Improvement In Daytime Sleepiness Research Articles

A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial

BackgroundCompliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP...

The Immediate and Sustained long-Term Changes in Daytime Sleepiness After Participation in a Workplace Pedometer Program: A Prospective Cohort Study.

To assess the potential benefit of a workplace physical activity program on daytime sleepiness. A total of 685 participants of a 4-month workplace physical activity program were assessed for daytime sleepiness (Epworth Sleepiness Scale [ESS]) at baseline, 4 months (postprogram), and 12 months. Changes in ESS were analyzed using multilevel mixed linear regression. In the total population, no changes in ESS scores were observed; 0 to 4 months: -0.2 (95% CI: -0.5 to 0.0), 4 to 12 months: 0.1 (95% CI: -0.2 to 0.4). In participants with baseline excessive daytime sleepiness (ESS > 10, n = 109), ESS scores improved significantly by -2.2 (95% CI: -3.0 to -1.4) at 4 months, sustained at 12 months; and almost half no longer had excessive daytime sleepiness by end of program. This study suggests that for employees with excessive daytime sleepiness, short- and long-term improvement in daytime sleepiness may be an unforeseen benefit of workplace physical activity programs.

Electrical Stimulation of the Genioglossus in Patients with Residual Obstructive Sleep Apnea Post-UPPP Surgery

Objective: Genioglossus is a major upper-airway dilator muscle, which leads to upper-airway obstruction when its activity is decreased. We evaluated the effect and safety of genioglossus stimulation for patients with residual mild-to-moderate obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Methods: We enrolled 23 patients diagnosed with OSA by polysomnography (PSG) 6 months after UPPP, who underwent nightly transcutaneous genioglossus stimulation (TGS) therapy. Apnea hypopnea index (AHI), microarousal index (MAI), the ratio of duration of SpO2 < 90% to total sleep time (T90) and Epworth sleepiness scale (ESS) before and during TGS treatment were compared. We first observed the overall effect of TGS, and then compared its influence on patients with mild and moderate sleep apnea. Results: Compared with non-TGS therapy, there was a significant decrease in AHI, MAI, T90, and ESS (9.15 ± 4.21 vs. 17.90 ± 6.85, p < 0.0001; 6.33 ± 3.75 vs. 10.93 ± 4.90, p < 0.0001; 4.87 ± 4.02 vs. 9.13 ± 4.24, p < 0.0001; 8.65 ± 3.35 vs. 9.30 ± 3.10, p = 0.002, respectively), and a significant increase in mean SpO2 and minimal SpO2 (mini SpO2) (95.52% ± 0.95% vs. 94.43% ± 1.12%, p < 0.0001; 88.74% ± 2.94% vs. 85.17% ± 4.67%, p < 0.0001, respectively) during TGS treatment. Patients in the mild and moderate groups had the same variation trend between TGS and non-TGS therapy nights. However, the moderate group had a higher absolute value of changed AHI (△AHI; 11.12 ± 3.95 vs. 5.66 ± 1.70, p < 0.05) and MAI (△MAI; 5.8 (3.3, 8.6) vs. 2.5 (1.05, 5.6), p < 0.05) than the mild group. There were no significant differences in absolute changed mean SpO2 (△mean SpO2), absolute changed miniSpO2 (△miniSpO2), changed T90 (△T90) and absolute changed ESS (△ESS) between the two groups. Moreover, the percentage of △AHI was not different between the two groups (47.89% ± 13.79% vs. 51.04% ± 13.32%, p = 0.587). There was no perceived discomfort during TGS therapy and no procedure-related adverse events. Conclusion: Submental transcutaneous electrical stimulation of the genioglossus led to a significant reduction in AHI and improvement of daytime sleepiness for existing mild-to-moderate OSA patient’s post-UPPP surgery.

Oral Appliance Therapy in Patients With Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea: A Randomized Clinical Trial.

Oral appliances that move the mandible forward during sleep are suggested as treatment for mild to moderate obstructive sleep apnea. To test whether an adjustable, custom-made oral appliance improves daytime sleepiness and quality of life in patients with daytime sleepiness and snoring or mild to moderate obstructive sleep apnea. Ninety-six patients with daytime sleepiness and an apnea-hypopnea index (AHI) lower than 30 were included in a randomized, placebo-controlled, parallel trial in Umeå, Sweden, from May 2007 through August 2011. Four months' intervention with an oral appliance or a placebo device. Daytime sleepiness was measured with the Epworth Sleepiness Scale, the Karolinska Sleepiness Scale, and the Oxford Sleep Resistance (OSLER) test. Quality of life was assessed with the Short-Form 36-Item Health Survey (SF-36) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Secondary outcomes included the apnea-hypopnea index, headaches, symptoms of restless legs, and insomnia. Oral appliance therapy was not associated with improvements in daytime sleepiness from baseline to 4-month follow-up when compared with the placebo device; Epworth score >10: 53% at baseline to 24% at follow-up for the oral appliance group vs 54% at baseline to 40% at follow-up for the placebo device group, P = .11; median (IQR) for Karolinska score ≥7/wk: 10 (8 to 14) at baseline to 7 (4 to 9) at follow-up for the oral appliance group vs 12 (6 to 15) at baseline to 8 (5 to 12) at follow-up for the placebo device group, P = .11; mean between-group difference in OSLER test, -2.4 min (95% CI, -6.3 to 1.4). The mean between-group difference for the total FOSQ score was insignificant (-1.2 [95% CI, -2.5 to 0.1]). No domain of the SF-36 differed significantly between the groups. The AHI was below 5 in 49% of patients using the active appliance and in 11% using placebo, with an odds ratio of 7.8 (95% CI, 2.6-23.5) and a number needed to treat of 3. Snoring (P < .001) and symptoms of restless legs (P = .02) were less frequent when using the oral appliance vs placebo, but this did not apply to headache or insomnia. A custom-made, adjustable oral appliance reduces obstructive sleep apnea, snoring, and possibly restless legs without effects on daytime sleepiness and quality of life among patients with daytime sleepiness and snoring or mild to moderate sleep apnea. clinicaltrials.gov Identifier: NCT00477009.

Pulse rate trends in obstructive sleep apnea: a reliable tool to predict long term response to CPAP?

To the editor, A predictive model of long term response to CPAP could be a useful tool for the clinician. In this regard, previous studies considered that changes in heart rate variability (HRV) are a key variable to assess continuous positive airway pressure (CPAP) response (1,2). We read with interest the recent article by Pengo MF et al. (3) were authors hypothesized that baseline nocturnal pulse rate (PR) trends help predict long term response to CPAP. In this study, main findings were improvement in daytime sleepiness among obstructive sleep apnea (OSA) patients with baseline negative change in PR contrary to OSA patients with positive change in PR. Nonetheless, we consider that a few aspects of this study deserve reviewing. First, the diagnostic modality was unattended pulse oximetry. So far, the published data on this method is difficult to compare because of differences in the parameters measured and differences in the reference standard. Some studies reported high specificity while others reported a high sensitivity. For screening purposes, both high sensitivity and high pretest likelihood of OSA are needed. Additionally, age, pulmonary function, and degree of obesity impact on nocturnal desaturation and also influence sensitivity and specificity. Therefore, for research purposes, diagnosis should be confirmed by polygraphy or polysomnography (4-6). In Pengo MF et al. patients in the OSA group had lower mean saturation of hemoglobin (SpO2) than controls (92.7% vs. 95.4%). This difference makes the OSA group more likely to desaturate during sleep just by virtue of the oxyhemoglobin dissociation curve dynamics (5). Furthermore, some of the OSA patients may have suffered from other comorbidities such as obesity hypoventilation syndrome. This was more likely in the OSA group with positive change PR, where patients were more obese (122+/–26 kg) and had lower mean SpO2 (90.9%) compared to those with negative change PR (107+/–26 kg, and 93.2%, respectively).

Daytime sleepiness in patients with obstructive sleep apnea and severe obesity: prevalence, predictors, and therapy.

We sought to determine prevalence and predictors of excessive daytime sleepiness in patients with severe obesity with a body mass index (BMI) >35kg/m(2) and obstructive sleep apnea (OSA) with an apnea-hypopnea index >15/h. The study population consisted of 245 obese OSA patients with a BMI >35kg/m(2), who were retrospectively recruited from 3256 consecutive patients who underwent polysomnography at our sleep laboratory between 2006 and 2009. Baseline clinical characteristics and polysomnography results of these 245 patients were compared between patients with and without excessive daytime sleepiness, which was diagnosed in the presence of an Epworth Sleepiness Scale score (ESS) ≥11. A total of 123 of 245 study patients (50.2%) had an ESS ≥11. Patients with an ESS ≥11 were younger and less often unemployed or retired compared with patients with an ESS <11. Polysomnography revealed a longer total sleep time (TST), higher sleep efficiency, and shorter sleep latency in patients with ESS ≥11. In addition, obstructive apneas during TST as well as oxygen saturations <80% occurred significantly more often in patients with versus without an ESS ≥11. Improvement of daytime sleepiness after initiation of continuous positive airway pressure (CPAP) therapy occurred more often in patients with versus without ESS ≥11 (93 versus 73%, p<0.01). Obese patients with OSA and excessive daytime sleepiness are characterized by younger age, longer TSTs, more frequent obstructive apneas, and oxygen desaturations <80% compared with patients without excessive daytime sleepiness. Excessive daytime sleepiness can be improved in more than 90% of patients using CPAP therapy.

The Efficacy of a Brief Motivational Enhancement Education Program on CPAP Adherence in OSA: A Randomized Controlled Trial

Poor adherence to CPAP treatment in OSA adversely affects the effectiveness of this therapy. This randomized controlled trial (RCT) examined the efficacy of a brief motivational enhancement education program in improving adherence to CPAP treatment in subjects with OSA. Subjects with newly diagnosed OSA were recruited into this RCT. The control group received usual advice on the importance of CPAP therapy and its care. The intervention group received usual care plus a brief motivational enhancement education program directed at enhancing the subjects' knowledge, motivation, and self-efficacy to use CPAP through the use of a 25-min video, a 20-min patient-centered interview, and a 10-min telephone follow-up. Self-reported daytime sleepiness adherence-related cognitions and quality of life were assessed at 1 month and 3 months. CPAP usage data were downloaded at the completion of this 3-month study. One hundred subjects with OSA (mean ± SD, age 52 ± 10 years; Epworth Sleepiness Scales [ESS], 9 ± 5; median [interquartile range] apnea-hypopnea index, 29 [20, 53] events/h) prescribed CPAP treatment were recruited. The intervention group had better CPAP use (higher daily CPAP usage by 2 h/d [Cohen d = 1.33, P < .001], a fourfold increase in the number using CPAP for ≥ 70% of days with ≥ 4 h/d [P < .001]), and greater improvements in daytime sleepiness (ESS) by 2.2 units (P = .001) and treatment self-efficacy by 0.2 units (P = .012) compared with the control group. Subjects with OSA who received motivational enhancement education in addition to usual care were more likely to show better adherence to CPAP treatment, with greater improvements in treatment self-efficacy and daytime sleepiness. ClinicalTrials.gov; No.: NCT01173406; URL: www.clinicaltrials.gov.

CPAP for excessive sleepiness in elderly patients

CPAP for excessive sleepiness in elderly patients

Nocturnal pulse rate and symptomatic response in patients with obstructive sleep apnoea treated with continuous positive airway pressure for one year.

Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing and a known risk factor for cardiovascular disease. We hypothesised that in patients with OSA the characteristics of nocturnal pulse rate (PR) are associated with changes in blood pressure and daytime sleepiness, following commencement of continuous positive airway pressure (CPAP) therapy. Pulse oximetry data, demographics, daytime sleepiness and blood pressure were recorded at baseline and at one year follow up. Patients with OSA were grouped according to positive and negative changes in the PR (ΔPR) response during the first night of pulse oximetry before commencement of CPAP. A total of 115 patients (58 with OSA and 57 matched subjects without OSA) were identified and included in the analysis. The scale of improvement in daytime sleepiness could be predicted by a negative or positive ΔPR, as recorded in the initial screening pulse oximetry [ΔESS -5.8 (5.1) vs. -0.8 (7.2) points, P<0.05]. A negative correlation was observed between mean nocturnal PR and changes in systolic blood pressure (SBP) after one year of CPAP treatment (r=-0.42, P<0.05). Mean nocturnal PR prior to CPAP initiation was associated with changes in SBP at one year follow up. A descending nocturnal PR in patients with OSA, prior to CPAP initiation, might help to identify a symptomatic response from long term CPAP treatment.

Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA).

Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .

Weight loss through adjustable gastric banding and improvement in daytime sleepiness: 2 year interim results of APEX study

Objective:Obesity is one factor associated with an increased risk of obstructive sleep apnea (OSA). This study reports the investigator-reported resolution or improvement of OSA and improvements in sleep-related quality of life (QOL) 2 years after surgical placement of the LAP-BAND AP (LBAP) system.Research design and methods:The LBAP Experience (APEX) study is an ongoing 5 year, prospective, observational study assessing change in weight, comorbidities, and QOL after LBAP implantation. This is an interim analysis of patients with evaluable data at 24 months who had OSA at baseline.Clinical trial registration:NCT00501085.Results:At baseline, 117 of 395 patients (29.6%; mean body mass index [BMI], 45.0 kg/m2) reported OSA; of these, 57 had evaluable patient-reported outcome data at 2 years. Investigator-reported resolution or improvement of OSA was 69% and 86% at post-operative years 1 and 2, respectively. Patients reporting resolution, improvement, or no change in OSA experienced mean changes in BMI and percentage of weight loss of −9.7 kg/m2/−21.7%, −8.3 kg/m2/−18.7%, and −5.7 kg/m2/−13.2%, respectively (n = 54). Mean 2 year BMI was not statistically different between the groups (p = not significant). Mean scores for all Epworth Sleepiness Scale responses for the OSA population improved by −0.43 from baseline (p < 0.0001; n = 78) compared with −0.29 for patients without OSA at baseline (n = 177; p = 0.037 between groups). In addition, the overall study population experienced resolution and/or improvement in other obesity-related comorbidities, such as type 2 diabetes (96%) and hypertension (91%).Conclusions:These data support that surgically facilitated weight loss can improve sleep-related QOL and may result in resolution or improvement of OSA; the degree of weight loss may be related to these changes.

Effects of acupuncture and massage on pain, quality of sleep and health related quality of life in patient with systemic lupus erythematosus.

A 41-years-old woman diagnosed of Systemic Lupus Erythematosus (SLE) in 2006 came to our hospital - outpatient department with the complaint of severe pain and swelling over multiple joints associated with disturbed sleep/sleeplessness and poor quality of life since seven years. She received acupuncture (20 minutes) and massage (20 minutes) daily for the period of 30 days with 7 days of rest period in between after first 15 days. After intervention we observed reduction of pain in Visual Analog Scale score; improvement in day time sleepiness, and quality of sleep in Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index, respectively; improvement in health related quality of life in Short Form-36 version 2 (SF-36v2) Health Survey. These results showed that acupuncture and massage can be considered as an integrative approach for symptomatic management of SLE.

Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing

BackgroundOral appliance therapy with a mandibular advancement device (OAm) can yield to complete therapeutic response (apnea–hypopnea index [AHI]<5 events/h), though some patients show little or no improvement in daytime sleepiness. The prevalence of residual excessive sleepiness (RES) despite effective treatment with OAm therapy is unknown. We aimed to determine the prevalence of RES in patients treated with a titratable custom-made duobloc OAm. MethodsA prevalence study was performed, collecting data from 185 patients with an established diagnosis of sleep-disordered breathing (SDB) under OAm therapy with a titratable custom-made duobloc device (baseline data were male:female ratio, 129:56; age, 48±9years; body mass index [BMI], 27±4kg/m2; Epworth Sleepiness Scale [ESS] score, 10±5; and AHI, 19±12 events/h). A full-night polysomnography was performed at baseline and after 3months of OAm therapy. Daytime sleepiness was assessed using the ESS with RES defined as an ESS score of 11 or higher out of 24, despite complete therapeutic response. ResultsOut of 185 patients, 84 patients (45%) showed a complete therapeutic response with an AHI of <5 events per hour after 3months of OAm therapy. Despite this normalization of AHI, 27 out of these 84 patients (32%) showed RES and had a significantly higher baseline ESS (15±4 vs 9±4; P<.001) and were younger (43±9 vs 47±9; P=.028) compared to patients without RES. ConclusionRES under OAm therapy showed a prevalence of up to 32% in SDB patients effectively treated with respect to AHI. Patients with RES were younger and had higher baseline daytime sleepiness.

Improvement in daytime sleepiness with clarithromycin in patients with GABA-related hypersomnia: Clinical experience

The macrolide antibiotic clarithromycin can enhance central nervous system excitability, possibly by antagonism of GABA-A receptors. Enhancement of GABA signaling has recently been demonstrated in a significant proportion of patients with central nervous system hypersomnias, so we sought to determine whether clarithromycin might provide symptomatic benefit in these patients. We performed a retrospective review of all patients treated with clarithromycin for hypersomnia, in whom cerebrospinal fluid enhanced GABA-A receptor activity in vitro in excess of controls, excluding those with hypocretin deficiency or definite cataplexy. Subjective reports of benefit and objective measures of psychomotor vigilance were collected to assess clarithromycin's effects. Clinical and demographic characteristics were compared in responders and non-responders. In total, 53 patients (38 women, mean age 35.2 (SD 12.8 years)) were prescribed clarithromycin. Of these, 34 (64%) reported improvement in daytime sleepiness, while 10 (19%) did not tolerate its side effects, and nine (17%) found it tolerable but without symptomatic benefit. In those who reported subjective benefit, objective corroboration of improved vigilance was evident on the psychomotor vigilance task. Twenty patients (38%) elected to continue clarithromycin therapy. Clarithromycin responders were significantly younger than non-responders. Clarithromycin may be useful in the treatment of hypersomnia associated with enhancement of GABA-A receptor function. Further evaluation of this novel therapy is needed.

Modafinil improves daytime sleepiness in patients with mild to moderate obstructive sleep apnoea not using standard treatments: a randomised placebo-controlled crossover trial

IntroductionPatients with mild to moderate obstructive sleep apnoea (OSA) commonly suffer excessive daytime sleepiness. Continuous positive airway pressure (CPAP) has limited effectiveness in reducing sleepiness in milder OSA. Modafinil is...

Daytime sleepiness: a risk factor for poor social engagement among the elderly

The aim of this study was to investigate the relationship between social engagement and daytime sleepiness among aged residents of a veterans' housing facility in Taiwan. A total of 597 men were enrolled in this cross-sectional study. Each subject was assessed with the Resident Assessment Instrument-Minimum Data Set, Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and Mini-Mental State Examination. Social engagement was measured with the Index of Social Engagement (ISE), and daytime sleepiness was defined according to the relevant Pittsburgh Sleep Quality Index subcomponent. Subjects were divided into two groups according to their ISE levels. A multivariate logistic regression model was used to examine the association between ISE and other variables. The sample's mean age was 80.8 ± 5.0 years (range: 65-99 years). Mean ISE score was 1.5 ± 1.3 (range 0-5), with 52% of participants reporting poor social engagement (ISE = 0-1). Mean Pittsburgh Sleep Quality Index global score was 5.6 ± 3.6 (range: 0-18), and 31% of participants reported daytime sleepiness. The analysis was adjusted for level of depression, cognitive impairment, dependence in activities of daily life, unsettled relationships, and illiteracy. After adjustment, daytime sleepiness was found to be independently associated with subjects' level of social engagement (odds ratio: 2.5; 95% confidence interval: 1.7-3.8; P < 0.001). Daytime sleepiness and poor social engagement are common among aged residents of a veterans' housing facility. Subjects experiencing daytime sleepiness but not poor general sleep quality were at increased risk of poor social engagement. The clinical care of older residents must focus on improving daytime sleepiness to enhance their social engagement.

Nocturnal Temazepam in the Treatment of Narcolepsy

Narcolepsy is characterized by fragmented nighttime sleep and frequent arousals. One treatment approach to improve daytime symptoms is to consolidate nighttime sleep through decreasing arousals. Sodium oxybate is the first FDA-approved medication that follows this approach. Benzodiazepines are known to also decrease arousals at night and have been proposed to help with sleep fragmentation. In one report, clonazepam was shown to improve cataplexy in 10 of 14 patients with narcolepsy although no improvement in daytime sleepiness was reported. The purpose of this case review was to share our experience of nocturnal temazepam on daytime sleepiness in patients with narcolepsy as measured by the Epworth Sleepiness Scale (ESS).

Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

Patients with attention-deficit/hyperactivity disorder (ADHD) often exhibit disrupted sleep and circadian rhythms. Determination of whether sleep disturbance and/or circadian disruption are differentially associated with symptom severity is necessary to guide development of future treatment strategies. Therefore, we measured sleep and ADHD symptoms in participants aged 19–65 who met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria for ADHD and insomnia without psychiatric comorbidities by monitoring actigraphy and daily sleep logs for 2 wks, as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), the ADHD Rating Scale (ADHD-RS), and a clinic-designed sleep behavior questionnaire. Principal components analysis identified correlated circadian- and sleep-related variables in all participants with ADHD who completed the study (n = 24). The identified components were entered into a backwards stepwise linear regression analysis, which indicated that delayed sleep timing and increased sleepiness (ESS) (but not sleep duration or sleep efficiency) significantly predicted greater severity of both hyperactive-impulsive and inattentive ADHD symptoms (p < .05 for partial regression coefficients). In addition, combined subtypes had the most impaired age-adjusted sleep quality (PSQI scores; p < .05 compared with healthy controls; n = 13), and 91.7% of them reported going to bed late due to being “not tired/too keyed up to sleep” compared with 57.2% and 50% of inattentive and symptom-controlled participants, respectively (p < .05). In conclusion, the results of this study suggest that ADHD symptom severity correlates with delayed sleep timing and daytime sleepiness, suggesting that treatment interventions aimed at advancing circadian phase may improve daytime sleepiness. In addition, ADHD adults with combined hyperactive-impulsive and inattentive symptoms have decreased sleep quality as well as the delayed sleep timing of predominately inattentive subtypes. (Author correspondence: rfargason@uab.edu)

Prognostic Factors for Improved Daytime Sleepiness after Uvulopalatal Flap for Obstructive Sleep Apnea

Background and ObjectivesZZWe aimed to evaluate pre-operative factors for patients with obstructive sleep apnea (OSA) and determine the correlation these factors have with the improvement of daytime sleepiness based on the change of Epworth Sleepiness Scale (ESS) score before and after uvulopalatal flap (UPF). Subjects and MethodZZTwenty-two patients with OSA who had received UPF surgery were enrolled in the study. We checked age, body mass index (BMI), size of tonsils, and position of palate. Using the Muller maneuver, we quantified the degree of obstruction at the velopharynx and the tongue base level. The cephalometric variables were checked by X-ray. Apnea-hypopnea index, respiratory distress index, and lowest oxygen saturation were obtained by portable monitoring. Finally, we obtained ESS score before and after UPF. The correlation between the aforementioned pre-operative factors and changes in ESS score was evaluated. ResultsZZA significant correlation was observed between the change in ESS score and patients’ age (R=0.168, p=0.031), BMI (R=0.642, p=0.004), and posterior airway space (PAS)(R=0.378, p=0.029). Patients who were older than 40 years old (p=0.030), obese patients with BMI≥25.0 (p=0.001), and those who had reported severe daytime sleepiness before surgery (pre-operative ESS score ＞10, p＜0.01) reported greater improvement of daytime sleepiness after UPF. ConclusionZZWe propose age, BMI, and wider PAS as predictors for greater improvement of daytime sleepiness after UPF in patients with OSA. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:495-500 Key WordsZZObstructive sleep apnea ㆍPrognosis ㆍTreatment outcome.

Factors associated with severity of daytime sleepiness and indications for initiating treatment in patients with periodic limb movements during sleep

Determinations of subjective daytime sleepiness among patients with periodic limb movements during sleep (PLMS), and of the cut-off level of periodic limb movement index (PLMI) for starting treatment have been inconclusive. This retrospective study was set out to clarify these issues by investigating the relationship between subjective sleepiness measure and PLMI as well as other demographic variables both before and after starting the treatment. Firstly, we investigated factors associated with excessive daytime sleepiness (Epworth sleepiness scale: ESS ≥ 11) in untreated 74 PLMS patients (42 men, 32 women) using multiple logistic regression analysis. Secondly, in 34 patients treated with pramipexole (PPX), a dopamine agonist, the cut-off PLMI for predicting treatment effectiveness on subjective sleepiness (≥ median reduction rate of ESS: 18%) was evaluated using the receiver operating characteristic (ROC) curve. As a result, PLMI and age positively correlated (r = 0.46, P < 0.0001), but age showed very small but significantly negative correlation with excessive daytime sleepiness (odds ratio = 0.96, 95% confidence interval = 0.93−0.99, P < 0.05) in untreated PLMS patients. Moreover, the optimal cut-off PLMI for predicting a substantial improvement in subjective daytime sleepiness was 31.35/h on ROC analysis among the patients who received the treatment with PPX. Although clear relationship between PLMI and subjective sleepiness severity was not observed, the present study indicated that a PLMI ≥ 31.35/h may become an indication for starting treatment so as to improve daytime sleepiness.