Increased Daytime Sleepiness Research Articles

0938 Sleep, Perfectionism and Cognitive Anxiety in Sports: An Exploratory Study

Abstract Introduction Perfectionism has been related to cognitive anxiety in sports. The bidirectional association between sleep and anxiety has also been well studied. However, the relationship between sleep habits, anxiety and perfectionism in physically active young individuals hasn’t been documented yet. This was the objective of the present study. Methods 150 young, physically active participants (10 to 18 years old; 47% boys, 51% girls) completed an online survey comprised of questions extracted from the Sport Multidimensional Perfectionism Scale-2, the Competitive State Anxiety Inventory-2R and the Adolescent Sleep Habits Survey. First, independent t-tests were conducted to compare sleep habits, personal standards (PS), perceived parental pressure (PPP) and perceived coach pressure (PCP) of more anxious (ANX) to less anxious (NOANX) participants. Then, stepwise multiple linear regression analyses were computed to examine the significant sleep habits and perfectionism variables associations with competitive cognitive anxiety. Results Results show that ANX participants have higher PS (t(148)=3.19, p=0.002), less total sleep time on weekend (TST; t(148)=-2.94, p=0.004), longer sleep onset latency (SOL) on weeknights (t(128.09)=2.28, p=0.03) and report more daytime sleepiness (t(148)=3.06, p=0.003) compared to NOANX participants. The significant sleep variables and PS collectively explained 17.7% of competitive cognitive anxiety variance (p=0.00). PS was the largest predictor (β=0.27, p=0.00), followed by daytime sleepiness (β=0.21, p=0.007), weekend TST (β=-0.17, p=0.023) and weeknight SOL (β=0.16, p=.038). Conclusion These results suggest that, even though PS is associated with cognitive anxiety, sleep seem to be an important factor to consider. Specifically, increased daytime sleepiness accompanied by difficulties falling asleep during school nights and no recovery sleep during weekends significantly contribute to competitive cognitive anxiety. These results could have important implications when addressing competitive anxiety issues in young athletes. Support N/A

1256 Narcolepsy Type 2 in a Pediatric Patient with Auto-Immune Disease

Abstract Introduction We present a case of Narcolepsy Type 2 in the setting of concomitant auto-immune disease. Report of Case At 9 years of age, an African-American female was referred to a sleep center for fatigue, excessive daytime sleepiness (EDS), and snoring. Polysomnogram (PSG) at an outside facility recorded a total sleep time (TST) of 408 minutes, 92% sleep efficiency (SE), sleep onset latency (SOL) 22 minutes, REM latency 70 minutes, and apnea-hypopnea index (AHI) of 0.3. Multiple Sleep Latency Test (MSLT) was not done at that time. Due to her daytime sleepiness, methylphenidate was initiated empirically twice daily with improvement in daytime sleepiness and sleep maintenance. Over time, methylphenidate was steadily increased due to increasing daytime sleepiness. Between 14 to 15 years of age, she developed increased fatigue, skin changes, arthralgias, myalgias, and presented to our hospital in respiratory distress secondary to severe pulmonary hypertension. Clinical exam and workup indicated scleroderma. Methylphenidate was discontinued due to pulmonary hypertension. At 17 years of age (after receiving treatment for scleroderma and pulmonary hypertension), she had an overnight PSG followed by MSLT. PSG recorded TST 309 minutes, 67% SE, SOL 1.5 minutes, REM latency 48 minutes, AHI 0.2. The MSLT recorded a mean SOL of 2.4 minutes with 2 out of 4 sleep onset REM periods - diagnostic of narcolepsy. She does not endorse cataplexy, hallucinations or sleep paralysis. Conclusion While the link between Narcolepsy Type 1 and an auto-mediated process is more supported given consistent human leukocyte antigen findings, the link between Narcolepsy Type 2 and auto-immune mediated process is less clear. Patients with autoimmune disease may have symptoms of narcolepsy; therefore, they may benefit from screening for EDS.

0992 Prevalence Of Insufficient Sleep Duration And Consequences On Daytime Sleepiness, Mood And Academic Performance In Thai Adolescents

Abstract Introduction Insufficient sleep duration in adolescents is key public health concerns in many societies. This study aims to assess the prevalence of insufficient sleep duration and the association between short sleep with daytime sleepiness, depressive symptoms, and anxiety among Thai adolescents. Methods Thai adolescents aged 11 -18 years completed a self-administered questionnaire including Phramongkutklao Hospital Sleep disorders center Questionnaire, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), The Children depress Inventory (CDI) scale and Child Anxiety Related Emotional Disorder (SCARED). Results 232 adolescents with the mean age of 14.58 (range 11-18) years participated in this survey. The average total sleep time was 7.44 hours. The overall prevalence of insufficient sleep duration (sleep duration <8 hours) was 37.5% and the small difference was found between males (42.0%) and females (32.7%). Compared with those who had a sleep length of 8 hours and more, insufficient sleep duration group exhibited higher in BMI and less in Grade Point Average (GPA). Subjective sleep insufficiency among Thai adolescent also had higher percentage of subjects with ESS ≥10 (43.2% vs 21.3%, P <0.001), depressive symptoms (56.3% vs 39.3%, P 0.012) and anxiety (54.0% vs 38.6%, P 0.022) compare to those with adequate sleep duration. Conclusion High amount of Thai adolescents with poor sleep duration were observed in the study, consistency with prior surveys. Insufficiency sleep duration group had significantly increased daytime sleepiness, mood and anxiety problems among Thai adolescents. These findings emphasized the development of interventions to improve sleep duration in Thai adolescents and more sample size should be achieved in the future. Support None

Biomarkers of Alzheimer's disease in severe obstructive sleep apnea-hypopnea syndrome in the Chinese population.

Patients with severe obstructive sleep apnea-hypopnea syndrome are often accompanied by symptoms such as decreased cognitive function and daytime sleepiness, while cognitive function is often associated with biomarkers of Alzheimer's disease. Therefore, this study aims to explore the level of Alzheimer's disease biomarkers in the plasma of obstructive sleep apnea-hypopnea syndrome patients as well as the relationship between cognitive function and daytime sleepiness. Between May and July 2019, 35 patients requiring hospitalization for severe obstructive sleep apnea-hypopnea syndrome and 16 normal control patients were selected from West China Hospital. Alzheimer's disease biomarkers (Aβ40, Aβ42, t-tau, p-tau) in plasma were detected by ELISA in all 51 subjects. The differences in Alzheimer's disease biomarkers between the two groups were compared. In addition, a correlation analysis of disease-related indicators and univariate analysis of the risk factors of obstructive sleep apnea-hypopnea syndrome was conducted using the logistic regression model. The plasma levels of Alzheimer's disease biomarkers (Aβ40, t-tau, p-tau) in patients with severe obstructive sleep apnea-hypopnea syndrome were significantly higher than those in the control group (29.24 ± 32.52, 13.18 ± 10.78, p = 0.049; 11.88 ± 7.05, 7.64 ± 4.17, p = 0.037; 26.31 ± 14.41, 17.34 ± 9.12, p = 0.027). Aβ42, Aβ40, t-tau, and p-tau were significantly negatively correlated with mean oxygen saturation, low oxygen saturation and Mini-Mental State examination scale scores, and positively correlated with oxygen desaturation index and Epworth Sleepiness Scale scores. T-tau and p-tau can be used as new risk factors for obstructive sleep apnea-hypopnea syndrome. Alzheimer's disease biomarkers in the plasma of obstructive sleep apnea-hypopnea syndrome patients are higher than those in the control group, and the mechanism of action may be related to sleep disorders and night hypoxia. The Alzheimer's disease biomarkers deposited in plasma may also cause the decline of patients' cognitive function, increased daytime sleepiness and accelerate the progression of obstructive sleep apnea-hypopnea syndrome.

CME: Obstructive Sleep Apnea: A Common Disease

CME: Obstructive Sleep Apnea: A Common Disease Abstract. Obstructive sleep apnea is a common sleep related breathing disorder with a collapse of the upper respiratory tract, leading to repetitive oxygen desaturations and 'micro arousals'. If the physiological sleep architecture is impaired, patients are at risk for an increased daytime sleepiness and an increased blood pressure. Main risk factors are central obesity, age, male sex, (and snoring). By means of weight loss, alcohol restriction, and continuous nocturnal positive pressure ventilation (CPAP), the obstructive sleep apnea syndrome can be treated, with mandibular advancement devices representing a second-choice therapy.

The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial

While cognitive and behavioral therapy for insomnia (CBTi) is an effective treatment in patients with comorbid moderate and severe obstructive sleep apnea (OSA), there is concern that the bedtime restriction component of CBTi might dangerously exacerbate daytime sleepiness in such patients. We examined randomized controlled trial data to investigate the effect of OSA severity, and pretreatment daytime sleepiness on week-to-week changes in daytime sleepiness and sleep parameters during CBTi and no-treatment control. One hundred and forty-five patients with untreated physician-diagnosed OSA (apnea-hypopnea index ≥15) and psychologist-diagnosed insomnia (ICSD-3) were randomized to a 4-week CBTi program (n = 72) or no-treatment control (n = 73). The Epworth sleepiness scale (ESS) and sleep diaries were completed during pretreatment, weekly CBTi sessions, and posttreatment. Effects of OSA severity, pretreatment daytime sleepiness, and intervention group on weekly changes in daytime sleepiness and sleep parameters were investigated. The CBTi group reported a 15% increase in ESS scores following the first week of bedtime restriction (M change = 1.3 points, 95% CI = 0.1-2.5, p = 0.031, Cohen's d = 0.27) which immediately returned to pretreatment levels for all subsequent weeks, while sleep parameters gradually improved throughout CBTi. There were no differences in changes in daytime sleepiness during treatment between CBTi and control groups or OSA-severity groups. Higher pretreatment ESS scores were associated with a greater ESS reduction during CBTi. CBTi appears to be a safe and effective treatment in the presence of comorbid moderate and severe OSA. Nevertheless, patients living with comorbid insomnia and sleep apnea and treated with CBTi should be monitored closely for increased daytime sleepiness during the initial weeks of bedtime restriction therapy. Treating comorbid insomnia with obstructive sleep apnoea (COMISA) study: A new treatment strategy for patients with combined insomnia and sleep apnoea, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 365184 Australian New Zealand Clinical Trials Registry: ACTRN12613001178730. Universal Trial Number: U1111-1149-4230.

Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions.

Background:A growing literature has revealed a relationship between shift-work, including night-shift, and the disturbance of sleep-wake cycle, leading to insomnia and/or increased daytime sleepiness in shift nurses; recent findings showed an association between shift work sleep disorders and distress, work accidents, decreased job performance and, consequently, lower quality of health service provision and lower standards of care.Objectives:To analyze across the gender how shift nurses experience shift work sleep disorders and job stress.Methods:A cross-sectional study was performed following the STROBE Statement. The Italian version of the Job Content Questionnaire, the Bergen Insomnia Scale and the Epworth Sleepiness Scale were administered to the registered nurses employed in three Departments of General Practice and Elderly Care Medicine.Results:No significant association was found between high job strain and insomnia and daytime sleepiness. Significantly more women than men experienced high job strain, insomnia and daytime sleepiness; among women the level of social support was significantly and negatively associated with insomnia and daytime sleepiness.Conclusions:The findings of this study suggest that interventions aimed to prevent shift work sleep disorder and job stress in shift-nurses should incorporate the assessment of social support across the gender. Moreover, longitudinal studies are required to evaluate the effectiveness of interventions targeted on social support to minimize the occurrence of insomnia and daytime sleepiness in shift nurses.

Three consecutive nights of restricted sleep: effects of morning caffeine consumption on mood, reaction time and simulated driving performance

Introduction: Sleep is a fundamental biological requirement, essential for optimal health. Individuals unable to achieve adequate amounts of sleep may experience a range of negative behavioural and psychological consequences (e.g. increased daytime sleepiness, altered mood, reduced cognitive performance, driving impairment). Caffeinated products are often consumed as a popular countermeasure to reduce sleepiness, enhance mood, and improve cognitive functioning. However, the efficacy of caffeine to exert these effects after consecutive nights of restricted sleep is poorly understood, particularly in relation to performance on complex applied tasks (e.g. driving a motor vehicle). Therefore, the aim of this study was to investigate the effects of three consecutive nights of restricted sleep on subjective ratings of mood, cognitive function, and simulated driving performance and assess the ability of a morning dose of caffeine to attenuate any effects associated with sleep restriction. Materials and methods: Twenty healthy habitual caffeine consumers (11 females; age: 23.3±5.7 y; BMI: 22.3±3.5 kg·m-2; caffeine intake: 204±89 mg·day-1; Mean±SD) who had normal sleeping patterns (≥8 h sleep/night) participated in this double-blind, placebo-controlled, randomised study. Following one night of normal sleep (Day 0: ≥8 h time in bed (TIB)), participants underwent three consecutive nights of restricted sleep (Day 1, 2, 3: 5 h TIB). Participants received caffeine (200 mg; n=10) or placebo (n=10) capsules, together with a decaffeinated coffee and standardised breakfast each morning. All participants received caffeine (100 mg) capsules to consume in the afternoon of each trial day. On Day 0, 1 and 3, participants completed visual analog scales to measure subjective ratings of alertness, concentration and tiredness, before and 1 h after capsule administration. Cognitive function was examined 1 h after capsule administration using a computerised Choice Reaction Time (CRT) task. Response speed and accuracy were the outcome variables. Analysis of response speed was conducted using both traditional central tendency measures (comparing mean and variance) and ex-Gaussian distributional analysis. Driving performance was assessed using a 30 min simulated driving task. Lateral (standard deviation of lane position [SDLP] and total number of line crossings [LC]) and longitudinal (standard deviation of speed [SDSP]) measures of vehicular control were the outcome variables. Results: Alertness and concentration significantly decreased, and tiredness increased across the three days of sleep restriction (all p's< 0.001). Caffeine only marginally alleviated these effects. No differences were observed between treatments or across trial days for response speed and accuracy on the CRT task, irrespective of the analytical approach employed. Likewise, no significant differences were observed between groups or across trial days for lateral (SDLP, LC) and longitudinal (SDSP) measures of simulated driving performance. Conclusion: Overall, results from this study indicate that three consecutive days of sleep restriction may influence subjective ratings of alertness, concentration and tiredness, but does not appear to impact CRT or simulated driving performance. Caffeine may alleviate some of the negative subjective effects imposed by restricted sleep, but the efficacy of caffeine to attenuate performance changes in cognitive function and driving performance were unable to be observed in this study.

Hypersomnolence in Children and Adolescents: Causes, Assessment, and Management

Hypersomnolence is common in children and adolescents and its etiology is multifactorial. Developmental changes in melatonin release and slower accumulation of sleep pressure lead to a preference for later sleep times, which conflicts with early school start times leading to increased daytime sleepiness. Although the most common cause of daytime sleepiness in children and adolescents is insufficient sleep, central disorders of hypersomnolence can also manifest in these age groups. Excessive sleepiness could also result from other disorders such as sleep apnea, psychiatric illnesses, and medication use. Hypersomnolence should be evaluated by careful history taking, and when necessary additional tests including actigraphy, polysomnography, and multiple sleep latency test may need to be performed. In this review, we discuss the prevalence of hypersomnolence in children and adolescents, common etiological factors, and assessment of excessive sleepiness. We also discuss management strategies for hypersomnolence. [ Psychiatr Ann. 2019;49(12):529–534.]

Sexual Orientation and Sleep Behaviors in a National Sample of Adolescents Followed Into Young Adulthood.

Sexual minority adolescents experience mental and physical health disparities attributable to increased discrimination and minority stress. These same factors may also impair sleep health, although available literature on this topic is limited. This study examined longitudinal associations between adolescent sexual minority status and seven sleep behaviors in young adulthood and tested depressive symptoms and overweight as mediators. Data were drawn from Waves 2 (11th grade) to 7 (4 years after high school) of the NEXT Generation Health Study, a national longitudinal cohort study of US adolescents (n = 1946; 6.3% sexual minorities). There were no significant sexual orientation disparities in sleep duration, trouble falling asleep, trouble staying asleep, or trouble waking up during young adulthood. Relative to heterosexual females, sexual minority females had higher odds of snoring/stop breathing (36.6% versus 19.2%; adjusted odds ratio = 2.57; 95% confidence interval = 1.30, 5.09) and reported more frequent daytime sleepiness (b = 0.66, 95% confidence interval = 0.05, 1.27). Mediation analyses revealed that female sexual minority status was associated with increased risk of snoring/stop breathing though overweight status (mediated 43.6% of total effect) and was also associated with increased daytime sleepiness through higher depressive symptoms (mediated 70.8% of total effect). Among US youth, no sexual orientation disparities were found except for snoring/stop breathing and daytime sleepiness among females. Sexual orientation disparities in these aspects of sleep are partially due to worse mental and physical health among sexual minority females, highlighting depressive symptoms and overweight problems as potential intervention targets. Registry: ClinicalTrials.gov; Title: Health Behavior in School-Aged Children: NEXT Longitudinal Study 2009-2016; Identifier: NCT01031160.

Evaluating the impact of gabapentinoids on sleep health in patients with chronic neuropathic pain: a systematic review and meta-analysis.

Chronic neuropathic pain (NP) is debilitating and impacts sleep health and quality of life. Treatment with gabapentinoids (GBs) has been shown to reduce pain, but its effects on sleep health have not been systematically evaluated. The objective of this systematic review and meta-analysis was to assess the relationship between GB therapy dose and duration on sleep quality, daytime somnolence, and intensity of pain in patients with NP. Subgroup comparisons were planned for high- vs low-dose GBs, where 300 mg per day or more of pregabalin was used to classify high-dose therapy. Trial data were segregated by duration less than 6 weeks and 6 weeks or greater. Twenty randomized controlled trials were included. Primary outcome measures included pain-related sleep interference and incidence of daytime somnolence. Secondary outcomes included daily pain scores (numerical rating scale 0-10) and patient global impression of change. Significant improvement in sleep quality was observed after 6 weeks of GB treatment when compared with placebo (standardized mean difference 0.39, 95% confidence interval 0.32-0.46 P < 0.001). Increased daytime somnolence was observed among all GB-treated groups when compared with placebo. Treated patients were also more likely to report improvement of patient global impression of change scores. Pain scores decreased significantly in patients both after 6 weeks of treatment (P < 0.001) and in trials less than 6 weeks (P = 0.017) when compared with placebo. Our data demonstrate that GBs have a positive impact on sleep health, quality of life, and pain in patients with NP syndromes. However, these benefits come at the expense of daytime somnolence.

Alexithymia and emotional awareness are negatively associated with sleep parameters in patients with myalgic encephalomyelitis/chronic fatigue syndrome – An exploratory study

Patients with Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS) suffer from both subjective and objective poor sleep. Unrefreshing sleep is one of the diagnostic criteria in ME/CFS. Our studies indicate even increased parameters of alexithymia and decreased level of emotional awareness (LEAS) in ME/CFS patients as compared to healthy controls. This indicates difficulties in emotional regulation, however, the reasons for that are not known. To investigate if there is an association between objective sleep parameters with alexithymia and LEAS. 20 patients (5 men and 15 women) of age 43 (12) with BMI 24 (3) fulfill TAS-20 which measures alexithymia and LEAS. Sleep parameters were investigated by full-night polysomnography (PSG) at university hospital if investigation was motivated due to increased daytime sleepiness or other clinical indications. The use of clinical data for scientific analysis was considered by the regional ethical review board in Stockholm (Ref. no. 2014/300-31) and approved by Danderyd University Hospital (DS2014-0447). Written informed consent was obtained from all participants. Patients had overall impaired parameters in PSG as compared to norms. Spearman correlation analysis showed that difficulties to identify feelings in TAS-20 and total TAS-20 correlated negatively with sleep stages 3–4 (−0.632, p = .005 and −0.634, p = .005, respectively). LEAS correlated negatively with number of arousals (−0.6, p = .005). Results indicate that sleep stages responsible for emotional regulation are impaired in patients with ME/CFS. Shorter deep sleep is associated with higher alexithymia, especially in identifying feelings. Number of arousals might negatively affect emotional awareness and should be treated if possible.

Dissociation between objectively quantified snoring and sleep quality.

The impact of simple snoring on sleep structure and sleepiness has not been well described. In several studies, self-reported snoring was associated with increased daytime sleepiness. However, most studies did not distinguish patients with simple snoring from those with coexisting obstructive sleep apnea (OSA) using objective measures. We therefore evaluated the relationship between objectively measured snoring and both sleep structure and daytime sleepiness in patients with no or mild OSA. Subjects referred for suspected sleep disorders underwent polysomnography (PSG) during which breath sounds were recorded by a microphone. Those with an apnea-hypopnea index (AHI) <15/h were analyzed. Individual snores were identified by a computer algorithm, from which the snore index (SI) was calculated as the number of snores/h of sleep. Sleep stages and arousals were quantified. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) score. 74 (35 males) subjects were included (age, mean ± SD: 46.4 ± 15.3 years and body mass index: 29.8 ± 7.0 kg/m2). The mean SI was 266 ± 243 snores/h. Subjects were categorized according to their SI into 3 tertiles: SI < 100, between 100-350, and >350. No sleep structure indeces, arousals, or ESS score differed among SI tertiles (p > 0.13). There was no correlation between SI and any of these variables (p > 0.29). In contrast, the AHI was significantly related to frequency of arousals (r = 0.23, p = 0.048). These findings suggest that simple snoring assessed objectively is not related to indices of sleep structure or subjective sleepiness.

Sleep disturbance and cognitive decline in multiple sclerosis patients with isolated optic neuritis as the first demyelinating event.

Multiple sclerosis (MS) patients whose first demyelinating event is optic neuritis have been claimed to display a milder disease course and reduced physical disability. Our aim was to investigate the impact of the clinical features of the first clinical episode on cognitive disability and sleep dysfunction in MS. A total of 26 (10 with optic neuritis as the first clinical event) MS patients were recruited. A comprehensive sleep study was performed, and a panel of tests were administered to examine cognitive and motor performance. Serum levels of sleep-related mediators orexin-A and melatonin were measured by enzyme-linked immunosorbent assay. Subjective sleep quality was evaluated by Pittsburgh sleep quality test, and daytime excessive sleepiness was tested by Epworth sleepiness scale. MS patients with the first clinical episode of optic neuritis and patients with at least one optic neuritis attack exhibited increased daytime sleepiness, higher sleep efficiency and NREM duration and lower total wake time. Patients with a history of optic neuritis obtained more favorable scores in neuropsychological tests measuring executive functions and complex attention as compared to those who had never experienced optic neuritis. Melatonin and orexin-A levels were lower in patients with optic neuritis onset. The higher no. of optic neuritis attacks was associated with reduced wake time and higher symbol digit modalities test scores. Having a history of optic neuritis is associated with improved sleep quality and executive functions but increased daytime sleepiness. Reduction of orexin-A and melatonin levels might be one of the underlying mechanisms.

Risk Assessment for Self Reported Obstructive Sleep Apnea and Excessive Daytime Sleepiness in a Greek Nursing Staff Population.

Background and objectives: The risk assessment of Obstructive Sleep Apnea (OSA) and Excessive Daytime Sleepiness (EDS) in specific occupational populations is important due to its association with morbidity. The aim of the present study was to identify the risk of OSA development and EDS in a Greek nursing staff population. Materials and Methods: In this cross-sectional study a total of 444 nurses, 56 males (age = 42.91 ± 5.76 years/BMI = 27.17 ± 4.32) and 388 females (age = 41.41 ± 5.92 years/BMI = 25.08 ± 4.43) working in a Greek secondary and tertiary hospital participated during the period from 18 January 2015 to 10 February 2015. The participants completed the Berlin Questionnaire (BQ), concerning the risk for OSA and the Epworth Sleepiness Scale (ESS), concerning the EDS. The work and lifestyle habits of the participants were correlated with the results of the questionnaires. Results: According to the BQ results 20.5% (n = 91) of the nursing staff was at high risk for OSA. Increased daytime sleepiness affected 27.7% (n = 123) of the nurses according to ESS results. Nurses at risk for Obstructive Sleep Apnea Syndrome (OSAS), positive for both BQ and ESS, were 7.66% (n = 34). Out of the nurses that participated 77% (n = 342) were working in shifts status and had significant meal instability (breakfast p < 0.0001, lunch p < 0.0001, dinner p = 0.0008). Conclusions: The population at high risk for OSA and EDS in the nursing staff was found to be 20% and 28% respectively. High risk for OSAS was detected in 7.66% of the participants. The high risk for OSA and EDS was the same irrespective of working in shift status. In specific, nursing population age was an independent predictor for high risk for OSA and skipping lunch an independent predictor of daytime sleepiness.

The associations between menopausal symptoms and sleep quality in Spanish postmenopausal women

Objectives: Around the menopause, sleep disturbances frequently occur or worsen and are associated with decreased health quality and physical and psychological problems. The aim of this study was to analyze sleep quality and its association with the impact of menopausal symptoms in Spanish postmenopausal women.Methods: A total of 278 postmenopausal women (age 60.95 ± 8.01 years) participated in this cross-sectional study. The Medical Outcomes Study Sleep Scale (MOS-SS) and the Menopause Rating Scale (MRS) were used to analyze sleep quality and severity of menopausal symptoms, respectively. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale.Results: The linear regression showed that a greater impact of menopausal symptoms (MRS total score) was associated with worse scores regarding sleep adequacy (p < 0.001, R2 = 0.056), snoring (p = 0.020, R2 = 0.036), awaken short of breath (p < 0.001, R2 = 0.089), and quantity of sleep (p < 0.001, R2 = 0.075) domains. Anxiety (p < 0.001) and worse somatic symptoms (p = 0.001) were related to greater sleep disturbances (R2 = 0.164). We also found relationships of heightened psychological symptoms (p < 0.001) and low physical activity level (p = 0.003) with increased daytime somnolence (R2 = 0.064). Finally, higher MRS total score and anxiety levels were associated with worse sleep quality assessed by MOS-SS Sleep Problems Index I (R2 = 0.179, p < 0.001 and p = 0.001, respectively) and Sleep Problems Index II (R2 = 0.146, p < 0.001 and p = 0.011, respectively).Conclusions: Anxiety and severity of menopausal symptoms were associated with poorer sleep quality. Furthermore, low physical activity level and worse psychological symptoms in menopause were predictors for increased somnolence. Therefore, screening for these factors in postmenopausal women is important, since they may be susceptible for intervention.

Speech difficulties in early de novo patients with Parkinson's disease

IntroductionSpeech difficulties are a common debilitating feature of Parkinson's disease and we aimed to investigate whether speech difficulties are associated with striatal dopaminergic deficits and faster disease progression. MethodsUsing the Parkinson's Progression Markers Initiative database, 143 early de novo Parkinson's disease patients with speech difficulties were identified and matched 1:1 with 143 Parkinson's disease patients without speech difficulties for age, disease duration and motor symptom severity. We investigated differences in clinical features and striatal [123I]FP-CIT single photon emission computed tomography (SPECT) uptake in Parkinson's disease patients with and without speech difficulties. Cox proportional hazards analysis was carried out to investigate whether speech difficulties were predictive of a faster motor progression and cognitive decline. ResultsSpeech difficulties were more common in patients with an akinetic-rigid motor phenotype compared to those with a tremor-dominant phenotype. Parkinson's disease patients with speech difficulties had lower resting tremor (P = 0.027), higher autonomic dysfunction (P = 0.034), increased daytime sleepiness (ESS; P = 0.048), and a higher prevalence of REM sleep behaviour disorder (RBD) symptoms (P = 0.007) compared to those without speech difficulties. Parkinson's disease patients with speech difficulties had significantly lower [123I]FP-CIT uptake in the striatum (P < 0.001), caudate (P = 0.003) and putamen (P = 0.003) compared to those without speech difficulties. The presence of speech difficulties was a predictor of cognitive decline [Hazard Ratio (HR): 0.341, 95% Confidence Interval (CI): 0.153–0.759; Wald: 6.945; P = 0.008), whereas it had no influence on motor progression (HR: 0.885, 95% CI: 0.662–1.183; Wald: 0.680; P > 0.10). ConclusionSpeech difficulties are associated with greater autonomic dysfunction, sleep disturbances and striatal dopaminergic deficit, and can serve as a predictor of faster cognitive decline in early Parkinson's disease.

A study on assessment of sleep pattern among school-going adolescents in semi-urban Chennai

Adolescent sleep pattern exerts an influence on their physical and mental wellbeing. Several factors such as academic stress, biological and psychosocial factors contribute to adolescent sleep. Reduction in the quantity and quality of sleep can lead to increased daytime sleepiness, interfere with cognitive functioning, memory as well as can lead to behavioural problems.300 adolescent school children in semi-urban Chennai participated by filling a questionnaire which was based on self- reporting of sleep pattern and sleep hygiene. On an average, most adolescents obtained inadequate sleep during the weekdays. The adolescents commonly reported daytime sleepiness, difficulty in falling asleep after going to bed, anxiety, morning headache and feeling tired of waking up in the morning. About half of the participants reported that parents exerted an influence on waking up time. Many adolescents reported the use of social media while going to bed which can reduce sleep duration. Paediatricians can play an important role in promoting healthy sleep practices by providing anticipatory guidance to adolescents and their parents.

0962 Objective Daytime Sleepiness Is Associated With Disease Severity And Inflammation In Patients With Mild To Moderate Dementia

It has been reported that patients with Dementia are sleepier and that daytime sleepiness is associated with worse cognitive performance. Inflammatory markers may be elevated in patients with cognitive impairment and have been proposed as mediators of excessive daytime sleepiness (EDS). The aim of this large, controlled study was to examine the association of sleepiness with cognitive performance and peripheral markers of inflammation in patients with dementia. A sub-sample of 46 patients with mild-to-moderate Dementia [mean age:80.3 (SD=5.6) years, 40% males] and 85 cognitively intact controls(NI) [mean age :73.0(SD=7.4) years, 37% males], were recruited from a large, population-based cohort in the island of Crete, Greece of 3,140 older adults (≥60yrs). All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, 3-day 24-h actigraphy and a single morning measure of IL-6 and TNFα plasma levels. Comparisons of sleep parameters and inflammation markers between Dementia and NI, and between nappers and non-nappers within each diagnostic group, were made using ANOVA controlling for demographics. Associations between inflammatory markers, sleep variables, and neuropsychological performance were assessed within each group using Partial Correlation analysis controlling for demographics, depression, use of psychotropic medications, and sleep apnea symptoms. Dementia patients compared to NI had marginally significant longer nap total sleep time (TST) (76.7±7.0min vs. 60.9±8min, respectively, p=0.2). Also, within Dementia patients, nappers compared to non-nappers had significantly worse performance in autobiographic memory scale (p=0.002), digits reverse (p=0.007), AVLT retention (p=0.010), and assessment of daily function (p=0.012). Finally, IL-6 levels were significantly associated with nap TST within Dementia patients (r=0.500, p=0.01). , while no significant associations were found between IL-6 and sleepiness within the NI group These data indicate that IL-6 plasma levels in patients with Dementia are associated with increased daytime sleepiness. In demented patients, objective sleepiness may be a biologic marker of the severity of the disease. National Strategic Reference Framework (ESPA) 2007-2013, Program: THALES, University of Crete, title: “A multi-disciplinary network for the study of Alzheimer’s Disease” (Grant :MIS 377299)

Smoking status in relation to obstructive sleep apnea severity (OSA) and cardiovascular comorbidity in patients with newly diagnosed OSA.

the relationship between smoking and sleep disturbance has been well documented. Smoking is a common risk factor for both obstructive sleep apnea (OSA) and cardiovascular diseases. The study aimed to: 1) evaluate the incidence of newly diagnosed OSA in patients presenting with symptoms suggestive of a sleep disorder, 2) assess the relation between smoking status and OSA severity; and 3) compare the prevalence of cardiovascular comorbidities in ever- and never smokers with newly diagnosed OSA. a retrospective analysis of 5,353 patients suspected of OSA was performed. OSA was diagnosed on the basis of polysomnography. The influence of smoking status on indices of OSA severity was evaluated and the incidence of self-reported cardiovascular diseases and diabetes mellitus type 2 was analyzed in relation to smoking history. OSA was diagnosed in 3,613 patients (67.5%); of these, 21.6% were ever-smokers. Smokers with OSA had a higher apnea-hypopnea index [AHI; 31 (18.4-53.29) vs 29 (18.3-47.7), p = 0.03], lower mean oxygenation during sleep [92 (90-93) vs 92 (91-94), p < 0.01] and a higher daytime sleepiness (Epworth Sleepiness Scale score 11.7 ± 5.5 vs 11.0 ± 5.5, p < 0.001). The most frequent comorbidity was hypertension, followed by obesity, diabetes mellitus type 2 and coronary artery disease, with a statistically higher incidence of hypertension in non-smokers (59.2 vs 64.7 %, p = 0.005). smoking is related with OSA severity and increased daytime sleepiness. Our study confirmed the elevated frequency of cardiovascular comorbidities in OSA patients in general but did not show an increased incidence of these comorbidities in smokers.