EDS and AD, and nearly one quarter of patients with AD has EDS in this setting. It is necessary to consider the systematic evaluation of EDS in subjects with AD to optimize their management.

The rate of decrease in oxygen desaturation during severe obstructive sleep apnea syndrome is correlated with subjective excessive daytime sleepiness.

To explore factors that influence subjective excessive daytime sleepiness (EDS) in patients with severe obstructive sleep apnea syndrome (OSAS). Patients with snoring seen at the Sleep Medicine Center of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University between October 2018 and November 2019 were included in this study. All patients underwent polysomnography (PSG). Noninvasive frequency-domain analysis was used to assess the autonomic nervous system regulation of the heart, with the low frequency (LF)/high frequency (HF) power ratio used to represent the sympathetic-parasympathetic balance. Daytime sleepiness was evaluated by the Epworth sleepiness scale (ESS). Overnight apnea episodes were included for analyses. The rate of pulse oxyhemoglobin saturation (SpO2) decrease was measured as the change in the percentage of SpO2 per second after obstructive apnea and was expressed as the oxygen desaturation rate (ODR). A total of 101 patients with severe OSAS were enrolled in this study and were further divided into two groups: the EDS group (ESS > 10, n = 52) and the non-EDS group (ESS ≤ 10, n = 49). The apnea-hypopnea index (AHI), respiratory effort-related arousals (RERAs), and LF/HF power ratio were significantly higher in the EDS group than in the non-EDS group (AHI: 69.9 ± 14.5 vs. 57.9 ± 16.1 events/h; RERAs: 42.2 ± 16.7 vs. 30.4 ± 13.7 events/h; LF/HF power ratio: 2.9 ± 0.8% vs. 2.4 ± 0.9%, all p < 0.001). Multiple linear regression analyses revealed that after adjusting for covariates expected to affect this relationship, ESS scores were correlated with ODR (β = 0.520, p < 0.001) and LF/HF power ratio (β = 0.155, p = 0.028), rather than with the traditional sleep-disordered breathing parameters. Compared with the traditional PSG parameters, both ODR and an increased LF/HF power ratio were more closely related to daytime sleepiness, especially ODR.

Sleep disordered breathing and subjective excessive daytime sleepiness in relation to the risk of motor vehicle crash: the Toon Health Study

Sleep disordered breathing (SDB) is a significant cause of motor vehicle crash (MVC). We conducted a prospective cohort study among 1047 Japanese community-dwellers to detect whether the presence or absence of subjective excessive daytime sleepiness (EDS) affect the association of SDB with a risk of MVC. SDB was assessed by a single airflow monitor which measured the respiratory disturbance index (RDI) during one-night, and participants were classified into the SDB group (RDI ≥ 10) and non-SDB group (RDI < 10). Subjective EDS was defined as Japanese version of Epworth Sleepiness Scale scores ≥ 11. A follow-up questionnaire five years after the baseline ascertained history of MVC over the period. Multivariable logistic regression analysis examined the association between SDB and MVC after stratification by subjective EDS. The multivariable-adjusted odds ratios (95% confidence interval) for MVC among the female SDB group were 1.66 (1.05–2.63) compared with the non-SDB group, and this association was more evident in females without subjective EDS [1.84(1.02–3.32)], but not among those with subjective EDS. There was no significant association in males. These findings indicate that SDB screening should be recommended regardless of subjective EDS to prevent SDB-related MVC among general population, particularly in females.

0711 Select Symptoms From The Epworth Sleepiness Scale Questionnaire And Response To Therapy Of Central Sleep Apnea With Phrenic Nerve Stimulation

Abstract Introduction Some subjects with central sleep apnea (CSA) complain of subjective excessive daytime sleepiness (EDS), as assessed by the Epworth Sleepiness Score (ESS). However, there is considerable variability in the level of chances of dozing for each of the 8 ESS questions, as each reflects a different situation. The aim of this analysis was to examine individual situations of the ESS and determine if transvenous phrenic nerve stimulation (TPNS) resulted in improvements of individual ESS situations which were scored moderate to high (2 and 3) at baseline. Patient Global Assessment (PGA) was also assessed. Methods All 151 subjects enrolled in the randomized (Treatment vs Control) remedē System pivotal trial were included in the analysis. All subjects were implanted, but activation in Control arm was delayed 6 months. Results Greater than or equal to 50% of patients scored moderate-high on several individual ESS situations: chance of dozing while sitting and reading (57%), watching television (62%), while lying down to rest in the afternoon when circumstances permit (76%). In the active arm, 68%, 44% and 29% of patients with moderate-high at baseline, respectively, for sitting and reading, watching television, and lying down to rest in the afternoon shifted to less than moderate at 6 months. Respective shifts for the control arm were 29%, 23% and 13%. Seventy-two percent of treated subjects with baseline ESS&amp;gt;10 shifted to ≤10 at 6 months compared to 26% of control patients. Additionally, 72% of treated compared to 7% of control subjects with baseline ESS&amp;gt;10 reported markedly or moderately improved QoL. Conclusion Results of this randomized controlled trial shows that compared to the control arm, TPNS leads to improvements in various situations of the ESS as well as QoL. The most improved situations were less chance of dozing while reading and watching television. Support Respicardia

Excessive Daytime Sleepiness and Hypertension in Cameroonian Adult Population

Data on association between excessive daytime sleepiness (EDS) and hypertension are very limited in sub-Saharan Africa. The aim of this study was to look for an independent association between EDS and hypertension and identify the factors associated to EDS in adult subjects with hypertension in Cameroon. Data from cross-sectional community surveys conducted from 2015 to 2018 in three regions of Cameroon (West, Littoral, and North) were analyzed. The participants aged ≥ 19 years were included using multilevel stratified random sampling method. EDS was defined as an Epworth score ≥ 10. Subjects were considered to have hypertension if they were on treatment for hypertension or had a blood pressure ≥ 140/90 mmHg measured by standard protocols. Logistic regression was used to investigate the factors associated to EDS. The p-value &lt; 0.05 was set as significant statistical threshold. A total of 8288 subjects (55.2% females) of median age (25th -75th percentiles) of 39 (27-54) years were included. The prevalence of EDS was higher in subjects who had hypertension as than in those without hypertension (13.4% vs 11.5%, p = 0.015), with an unadjusted odds ratio (IC 95%) of 1.19 (1.04-1.38). After multivariate analysis including place of residence, age, sex, education level and body mass index (BMI), we did not find an independent association between EDS and hypertension [odds ratio 95% CI): 1.01 (0.8-1.18), p = 0.937]. The determinants of EDS in subjects with hypertension were residence in Bandjoun [2.23 (1.12-4.11), p = 0.10], Douala [2.78 (1.48-5.25), p = 0.002] and Garoua [1.95 (1.01-3.74), p = 0.045] compared to Figuil; and BMI [1.04 (1.02-1.06) per 1kg/m2 increase, p = 0.001]. In conclusion, we did not find an independent association between EDS and hypertension in Cameroon. Obesity is associated with EDS in subjects with hypertension.

Excessive Daytime Sleepiness and Hypertension in Cameroonian Adult Population

Data on association between excessive daytime sleepiness (EDS) and hypertension are very limited in sub-Saharan Africa. The aim of this study was to look for an independent association between EDS and hypertension and identify the factors associated to EDS in adult subjects with hypertension in Cameroon. Data from cross-sectional community surveys conducted from 2015 to 2018 in three regions of Cameroon (West, Littoral, and North) were analyzed. The participants aged ≥ 19 years were included using multilevel stratified random sampling method. EDS was defined as an Epworth score ≥ 10. Subjects were considered to have hypertension if they were on treatment for hypertension or had a blood pressure ≥ 140/90 mmHg measured by standard protocols. Logistic regression was used to investigate the factors associated to EDS. The p-value < 0.05 was set as significant statistical threshold. A total of 8288 subjects (55.2% females) of median age (25^th -75^th percentiles) of 39 (27-54) years were included. The prevalence of EDS was higher in subjects who had hypertension as than in those without hypertension (13.4% vs 11.5%, p = 0.015), with an unadjusted odds ratio (IC 95%) of 1.19 (1.04-1.38). After multivariate analysis including place of residence, age, sex, education level and body mass index (BMI), we did not find an independent association between EDS and hypertension [odds ratio 95% CI): 1.01 (0.8-1.18), p = 0.937]. The determinants of EDS in subjects with hypertension were residence in Bandjoun [2.23 (1.12-4.11), p = 0.10], Douala [2.78 (1.48-5.25), p = 0.002] and Garoua [1.95 (1.01-3.74), p = 0.045] compared to Figuil; and BMI [1.04 (1.02-1.06) per 1kg/m2 increase, p = 0.001]. In conclusion, we did not find an independent association between EDS and hypertension in Cameroon. Obesity is associated with EDS in subjects with hypertension.

The impact of subjective excessive daytime sleepiness on cognition in parkinson disease

The impact of subjective excessive daytime sleepiness on cognition in parkinson disease

Atopic Dermatitis and Excessive Daytime Sleepiness: Analysis of Data from 8362 Adult Subjects in a Sub-Saharan Africa Country

Sleep disorders in patients with atopic dermatitis (AD) are common and can have a negative impact on the quality of life of the affected subjects. Very little data are available on the association between AD and excessive daytime sleepiness (EDS) in adults. The objective of this study was to compare the prevalence of EDS in subjects with AD and those without AD, and to investigate the determinants of EDS in adults with AD. In this cross-sectional population-based study conducted from 2015 to 2018 in Cameroon, adult subjects aged at least 19 years were included by multi-level stratified random sampling. AD was defined as the presence of a chronic itchy dermatitis evolving intermittently over a period of at least 6 months and electively affecting certain areas (fronts of the elbows, back of the knees, front of the ankles, under the buttocks, around the neck, around the eyes or ears) during the last 12 months preceding the survey. EDS was defined by an Epworth score≥10. Logistic regression was used to investigate the independent association between EDS and AD. A difference was considered significant if p<0.05. A total of 8362 subjects (55.2% women) with median age (25th-75th percentiles) of 39 (27-54) years were included. There were 217 subjects (2.6%) with AD and 1022 subjects (12.2%) with EDS. The prevalence of EDS was higher in subjects with AD than in those without AD (22.1% vs. 12%, p<0.001). In multivariate analysis integrating potential confounders (area of recruitment, age, education level, body mass index, association with other allergic diseases), AD remained independently associated with EDS with an adjusted odds ratio (95% CI) of 2.18 (1.54-3.08). No independent associated factors to EDS were found in subjects with AD. There is an independent association between EDS and AD, and nearly one quarter of patients with AD has EDS in this setting. It is necessary to consider the systematic evaluation of EDS in subjects with AD to optimize their management.

Disease-specific attention impairment in disorders of chronic excessive daytime sleepiness

ObjectivePatients with chronic excessive daytime sleepiness (EDS) complain of substantial attention deficits. However, their underlying neuronal dysfunction is largely unknown. Previous studies showed similar attention performances in central disorders of hypersomnolence suggesting that EDS-related cognitive impairment is independent of its cause. The aim of the current study was to further explore attentional profiles in disorders of chronic EDS. MethodsTen patients with narcolepsy type 1 (NT1; age 26.7 ± 9.3 years), 14 patients with idiopathic hypersomnia (IH; age 26.7 ± 9.3 years), 14 patients with subjective EDS (sEDS; age 31.4 ± 14.3 years), ie, a mean sleep latency >8 min in the multiple sleep latency test (MSLT), and 20 healthy controls (HC; age 32.6 ± 11.3 years) performed the vigilance task and the selective attention task of the test battery SLEEP® (Vienna Test System Neuro®). We assessed mean response time (RT) and standard deviation of RT separately for the first and the second half of the vigilance task to evaluate performance changes over time (time on task effect; TOT). ResultsA significant interaction effect between group and TOT on the mean RT in the vigilance task suggests partly group-specific attention deficits. Combining paradigms of sustained and selective attention discriminated patients with NT1, IH, sEDS and HC. Behavioral results were unrelated to the mean sleep latency in the MSLT. ConclusionsDiscriminative performance of the sustained and selective attention tasks indicate disease-specific components of attention in NT1, IH, and sEDS. Different temporal dynamics of attentional control efficiency might be one factor underlying group differences.