Level Of Daytime Sleepiness Research Articles

The effects of cortisol on sleep disorders in patients with hypertension and type 2 diabetes mellitus

Objective — to assess the relationship between cortisol levels and sleep disorders in patients with hypertension (H) and type 2 diabetes mellitus (DM2).Materials and methods. The study included 107 patients with H and DM2. All patients were evaluated for sleep disor­ders using the Epworth Daytime Sleepiness Scale and the International Classification of Sleep Disorders Scale (Interna­tional Academy of Sleep Disorders, Issue 3, 2014). Plasma lipids, blood levels of glucose and glycosylated hemoglobin as well as anthropometric parameters were measured in all patients. Prolactin was determined using immunosorbent analysis using fixed enzymes (principle conjugated by ELISA peroxidase) on an Immunochem 2100 analyzer.Results and discussion. Patients were divided into 2 groups. Group 1 included 74 patients with a combined course of H and DM2 with an average age of (59.7 ± 10.5) years. Group 2 included 33 patients with an isolated hypertension, the average age of which was (54.6 ± 9.8) years. There were no significant differences in the age of patients between the groups (p = 0.25). In the whole group, when analyzing indicators of cortisol, glucose, glycosylated hemoglobin, blood pressure and heart rate, depending on early awakenings, there were no significant differences in the level of daytime sleepiness on the basis of the Epworth scale. At the same time, it was found that early awakenings are significantly more likely to occur with high levels of cortisol. Thus, the median of cortisol in the group of patients with early awakenings was 557.23 [461.74 ÷ 655.70] nmol/l, while in the group without early awakenings it was 534.90 [435.80 ÷ 648.40] nmol/l, p = 0.05. When analyzing separately the data of patients of group 1 and group 2, depending on the presence of early awakenings and their relationship with the level of cortisol, it was found that in group 1, patients who had early awakenings, cortisol was 551.13 [452.53 ÷ 728.36] nmol/l, in patients without early awakenings — 495.79 [407.82 ÷ 557.96] nmol/l, p = 0.05; whereas in group 2 in patients who had early awakenings, cortisol was 535.4 [356.50 ÷ 631.67], in patients without early awakenings — 497.93 [448.84 ÷ 80.23] nmol/l, p = 0.90.Conclusions. A relationship was established between cortisol levels and early awakenings in patients with hypertension and type 2 diabetes. Patients with a combined hypertension and type 2 diabetes mellitus, and early awakenings have a higher level of cortisol, than patients with an isolated hypertension.

The estimation of excessive daytime sleepiness in post-stroke patients - a polysomnographic study

Abstract Excessive daytime sleepiness (EDS) has been reported in stroke patients. EDS in acute stroke was studied repeatedly, but there is a modest amount of data in post-stroke patients. The aim of this study was to assess the frequency of EDS and characterize sleep architecture in patients >3 months after stroke and identify factors which may affect EDS. 66 patients were enrolled, of which 33 had experienced stroke. All underwent a standardized overnight, diagnostic single night polysomnography, including electrocephalogram (EEG) leads, electrooculograms (EOG), chin electromyogram (EMG), and electrocardiogram (ECG). Epworth Sleepiness Scale (ESS) was used to measure subjects’ level of daytime sleepiness. We observed similar total ESS score, total sleep time (TST), sleep efficiency, as well as respiratory disturbance index /apnea-hypopnea index (RDI/AHI), oxygen desaturation index (ODI) and mean heart rate in both groups. We observed positive linear correlation between EDS and mean heart rate in the stroke group (r = 0.46, p In summary, in stroke patients subjective daytime sleepiness is associated with heart rate, but not with the severity of OSA. Thus ESS (Epworth Scale Score) may be not as useful as a marker of obstructive sleep apnea (OSA) presence or severity in post stroke patient as in the general population.

Predicting daytime sleepiness and fatigue: a 9-year prospective study in myotonic dystrophy type 1.

Daytime sleepiness and fatigue are prominent symptoms of myotonic dystrophy type I (DM1) that exact a heavy toll on patients' quality of life, but information is scarce on their predictive factors. This study aimed to determine factors that may influence levels of daytime sleepiness and fatigue in a large cohort of DM1 patients followed for 9years. This study included 115 patients with DM1 at baseline (Time 1, T1) and at Time 2 (T2) who were questioned for daytime sleepiness, fatigue, history of depression, psychological distress, pain, hypothyroidism, and sleep habits. Also, their muscular impairment and intellectual quotient were evaluated. Regression models were used to identify correlates of daytime sleepiness and fatigue while controlling for time effect. Both daytime sleepiness and fatigue increased between T1 and T2, but their rate of change are higher when CTG repeat number is higher (p < 0.05). Also, higher psychological distress level is associated with higher daytime sleepiness and fatigue levels both at T1 and T2 (p < 0.01). Moreover, patients with a history of depression report higher daytime sleepiness levels both at T1 and T2 (p < 0.05). In addition, patients with higher fatigue levels both at T1 and T2 have more severe muscular impairment (p < 0.01) and report a longer habitual sleep duration (p < 0.05). Finally, a higher BMI and a history of hypothyroidism predict higher daytime sleepiness levels at T2 (p < 0.05). This study identified potentially modifiable risk factors of future daytime sleepiness and fatigue in DM1 patients, including BMI, psychological distress, hypothyroidism, and sleep habits.

Sleep Deprivation and Risk for Cognitive Vulnerability in School-Going Adolescents: Does the Biopsychosocial Correlates have a Significant Role over Sleep Behavioral Practices?

Inadequate sleep arising from various lifestyle and behavioral factors can affect the daytime functioning in adolescents and influence their health and well-being We studied the influence of various biopsychosocial correlates (age, gender, grade level, problems at home, afterschool classes, extracurricular activities, parental influence at bedtimes and rise times) on adolescents’ sleep behavioral variables (sleep hygiene practices, sleep quality, sleep duration, daytime sleepiness). Design: A cross-sectional study design was used. Socio-demographic questionnaire on sleep and activities, standardized questionnaires on sleep hygiene, sleep quality and daytime sleepiness were distributed to a sample of 660 healthy adolescents, aged 11–17 years, studying from grade 6 to grade 12 in various schools in Mangalore, India. Participants’ age was significantly associated with sleep quality and daytime sleepiness, with a higher level of daytime sleepiness and poor sleep quality noticed in older adolescents’ age group. Grade level, average time spent on additional classes, and home atmosphere of the participants were significantly associated with the entire target variables, with higher grade levels, more hours spent on additional classes, and problems at home contributing to worsening of sleep practices. Gender or time spent on extracurricular activities was not significantly associated with target variables. Sleep hygiene, daytime sleepiness, weekdays and weekends sleep duration were found to be significantly associated with parental influence at rising times, whereas only sleep hygiene and sleep quality was significantly associated with parental influence at bedtimes. The study results suggest that various biopsychosocial correlates significantly influence sleep behavioral practices in adolescents.

Self-Reported Daytime Sleepiness and Sleep-Disordered Breathing in Patients With Atrial Fibrillation: SNOozE-AF

BackgroundAtrial fibrillation (AF) management guidelines recommend screening for symptoms of sleep-disordered breathing (SDB). We aimed to assess the role of self-reported daytime sleepiness in detection of patients with SDB and AF. MethodsA total of 442 consecutive ambulatory patients with AF who were considered candidates for rhythm control and underwent polysomnography comprised the study population. The utility of daytime sleepiness (quantified by the Epworth Sleepiness Scale [ESS]) to predict any (apnea-hypopnea index [AHI] ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB on polysomnography was tested. ResultsMean age was 60 ± 11 years and 69% patients were men. SDB was present in two-thirds of the population with 33% having moderate-to-severe SDB. Daytime sleepiness was low (median ESS = 8/24) and the ESS poorly predicted SDB, regardless of the degree of SDB tested (area under the curve: 0.48-0.56). Excessive daytime sleepiness (ESS ≥ 11) was present in 11.9% of the SDB population and had a negative predictive value of 43.1% and a positive predictive value of 67.5% to detect moderate-to-severe SDB. Male gender (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.8, P = 0.001), obesity (OR: 3.5, 95% CI: 2.3-5.5, P < 0.001), diabetes (OR: 2.3, 95% CI: 1.2-4.4, P = 0.08), and stroke (OR: 4.6, 95% CI: 1.7-12.3, P = 0.002) were independently associated with an increased likelihood of moderate-to-severe SDB. ConclusionsIn an ambulatory AF population, SDB was common but most patients reported low daytime sleepiness levels. Clinical features, rather than daytime sleepiness, were predictive of patients with moderate-to-severe SDB. Lack of excessive daytime sleepiness should not preclude patients from being investigated for the potential presence of concomitant SDB.

Journal Digest: Video Games; 3D Mapping; Suicide; Cannabis; Sexting; Sleep Apnea

Journal Digest: Video Games; 3D Mapping; Suicide; Cannabis; Sexting; Sleep Apnea

Shorter REM latency in children with attention-deficit/hyperactivity disorder

The discrepancies in prior research about the actual sleep problems underlying attention-deficit/hyperactivity disorder (ADHD) demand more studies of children with this disorder. This study aimed to compare the subjective and objective sleep characteristics of 20 children with ADHD (DSM-IV criteria) and 20 typically developing children (aged 7–11 years). We assessed the children using sleep questionnaires and polysomnography recordings and analysed differences between the two groups using two-tailed Mann–Whitney U exact tests and Rosenthal's r as effect size measure. We also assessed associations between sleep measures and psychopathology using Spearman's correlation coefficients. No significant difference was found between the groups in almost any objective sleep variable, except for shorter REM latency in the ADHD group. Children with ADHD also showed significantly higher levels of daytime sleepiness and greater general sleep problems than control children, as reported by their parents, after discarding the primary sleep problems commonly associated with ADHD. Significant correlations were found between psychopathology and sleep measures. Our findings might support the link between narcolepsy-like sleep phenotype and ADHD. However, longitudinal research combining objective and subjective assessments should further explore the involvement of other variables, such as ADHD subtypes, medication, and comorbid symptoms in this relationship.

Is severe obstructive sleep apnea associated with less depressive symptoms?

PurposeTo investigate the relationship between obstructive sleep apnea (OSA) and symptoms of depression and anxiety in OSA patients. MethodsSymptoms were assessed using the Beck Depression Inventory (BDI) and the state part of the State-Trait Anxiety Inventory (STAI-S). BDI scores of ≥10 and STAI-S scores of ≥40 were considered to indicate the presence of depression and anxiety, respectively. Apnea severities measured using polysomnography were categorized into mild, moderate, and severe subgroups bounded by the 33rd and 66th percentiles of each polysomnographic parameter. Data were stratified by age, gender, and level of daytime sleepiness. ResultsThe study population comprised 795 adult patients (86.9% men). Symptoms of depression and anxiety were present in 46.2% and 49.2% of patients, respectively. Excessive daytime sleepiness was present in 40.0% of patients and did not differ depending on the level of apnea severity. Results of crude logistic regression analyses indicated that depressive symptoms were more prevalent in patients with mild OSA than those with severe OSA, regardless of the categorizing method. These results remained statistically significant following adjustment for several confounding factors. These relationships were similar but less prominent in measures of anxiety. In the sub-analyses, such negative associations between severity of OSA and depressive symptoms tended to be observed only in patients with daytime sleepiness. ConclusionsSymptoms of depression and anxiety were found to be more prevalent in patients with mild OSA than those with severe OSA. Excessive daytime sleepiness was shown to affect the severity of depressive symptoms.

Scoring of Hypersomnolence and Fatigue in Patients With Obstructive Sleep Apnea Treated With a Titratable Custom-Made Mandibular Advancement Device.

The objective of this study was to measure fatigue and hypersomnolence in patients with obstructive sleep apnea (OSA) treated with a mandibular advancement device (MAD), using Epworth Sleepiness Scale (ESS) for hypersomnolence and Checklist Individual Strength questionnaire (CIS20R) for fatigue. This was a single-center, prospective cohort study. A total of 58 patients with OSA filled out ESS and CIS20R questionnaires at baseline and after 3 months of MAD treatment. A total of 39 full datasets were collected. Statistical analysis for reliability of the questionnaires, comparison between baseline and 3-month follow-up, correlation between the changes in the values of the two questionnaires, and changes in apnea-hypopnea index (AHI) were performed. CIS20R showed excellent reliability in this patient group at baseline and 3-month follow-up (Cronbach α = .97), ESS showed a marginally good reliability (Cronbach α = .82). The CIS20R (82/140) expressed high levels of fatigue at baseline, and ESS showed a normal level of daytime sleepiness. AHI, ESS, and CIS20R were significantly reduced under MAD treatment. A significant correlation between ESS and CIS20R was observed. No significant correlation between any of the questionnaires and the change in AHI was found. The CIS20R questionnaire results showed a high level of fatigue in the patients with OSA, and the questionnaire can be used to evaluate changes in fatigue due to MAD treatment after 3 months. The ESS failed to show similar characteristics. Therefore, a combination of ESS for hypersomnolence with CIS20R for fatigue is proposed for the follow-up of patients with OSA treated with MAD.

Factors That Contribute to Excessive Sleepiness in Midwives Practicing in the United States.

Excessive daytime sleepiness is defined as difficulty maintaining wakefulness and alertness during normal waking hours. Excessive daytime sleepiness can lead to clinical errors in health care workers and is associated with dangerous driving. Little is known about the level of daytime sleepiness in midwives in the United States. The purposes of this study, conducted by the American College of Nurse-Midwives (ACNM) Sleep and Safety Taskforce, were first to identify the sleepiness level of US certified nurse-midwives (CNMs) and certified midwives (CMs) by calculating Epworth Sleepiness Scale scores for CNM/CMs in full-scope practice, and then to determine factors that significantly contribute to elevated Epworth Sleepiness Scale scores (>10). Participants in this descriptive, correlational survey study were active ACNM members in full-scope midwifery practice. Descriptive statistics, bivariate analysis, and logistic regression were used for data analysis. Surveys were emailed to all active members of ACNM (N = 4358). A total of 753 (17.3%) survey responses were returned, of which 639 (14.7%) were eligible for analysis. Within this group, 639 (84.9%) self-identified as being in full-scope midwifery practice, and one-fourth (n = 164; 25.7%) had elevated Epworth Sleepiness Scale scores. Duration of work shifts was the only variable found to significantly contribute to differences in Epworth Sleepiness Scale scores, with midwives working shifts longer than 12 hours having higher rates of excessive daytime sleepiness compared with midwives who worked shifts of 12 hours or less. Midwives, midwifery services, and maternity care centers can work together to ensure that clinicians obtain adequate sleep. Reducing excessive sleepiness will contribute to increased safety for midwives, women, newborns, and the general public.

Sleep, energy disturbances and pre-competitive stress in female traveller athletes.

Background: Gymnasts of high performance level are submitted to a demanding competitive schedule, which can negatively affect their circadian rhythm, sleep, appetite and pre-competitive stress. Therefore, the purpose of this study was to investigate sleep, body composition, pre-competitive stress and energy in elite female athletes just before a World Cup and potential sleep risks according to the travelled distance by athletes in order to compete.Methods: Sixty-seven rhythmic gymnasts of high performance level were evaluated in order to collect training and competition data, daytime sleepiness (DS) by the Epworth Sleepiness Scale, sleep quality (SQ) by the Pittsburgh Sleep Quality Index, precompetitive anxiety by the Sport Competition Anxiety Test-A and dietary intake prior to a World Cup.Results: Gymnasts suffering from severe DS had worse scores in the competition than those who reported normal DS (p=0.004). In addition, gymnasts with severe DS reported reduced SQ (p=0.014) and showed high levels of precompetitive stress (p<0.01). Gymnasts with reduced SQ demonstrated great DS (p=0.014) and high levels of precompetitive stress (p=0.010).Conclusions: Gymnasts demonstrated disordered sleep and precompetitive stress. Athletes who travelled long distances to compete presented high risk for short sleep duration, abnormal DS and reduced SQ.

Associations of bullying, victimization, and daytime sleepiness with academic problems in adolescents attending an alternative high school.

Adolescents attending alternative high schools often present with high rates of academic and behavior problems. They are also at increased risk of poor health behaviors and engaging in physical violence compared with students in traditional high school settings. To address the needs of students in these educational settings, examining factors that influence academic problems in this population is essential. Research has established that both bullying/victimization and sleep problems increase adolescents' risk for academic problems. Little is known about how these 2 factors together may exacerbate risk for academic problems among students attending an alternative high school. The current study investigated the interaction between teacher-reported bullying, victimization and daytime sleepiness on academic concerns (attention and learning problems) among a sample of 172 students (56% female; age M = 18.07 years, SD = 1.42) attending an alternative high school in a large, Southeastern U.S. city. Findings from path models indicated that daytime sleepiness, bullying, and victimization were uniquely associated with attention and learning problems. Further, significant interactions indicated that the association between victimization/bullying and attention/learning problems weakened as levels of daytime sleepiness increased. Results suggest the importance of assessing and addressing multiple contextual risk factors in adolescents attending alternative high schools to provide comprehensive intervention for students in these settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Predictors of Obstructive Sleep Apnea at A High Altitude: Results of a Population-based Study in the Western region of Saudi Arabia

Background: The sleep disturbances are common at high altitudes. This study aimed to determine the prevalence and predictors of obstructive sleep apnea at high altitudes. Methods: This cross-sectional observational study was conducted from March 2018 to June 2018 to assess the predictors of obstructive sleep apnea based on Berlin, Stop-Bang and Epworth sleepiness scale questionnaire from adult population of Taif City at an altitude of 1879 m from sea level in Saudi Arabia. Results: Of 1002 participants, the majority (614 participants, 61.3%) was males and the mean± SD age of participants was 30.6± 10.3 years (Range 11 - 67 years). In this study 24.9% participants were found to be at a high risk of having sleep apnea. Male gender, older age and smoking were found to be significantly associated with higher risk of sleep apnea according to Berlin, Stop-Bang and Epworth sleepiness scale questionnaire. Diseases found to be associated with a high risk of developing sleep apnea included hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes (p<0.001), psychological disorders (p<0.001) and asthma (p<0.001) .On the other hand, cardiac disorders were found to have an insignificant effect on sleep apnea (p=0.076) in this study. Almost one-third of the participants (34.9%; 95% CI= 32.0% to 37.9%) were found to have an abnormal level of daytime sleepiness according to Epworth Sleepiness Scale (ESS). These results were comparable to the previous studies at low altitude. Conclusions: Our study demonstrated that the predictors of OSA at high altitudes are comparable to those at low altitudes.

The Predictors of Obstructive Sleep Apnea at A High Altitude: Results of a Population-based Study in the Western region of Saudi Arabia

Background: The sleep disturbances are common at high altitudes. This study aimed to determine the prevalence and predictors of obstructive sleep apnea at high altitudes. Methods: This cross-sectional observational study was conducted from March 2018 to June 2018 to assess the predictors of obstructive sleep apnea based on Berlin, Stop-Bang and Epworth sleepiness scale questionnaire from adult population of Taif City at an altitude of 1879 m from sea level in Saudi Arabia. Results: Of 1002 participants, the majority (614 participants, 61.3%) was males and the mean± SD age of participants was 30.6± 10.3 years (Range 11 - 67 years). In this study 24.9% participants were found to be at a high risk of having sleep apnea. Male gender, older age and smoking were found to be significantly associated with higher risk of sleep apnea according to Berlin, Stop-Bang and Epworth sleepiness scale questionnaire. Diseases found to be associated with a high risk of developing sleep apnea included hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes (p<0.001), psychological disorders (p<0.001) and asthma (p<0.001) .On the other hand, cardiac disorders were found to have an insignificant effect on sleep apnea (p=0.076) in this study. Almost one-third of the participants (34.9%; 95% CI= 32.0% to 37.9%) were found to have an abnormal level of daytime sleepiness according to Epworth Sleepiness Scale (ESS). These results were comparable to the previous studies at low altitude. Conclusions: Our study demonstrated that the predictors of OSA at high altitudes are comparable to those at low altitudes.

Effects of continuous positive airway pressure on neurocognitive and neuropsychiatric function in obstructive sleep apnea.

The aim of this study was to determine the neurocognitive and neuropsychiatric effects of continuous positive airway pressure treatment on patients with obstructive sleep apnea. This cross-sectional, prospective, observational study included 126 patients with sleep apnea. The following tests were performed: the Montreal Cognitive Assessment for the evaluation of cognitive impairment, the Beck Depression Inventory, and the State-Trait Anxiety Inventory, together with the Epworth Sleepiness Scale for the evaluation of neuropsychiatric symptoms and a person's general level of daytime sleepiness. The first measurement did not show neurocognitive impairment or a higher level of depressive and anxiety symptoms in 126 patients with obstructive sleep apnea in comparison to normative standards. After the 3-month treatment indicated for 43 patients with obstructive sleep apnea, we did not find any significant improvement in cognitive performance (p = .213). However, patients with sleep apnea with continuous positive airway pressure treatment did show significantly less daytime sleepiness, anxiety and depressive symptoms (all p < .001). In conclusion, short-term (3 months) treatment of patients with obstructive sleep apnea can substantially alleviate their daytime sleepiness, as well as depressive and anxiety symptoms.

Time Perspective Biases Are Associated With Poor Sleep Quality, Daytime Sleepiness, and Lower Levels of Subjective Well-Being Among Older Adults.

This study examined the extent to which individual differences in time perspective, i.e., habitual way of relating to the personal past, present, and future, are associated with sleep quality and daytime sleepiness in a sample of older adults. The participants (N = 437, 60–90 years) completed the Karolinska Sleep Questionnaire (KSQ), a the Swedish version of the Zimbardo Time Perspective Inventory (S-ZTPI), and two ratings of subjective well-being (SWB) (life satisfaction, happiness). Based on established relationships between dimension of time perspective and other variables (e.g., depression) and relations between negative retrospection (rumination) and negative prospection (worry) in prior studies, we expected higher scores on Past Negative and Future Negative to be linked to poor sleep quality and (indirectly) increased daytime sleepiness. Moreover, we examined the possibility that variations in perceived sleep and sleepiness during the day mediates the expected association between an aggregate measure of deviations from a so called balanced time perspective (DBTP) and SWB. In regression analyses controlling for demographic factors (age, sex, and work status), higher scores on Past Negative and Future Negative predicted poorer sleep quality and higher levels of daytime sleepiness. Additionally, most of the association between time perspective and daytime sleepiness was accounted for by individual differences in sleep quality. Finally, structural equation modeling yielded results consistent with the hypothesis that variations in sleep mediate part of the negative relationship between DBTP and SWB. Given that good sleep is essential to multiple aspects of health, future studies evaluating relationships between time perspective and adverse health outcomes should consider sleep quality as a potentially contributing factor.

The Epworth Sleepiness Scale: Validation of One-Dimensional Factor Structure in a Large Clinical Sample.

The Epworth Sleepiness Scale (ESS) is used by clinicians and researchers to determine level of daytime sleepiness. The number of factors included in the scale has been debated. Our study objective was to clarify the dimensionality of the ESS using a large clinical sample. A retrospective cohort study included all patients presenting for care in a tertiary care sleep disorders center who answered all items on the ESS from January 8, 2008 to September 28, 2012. Dimensionality was assessed using scree plot, eigenvalues, factor loadings, principal factor analysis, and confirmatory factor analysis. Multigroup confirmatory factor analysis (MGCFA) evaluated dimensionality within 10 subgroups of clinical interest. The mean age of the 10,785 study participants was 50 (± 15) years with 49% female, and 81% white. The one-factor solution explained 63% of the variability in responses with high factor loadings (> .67 for all 8 items). The scree plot identified one factor with eigenvalue > 1. Results of confirmatory factor analysis demonstrated a one-factor solution had acceptable goodness of fit as assessed by root mean square error of approximation of .094 (90% confidence interval: .089-.099). MGCFA confirmed measurement invariance within all 10 demographic and clinical subgroups. Our study confirmed the unidimensionality of the ESS in a large diverse clinical population. Results from this study can be used to justify the interpretation of the ESS within clinical populations, and supports valid comparisons between groups based on the ESS. Future studies are warranted to further understand the items comprising the ESS and potentially eliminate redundant items for increased efficiency in clinical settings.

The association of smartphone usage with subjective sleep quality and daytime sleepiness among medical students

ABSTRACTAbout a third of adults have sleep problems, while in the student population this number is much higher due to a specific lifestyle. It has been shown that the use of devices with light-emitting diode screens before sleep adversely affects sleep, sleeping and circadian rhythm in respondents. The aim of this study was to assess subjective sleep quality and level of daytime sleepiness among medical students, as well as the correlation of these parameters with the smartphone usage time. Smartphone usage time was determined using the Android Application Quality Time. A statistically significant and strong positive (r = 0.613) correlation between subjective sleep quality and the use of mobile phones has been determined. By correlation analysis of daytime sleepiness and the use of mobile phones, it was found that there was a medium strong negative (r = -0.23) correlation between these parameters, which was not statistically significant. The results of this study have shown that the subjective quality of sleep is significantly impaired and of poor quality; and a significant correlation between the use of mobile phones and the quality of sleep has been demonstrated.

Sleep and self-care correlates before and after implantation of a left-ventricular assist device (LVAD).

The impact of sleep on LVAD patients' self-care behaviors is unknown. This study examined the patterns and changes of patients sleep quality (SQ), daytime sleepiness (DS), instrumental activities of daily living (IADL), and self-care capability (SCC) before and after LVAD. In addition, the relationships among these variables were explored. This observational study consisted of 38 subjects from two VAD Centers in Michigan. The subjects completed self-reported demographics and psychometrically sound SQ, DS, IADL, and SCC questionnaires before LVAD implant and at 1, 3, and 6months after implant. Data were analyzed using descriptive statistics, linear mixed models, and partial least square models. Subjects (mean age, 56.3 ± 10.3years) were predominantly white (63%), male (68%), married (60%), and living with caregivers (92%). Over 70% had axial flow LVADs implanted as bridge-to-transplant (55%). Subjects' SQ was poor throughout the study period, along with high normal-to-excessive levels of DS. Problems with IADL before implant were significantly reduced at 1 through 6months after implant. SCC ranged from "good" to "excellent" before and after implant. Significant relationships between SQ and IADL (β = 0.43, p < 0.01) and DS and SCC (β=- 0.62, p < 0.01) were found. In conclusion, poor SQ and high degrees of DS were prevalent before and up to 6months after LVAD implant. The data inferred that the improvement in IADL was associated with an improvement in SQ. Research is needed to clarify the negative impact of DS on SCC and explain the contributions of caregivers on patients' SCC over time.

Metabolic Syndrome and Vitamin D Levels in Patients with Obstructive Sleep Apnea Syndrome.

Numerous studies have indicated that obstructive sleep apnea syndrome (OSAS), may contribute to the development of metabolic syndrome (MetS) and diabetes. Moreover, OSAS has been associated with lowered vitamin D (Vit D) levels, but reports are inconclusive. Aim of the study was to compare Vit D levels according to the presence of MetS and its components in OSAS patients. The presence of MetS was evaluated and serum 25-hydroxy vitamin D [25(OH)D] levels were measured in consecutive newly diagnosed, by polysomnography, subjects with OSAS. A total of 107 subjects (88 men) with OSAS were included in the study. Patients were divided into group A (OSAS with MetS group: 55 subjects) and group B (OSAS without MetS: 52 subjects). There were no differences between the two groups in terms of age, body mass index, and sleep parameters. Patients in group A exhibited higher levels of daytime sleepiness, as expressed by Epworth Sleepiness Scale score (12 ± 5.5 vs. 9.3 ± 4.8 for groups A vs. B, p = 0.008). Serum 25(OH)D levels were significantly decreased in group A, as compared with group B (18 ± 8.6 ng/mL vs. 23.9 ± 14.1 ng/mL, respectively, p = 0.012). Group A was then subdivided in two smaller groups, according to patients' metabolic index: OSAS patients with metabolic score = 3 and OSAS patients with metabolic score >3. Serum 25(OH)D levels were higher in OSAS patients with metabolic score = 3 compared with OSAS patients with metabolic score >3 (19.8 ± 8.9 ng/mL vs. 15.1 ± 7.3 ng/mL respectively, p = 0.038). OSAS patients with concurrent MetS exhibit lower serum Vit D levels, as compared with those without MetS.