Lower Epworth Sleepiness Scale Research Articles

Olfactory Dysfunction and Long-Term Trajectories of Sleep Disorders among early Parkinson’s Disease: Findings from a Longitudinal Cohort

Background: Previous studies have suggested a connection between impaired olfactory function and an increased risk of rapid eye movement sleep behavior disorder (RBD) in individuals diagnosed with Parkinson’s disease (PD). However, there is a gap in knowledge regarding the potential impact of olfactory dysfunction on the long-term patterns of sleep disorders among early PD patients. Methods: Data from the Parkinson’s Progression Markers Initiative program included 589 participants with assessments of sleep disorders using the Epworth Sleepiness Scale (ESS) and RBD Screening Questionnaire (RBDSQ). Olfactory dysfunction at baseline was measured using the University of Pennsylvania Smell Identification Test. Trajectories of sleep disorders over a 5-year follow-up were identified using group-based trajectory modeling, and the relationship between olfactory dysfunction and sleep disorder trajectories was examined through binomial logistic regression. Results: Two distinct trajectories of sleep disorders over the 5-year follow-up period were identified, characterized by maintaining a low or high ESS score and a low or high RBDSQ score. An inversion association was observed between olfactory function measures and trajectories of excessive daytime sleepiness (odds ratio [OR] = 0.97, 95% confidence interval [CI] 0.95, 1.00, p = 0.038), after controlling for potential covariates. Similarly, olfactory function showed a significant association with lower trajectories of probable RBD (OR = 0.96, 95% CI 0.94, 0.98, p = 0.001) among early PD individuals. Consistent findings were replicated across alternative analytical models. Conclusions: Our findings indicated that olfactory dysfunction was associated with unfavorable long-term trajectories of sleep disorders among early PD.

Machine learning polysomnographically-derived electroencephalography biomarkers predictive of epworth sleepiness scale

Excessive daytime sleepiness (EDS) causes difficulty in concentrating and continuous fatigue during the day. In the clinical setting, the assessment and diagnosis of EDS rely mostly on subjective questionnaires and verbal reports, which compromises the reliability of clinical diagnosis and the ability to robustly discern candidacy for available therapies and track treatment response. In this study, we used a computational pipeline for the automated, rapid, high-throughput, and objective analysis of previously collected encephalography (EEG) data to identify surrogate biomarkers for EDS, thereby defining the quantitative EEG changes in individuals with high Epworth Sleepiness Scale (ESS) (n = 31), compared to a group of individuals with low ESS (n = 41) at the Cleveland Clinic. The epochs of EEG analyzed were extracted from a large overnight polysomnogram registry during the most proximate period of wakefulness. Signal processing of EEG showed significantly different EEG features in the low ESS group compared to high ESS, including enhanced power in the alpha and beta bands and attenuation in the delta and theta bands. Our machine learning (ML) algorithms trained on the binary classification of high vs. low ESS reached an accuracy of 80.2%, precision of 79.2%, recall of 73.8% and specificity of 85.3%. Moreover, we ruled out the effects of confounding clinical variables by evaluating the statistical contribution of these variables on our ML models. These results indicate that EEG data contain information in the form of rhythmic activity that could be leveraged for the quantitative assessment of EDS using ML.

The Relationship between Carotid Doppler Ultrasound and EEG Metrics in Healthy Preschoolers and Adults.

Despite widespread using electroencephalography (EEG) and Doppler ultrasound in pediatric neurology clinical practice, there are still no well-known correlations between these methods that could contribute to a better understanding of brain processes and development of neurological pathology. This study aims to reveal relationship between EEG and Doppler ultrasound methods. We compared two cohorts of adults and preschool children with no history of neurological or mental diseases. The data analysis included investigation of EEG and carotid blood flow indexes, which are significant in neurological diagnosis, as well as calculation of linear and non-linear EEG parameters and ratios between the systolic peak velocities of carotid arteries and carotid blood asymmetry. We have found age-dependent correlations between EEG and power Doppler ultrasound imaging (PDUI) data. Carotid blood flow asymmetry correlated with delta-rhythm power spectral density only in preschoolers. The ratios of blood flow velocities in the internal carotid arteries to those in the common carotid arteries correlated with higher peak alpha frequency and lower fractal dimension; moreover, they were associated with lower Epworth sleepiness scale scores. The study revealed significant correlations between EEG and PDUI imaging indexes, which are different for healthy children and adults. Despite the fact that the correlations were associated with non-clinical states such as overwork or stress, we assumed that the investigated parameters could be applicable for clinical trials.

EFFECTS OF POSITIVE AIRWAY PRESSURE ADHERENCE ON READMISSION AND LENGTH OF STAY IN HOSPITALIZED PATIENTS WITH SEVERE OSA

SESSION TITLE: New Insights Into the Relationship Between OSA and Cardiovascular Disease SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: To determine the effects of positive airway pressure (PAP) adherence on unplanned 30-day-readmission and length of stay in hospitalized patients with severe obstructive sleep apnea (OSA). METHODS: Records of patients 18 years and older with a history of OSA hospitalized in the Gundersen Health System between January 1, 2014, and December 31, 2018, were reviewed. Patients with non-severe OSA, missing baseline apnea-hypopnea index (AHI), or lack of adherence data 30 days prior to admission were excluded. Severe OSA was defined as an AHI ≥ 30 events per hour. Patients were categorized as being adherent or non-adherent to PAP treatment. Adherence to PAP was defined as an average use ≥ 4 hours per night over at least 30 days. Outcomes were compared between the two groups. Statistical analysis included Chi-squared-test, Fisher’s exact test, Wilcoxon rank-sum, and multivariate logistic regression. RESULTS: There were 2,419 admissions included in the study, of which 44.4% (n=1,075) were from PAP adherent patients. Adherent patients were older 68.4 ± 12.5 vs. 67 ± 14 years (p=0.0240), had a longer period of time between OSA diagnosis and admission 6.2 ± 3.5 vs.5.7 ± 3.3 years (p<0.0001), had lower Epworth Sleepiness Scale (ESS) scores 7.7 ± 4.6 vs 9.2 ± 5.6 (p<0.0001), had a higher baseline AHI 66.4 ± 27.7 vs. 63.1 ± 27.6 (p=0.0023) and were more likely to receive PAP therapy during admission 82.2% vs 37.4% (p<0.0001). Non-adherent patients were more likely to be active smokers 13% vs 4.7% (p<0.0001), and more likely to have coronary artery disease 31.4% vs. 25.7% (p=0.002), congestive heart failure 22.3% vs. 17.9% (p=0.008) and diabetes mellitus 39.2 vs. 34.6 (p=0.02). Patients who were adherent to PAP treatment had a significantly shorter length of stay 4.1 ± 5 vs. 4.7 ± 5.5 days (p<0.0001) and less unplanned 30-day readmissions 10.8% vs 15% (p=0.0026). PAP non-adherence (p=0.0059) and diabetes status (p=0.0228) independently predicted higher readmission rate. The number needed to treat (NNT) was 26 patients with severe OSA adherent to PAP to prevent 1 readmission. CONCLUSIONS: Results of this study support findings from previous research, PAP adherence is associated with shorter length of stay and reduced 30-day readmissions in hospitalized patients with severe OSA. Pap nonadherence and diabetes were also found to be independently associated with unplanned readmissions. CLINICAL IMPLICATIONS: The identification of hospitalized people with severe OSA and subsequent adherence to PAP therapy is important in decreasing length of stay and hospital readmissions. DISCLOSURES: No relevant relationships by Andrew Borgert, source=Web Response No relevant relationships by Cary Herman, source=Web Response no disclosure on file for Marc Rademaker; No relevant relationships by Alexander Villareal, source=Web Response

1160 Improved Daytime Sleepiness Following Daily Morning Blue Light Therapy Is Associated With Altered Resting-state Network Connectivity

Abstract Introduction Light exposure, particularly blue wavelength light, has consistent positive effects on daytime sleepiness following mild traumatic brain injuries (mTBIs). While self-perceived improvements in daytime sleepiness are well-documented, the neurobiological underpinnings are not well understood. The purpose of this study was to localize changes in functional connectivity after daily morning blue light therapy (BLT) and to associate these changes with improvements in post-mTBI daytime sleepiness. Methods 29 individuals with a history of mTBI were randomized to receive either BLT (n=13) or placebo amber light (ALT; n=16). All participants self-reported daytime sleepiness (Epworth Sleepiness Scale (ESS); lower is better) and underwent resting-state functional magnetic resonance imaging at pre- and post-treatment. Whole-brain functional connectivity (FC) was estimated as the correlations between 400 cortical regions of interest (ROIs) assigned to 7 resting-state networks. A two-sample T-test for post-treatment ROI-to-ROI FC identified target connections (FDR corrected p&amp;lt;0.01). Post-treatment ESS scores and FC for these connections were correlated for treatment-related brain-behavior associations (uncorrected p&amp;lt;0.05). Results Lower FC after BLT in 4 ROI-to-ROI connections linking the default mode and visual networks was associated with lower ESS scores. Higher FC after BLT in 9 ROI-to-ROI connections linking attention, cognitive control, and visual networks was also associated with lower ESS scores. Conclusion BLT resulted in decreased self-reported daytime sleepiness, which was associated with decoupling of the default mode and visual networks as well as increased connectivity between and within attention and cognitive control networks, suggesting potentially improved attention to relevant stimuli and cognitive processes and less internal mentation. These associations may contribute to improved alertness, attention, and cognitive performance following a mTBI. Further work is needed to identify the optimal timing and dosage of BLT to maximize these outcomes. Support This study was funded by an award to Dr. Killgore from the US Army Medical Research and Materiel Command (USAMRMC; award number: W81XWH-14-1-0571).

Factors Affecting Patients' Adherence to Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea Disorder: A Multi-Method Approach.

Background: Continuous positive airway pressure (CPAP) is the gold standard therapy for treating obstructive sleep apnea (OSA) disorder. However, patients’ adherence to its regular use is poor. The present study aimed to determine the adherence rate to CPAP therapy by identifying factors affecting its regular use and its associated problems and discomforts among a sample population in Mashhad (Iran). Methods: The study was conducted from October 2017 to March 2018 in Mashhad (Iran) using both quantitative and qualitative methods. The quantitative study was carried out using a retrospective cross-sectional data collection from five sleep clinics and one CPAP sales office. The patients were classified into an adherent and a non-adherent group to determine the factors affecting CPAP adherence. Quantitative data were analyzed using SPSS software (version 22.0). Additionally, a prospective qualitative study was performed through a series of telephone interviews using the content analysis method. Qualitative data were analyzed using MAXQDA 10 software.Results: In the quantitative study, the medical records of 159 patients were used, out of which 79 (49.6%) were non-adherent to CPAP therapy. The mean age of all patients was 56.9±9.8 years. The mean body mass index, apnea-hypopnea index, and Epworth sleepiness scale (ESS) scores were 30.9±6.6 kg/m2, 37.2±28.1 events/hour, and 10.4±5.5, respectively. At baseline, the adherent group had a significantly higher age (P=0.006), higher oxygen desaturation index (P=0.006), and lower ESS (P=0.023) compared to the non-adherent group. In the qualitative study, a total of 29 telephone interviews were held with patients from the non-adherent group (8 women and 21 men). Analysis of the interviews resulted in three main categories (level of knowledge, discomfort, and costs) and nine sub-categories. Conclusion: A high percentage of OSA patients had poor adherence to CPAP therapy. Device-related issues could be adequately resolved by providing complementary information during follow-up visits. Moreover, efforts to reduce costs through comprehensive insurance coverage or with government subsidy would improve patients’ adherence to CPAP therapy.

PREVALENCE OF NORMAL EPWORTH SLEEPINESS SCORE IN SLEEP APNEA AND GENDER INFLUENCES

PURPOSE: The Epworth Sleepiness Scale (ESS) is a widely used screening tool for evaluation for sleep apnea (OSA) and as a criterion for making decisions about CPAP therapy. A significant proportion of patients with sleep apnea have low ESS scores. The purpose of this study was to evaluate the prevalence of normal ESS score in patients with a diagnosis of OSA METHODS: A retrospective evaluation of all patients referred to our sleep center and who underwent overnight polysomnography (PSG). OSA defined as a AHI of > 15. ESS score <10 considered normal and high if >12. RESULTS: 493 patients were included - 173 were females and 370 males. 54% of patients had a normal ESS. There was no gender difference in prevalence nor any difference in age between high and normal ESS groups. See Table 1. Both RDI and SaO2 nadir were higher in the group with high ESS. CPAP requirements were higher in the High ESS group only in males – in females this difference not seen. Arousal index was higher in males with high ESS group, but interestingly this difference was not seen in females. CONCLUSIONS: More than 50% of patients with OSA have normal ESS scores. Hypoxemia rather than sleep disruption may be a better correlate for daytime sleepiness in OSA. CLINICAL IMPLICATIONS: Use of ESS as a screening tool for OSA may lead to a significant degree of under recognition of this disease. There may be a gender influence on the impact of sleep disruption in modulating daytime sleepiness in OSA.

Screening obstructive sleep apnea-hypopnea syndrome in hypertensive patients: a comparative study of the efficiency of the Epworth sleepiness scale

BackgroundUntreated Obstructive Sleep Apnea Hypnopnea Syndrome (OSAHS) is a known factor contributing to resistant hypertension (HT). Continuous Positive Airways Pressure (CPAP) is effective to decrease blood pressure (BP) in severe OSAHS. In our clinical practice, hypertensive patients seem less symptomatic with regard to severe OSAHS than normotensive patients, leading to a risk of underdiagnosis when OSAHS is screened with Epworth Sleepiness Scale (ESS). We aimed to confirm that severe OSAHS is less symptomatic in HT patients than normotensive patients using ESS.MethodsWe retrospectively compared two age, gender-matched groups - 100 hypertensive patients and 100 normotensive patients - with severe OSAHS defined as an AHI (Apnea Hypopnea Index) ≥30. OSAHS was considered symptomatic when ESS > 10.ResultsThe two groups of patients did not differ significantly with respect to main characteristics including Body Mass Index (BMI), AHI and ODI (Oxygen Desaturation Index). Systolic and Diastolic BP were higher in HT patients (p < 0.01). HT patients were less symptomatic with regard to severe OSAHS with a lower ESS (10.0 vs 11.9, p < 0.01), and a lower number of patients with an ESS > 10 (30% vs 58%, p < 0.01). In multivariable analysis adjusted on age, gender, Obesity, Systolic BP, Diastolic BP, AHI and ADO, normotension was significantly associated with symptomatic OSAHS (OR = 2.83, [1.298–6.192], p < 0.01).ConclusionsIn our study on patients with severe OSAHS, ESS score was lower in hypertensive patients than in normotensive patients. This discrepancy may lead to an underestimation of severe OSAHS in hypertensive patients.

Spatial clusters of daytime sleepiness and association with nighttime noise levels in a Swiss general population (GeoHypnoLaus).

Daytime sleepiness is highly prevalent in the general adult population and has been linked to an increased risk of workplace and vehicle accidents, lower professional performance and poorer health. Despite the established relationship between noise and daytime sleepiness, little research has explored the individual-level spatial distribution of noise-related sleep disturbances. We assessed the spatial dependence of daytime sleepiness and tested whether clusters of individuals exhibiting higher daytime sleepiness were characterized by higher nocturnal noise levels than other clusters. Population-based cross-sectional study, in the city of Lausanne, Switzerland. Sleepiness was measured using the Epworth Sleepiness Scale (ESS) for 3697 georeferenced individuals from the CoLaus|PsyCoLaus cohort (period = 2009-2012). We used the sonBASE georeferenced database produced by the Swiss Federal Office for the Environment to characterize nighttime road traffic noise exposure throughout the city. We used the GeoDa software program to calculate the Getis-Ord Gi* statistics for unadjusted and adjusted ESS in order to detect spatial clusters of high and low ESS values. Modeled nighttime noise exposure from road and rail traffic was compared across ESS clusters. Daytime sleepiness was not randomly distributed and showed a significant spatial dependence. The median nighttime traffic noise exposure was significantly different across the three ESS Getis cluster classes (p < 0.001). The mean nighttime noise exposure in the high ESS cluster class was 47.6, dB(A) 5.2 dB(A) higher than in low clusters (p < 0.001) and 2.1 dB(A) higher than in the neutral class (p < 0.001). These associations were independent of major potential confounders including body mass index and neighborhood income level. Clusters of higher daytime sleepiness in adults are associated with higher median nighttime noise levels. The identification of these clusters can guide tailored public health interventions.

Patient-Reported Outcomes in Older Adults With Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure Therapy.

Although continuous positive airway pressure (CPAP) therapy is regarded as the gold standard treatment for obstructive sleep apnea (OSA) in adults, outcomes in older patients are limited. This study examines the effect of CPAP therapy in older adults with OSA (older than 60 years) compared to younger adults (age 18 to 60 years) to inform the current standard of practice. We performed a retrospective study with a convenience sample to compare responses to CPAP treatment in older versus younger adults with OSA using validated, patient-reported outcomes (PROs). A total of 532 patients were analyzed at baseline and at 3, 6, and 12 months after CPAP initiation. The effects of CPAP adherence and OSA severity on PRO scores were measured in each age group. Patients older than 60 years had higher apnea-hypopnea indices but lower Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9) scores and higher Functional Outcomes of Sleep Questionnaire (FOSQ) scores at baseline compared to patients age 18 to 60 years. At 1 year after CPAP initiation, significant and comparable improvements in ESS, FSS, PHQ-9, and FOSQ scores were observed in patients older than 60 years relative to younger patients. When stratifying by OSA severity, change between age groups was significantly different only for PHQ-9 in patients with mild OSA, with greater improvements observed in younger patients. This study adds to the limited data on treatment outcomes with CPAP therapy in older adults with OSA. Patients older than 60 years achieve improvement in sleepiness, fatigue, depressive symptoms, and quality of life analogous to that of younger adults.

114 Telemetrically triggered interventions in the first month of CPAP: 6-months results of a prospective, randomized controlled trial

Introduction: CPAP is the standard treatment for OSAS. Long term adherence is relatively low, many patients abscond in the first months of treatment. In a pilot study, we observed an improvement in 1-month adherence for patients supported with telemetrically triggered interventions. Therefore, a prospectively randomized trial was conducted. Methods: 240 symptomatic OSAS patients with an apnea-hypopnea index (AHI) of >5/h started CPAP with a structured instruction session of 1 hour, including a trial period in bed. Patients who agreed for long-term CPAP were randomized 1:1 to a telemedicine (TM) or control group (non-TM). For the TM group, CPAP usage, mask leakage and residual AHI were checked on an online data depository 3 times per week during the first month of treatment. Phone calls were undertaken if there was usage < 4h or excessive leakage for 2 consecutive nights. For all patients, data on usage and sleep and daytime quality of life (Quebec sleep Quality QSQ) was collected at 1 and 6 months of treatment.Table 1With TMNon-TMp-valN8287% male82.585.4nsAge55.2 [44.4 - 66.0]57.2 [43.8 - 65.7]nsBMI31.3 [27.5 - 34.7]31.0 [27.9 - 34.9]nsODI32.5 [17.0 - 59.0]36.0 [23.5 - 60.5]nsAHI39.0 [26.0 - 69.0]52.0 [32.5 - 70.5]nsESS10 [6 - 13]10 [7 - 13]nsQSQ sum score140.0 [103.5 - 170]151.5 [124.5 - 176.5]ns Open table in a new tab Results: 240 patients were randomized. According to the predefined protocol, 17 1-month absconders (11 TM, 6 non-TM) and 54 6-months absconders (27 TM, 27 non-TM) were excluded from analysis. Baseline characteristics of the study population were comparable in both groups (Table 1). Among TM patients, 18 (22%) had no indication for calls, 26 (32%) received 1 or 2 calls and 38 (46%) 3 or more calls. Usage data at 6 months for TM and non-TM patients are given in Table 2. Usage differences between groups were not statistically significant. In a subgroup analysis, we found that for the quartile of patients with low baseline scores in the Epworth sleepiness scale (ESS), a significant increase in usage was observed. Similarly, the quartile of patients with low baseline AHI had a significantly higher CPAP usage in the TM group. Interestingly, there was a significantly higher improvement in QSQ when comparing TM vs. non-TM from baseline to 1 month (p=0.021) and from baseline to 6 months (p=0.028).Table 2With TMNon-TMpN8287Month 1: Daily usage (h)5.7h [4.4 - 6.8]5.3 [4.2 - 7.0]0.8Month 1: % nights with CPAP used95.3 [85.4 - 98.6]95.3 [88.7 - 98.6]0.811Month 1: % nights with efficient CPAP use93.4 [80.3 - 100.0]90.1 [67.1 - 100.0]0.233Month 1: QSQ sum score174 [152 - 195]172 [150 - 194]nsMonth 6: Daily usage (h)5.6 [3.8 - 6.3]4.8 [3.3 - 6.7]0.663Month 6: % nights with CPAP used92.0 [72.3 - 98.0]88.2 [71.5 - 97.7] 0.5650.565Month 6: % nights with efficient CPAP use89.6 [79.2 - 96.7]89.6 [74.0 - 97.3]0.716QSQ sum score174 [150 - 195]169 [145 - 188]ns Open table in a new tab Conclusion: Telemetrically triggered targeted patient support during the first CPAP month did not result in a statistically significant increase in CPAP usage at 1 and 6 months of treatment in an unselected patient population. A significant improvement was observed in the subgroup of patients with low ESS scores as well as in patients with low AHI.

The influence of hypertension on daytime sleepiness in obstructive sleep apnea

Daytime sleepiness is a common symptom among hypertensive patients. The aim of this study was to determine subjective sleepiness assessed by Epworth Sleepiness Scale (ESS) and to asses sleep architecture in 304 patients with arterial hypertension. All patients underwent a standardized diagnostic overnight, polysomnography. The control group consisted of 67 normotensives. The hypertensive patients had a decreased sleep efficiency, mean and minimum oxygen saturation levels, and increased apnea/hypopnea index and oxygen desaturation index compared with normotensive patients. The lower ratio of N3 sleep, higher of N2 sleep, and decreased sleep efficiency was observed in hypertensives without obstructive sleep apnea (OSA). In the moderate to severe OSA groups, the total ESS score was significantly lower in hypertensives compared with normotensives. The ESS scores decreased with age in hypertensives, but not in normotensives. The study showed that ESS total score is lower in hypertensives than in normotensives with OSA, making the OSA more difficult to suspect. Thus, the low ESS score in hypertensives should not discourage further evaluation.

Daytime sleepiness and nighttime sleep quality across the full spectrum of cognitive presentations in essential tremor

There is increasing evidence that essential tremor (ET) is a complex and heterogeneous disorder with nonmotor features including cognitive deficits and sleep problems. We are unaware of a study that has examined sleep deficits in ET across the full spectrum of cognitive presentations. Cross-sectional (baseline) data on self-reported nighttime sleep dysfunction and excessive daytime sleepiness were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) in 96 ET cases enrolled in a prospective study. Cases underwent a comprehensive neuropsychological assessment, and were classified as ET with normal cognition (ET-NC), ET with mild cognitive impairment (ET-MCI), and ET with dementia (ET-D). PSQI scores did not significantly differ across the three ET cognitive groups (p=0.22). ESS scores were highest (more daytime sleepiness) in the ET-MCI group, followed by the ET-D and ET-NC groups, respectively (p=0.016). We examined sleep dysfunction across the cognitive spectrum in ET. We demonstrate for the first time that excessive daytime sleepiness is greater in ET-MCI than ET-NC. Unpredicted low ESS scores in the dementia group raises two possibilities: a self-report bias related to cognitive impairment and/or the possibility that currently undefined pathological heterogeneity in ET may map onto multiple presentations of non-motor deficits.

Patients' preference of established and emerging treatment options for obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing. The standard treatment, continuous positive airway pressure (CPAP), has limited long-term compliance. Alternative treatment options are required and new methods, including hypoglossal nerve stimulation (HNS) and continuous transcutaneous electrical stimulation (CTES), are currently emerging. We report on patients' preference for different treatments of OSA. We recorded patients' age, gender, body mass index (BMI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire with 10 questions (FOSQ10), severity of OSA, and current treatment. We showed pictures of existing [CPAP, mandibular advancement device (MAD)] and emerging treatments (HNS and CTES). We then asked (I) whether participants were interested in further information about HNS/CTES; (II) if they would be willing to try HNS/CTES; and (III) if they were to choose only one of the four listed treatments, which one would they prefer to use every night. One hundred sixty-two patients completed the survey {81 males, mean age 52 [12] years, BMI 34 [7] kg/m(2), ESS 10.2 (6.0) points, FOSQ10 28.5 (8.1) points}. The majority of the respondents (89.5%) had been diagnosed with OSA. A total of 91.3% of the respondents were interested in more information and were willing to try HNS/CTES. Most respondents preferred the potential use of CTES (56.7%), while 21.7% chose HNS, 17.8% CPAP, and 3.8% the MAD. There were no differences in the characteristics of the patients who preferred CTES compared to those who preferred other treatments, but a regression analysis revealed that a low ESS score was an independent predictor of patients choosing CTES (P<0.05). More than 9 out of 10 of the respondents were interested in trying emerging technologies to treat OSA, most preferring CTES. Less sleepy patients were more likely to choose less invasive treatments. These findings will likely impact on future research and development of therapies for sleep-disordered breathing.

P295 Patients' Preference Of Established And Emerging Treatments For Obstructive Sleep Apnoea

Background Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing, and the standard treatment is continuous positive airway pressure (CPAP). Emerging treatments for OSA, including electrical hypoglossal nerve stimulation (HNS) and non-invasive electrical stimulation (nES), are currently being developed. To involve patients in the development of research projects, we evaluated patients’ preference for different treatments of OSA using a short survey. Patients and methods We recorded patients’ age, gender, body-mass-index (BMI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ10), severity of OSA, and current treatment. We showed pictures of existing (CPAP, mandibular advancement device (MAD)) and emerging treatments (HNS and nES). We then asked 1) whether they were interested in further information about HNS/nES, 2) if they would be willing to try HNS/nES, and 3) if they were to choose only one of the four listed treatments, which one would they prefer to use every night. Results 162 patients completed the survey (81 males, mean age 52 (12) years, BMI 34 (7.3) kg/m2, ESS 10.2 (6.0) points, FOSQ10 28.5 (8.1) points). The majority of the respondents (89.5%) had been diagnosed with OSA, with 95.4% of those being treated with CPAP. 91.3% of the respondents were interested in more information and were willing to try HNS/nES. Most respondents preferred the potential use of nES (56.7%), while 21.7% chose HNS, 17.8% CPAP, and 3.8% the MAD. There were no differences in the characteristics of the patients who preferred nES compared to those who preferred other treatments; however, a regression analysis showed that a low ESS score was a predictor of patients choosing nES (p Conclusion Although the CPAP is the established treatment for OSA, most patients would prefer alternatives for long-term treatment. The majority of the respondents were interested in emerging technologies, with less sleepy patients more likely to choose less invasive treatment options.

Psychometric evaluation of a Swedish version of the Functional Outcomes of Sleep Questionnaire, FOSQ

Objective. The Functional Outcomes of Sleep Questionnaire, FOSQ, is a self-administered 30 item questionnaire, designed to assess the impact of disorders of excessive sleepiness on activities of daily living. The aim was to evaluate the psychometric properties of a Swedish translation of the English original. Materials and methods. A Swedish version of the FOSQ was answered by 75 consecutive patients, diagnosed with obstructive sleep apnea syndrome and in need of treatment. The Short Form Health Survey (SF-36) and Epworth Sleepiness Scale (ESS) were also answered at the same time to evaluate validity. The first 25 patients answered the FOSQ a second time, 3 weeks later, to assess reliability. Results. The test–re-test reliability and intra-class correlation of the different sub-scales in the FOSQ varied between 0.71–0.92 and was 0.92 for the total scale, all statistically significant. Cronbach's alpha, calculated as a measure of internal consistency, varied between 0.84–0.92 for FOSQ sub-scales and was 0.96 for the total score. Statistically significant correlations between FOSQ sub-scales and the eight sub-scales in the SF-36 supported the validity. Discriminant validity, calculated by splitting responders with high and low ESS scores, revealed that FOSQs scores differed significantly between the groups. Conclusions. The results suggest that the Swedish version of the FOSQ has psychometric qualities in line with the original. It might, therefore, be a potentially useful, reliable and valid instrument for clinicians and researchers when measuring variables related to quality-of-life in sleep disorders in this language area.

SUBJECTIVE SLEEP QUALITY AND DAYTIME SLEEPINESS IN A LARGE SAMPLE OF PATIENTS WITH CHRONIC FATIGUE SYNDROME (CFS)

Chronic fatigue syndrome (CFS) is characterised by incapacitating fatigue in combination with a number of minor criteria, including unrefreshing sleep without further specifications, in the absence of psychiatric and internal disease. As little data exist on subjective sleep quality and daytime sleepiness, these parameters were assessed in a large sample of CFS patients.Consecutive patients with a diagnosis of CFS in a tertiary referral centre filled out the Fatigue Questionnaire (FQ), Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI).Inclusion comprised 415 individuals (mean age 40.5 yr, SD 7.9, range 18-64; 86% female). Mean FQ (26.90; SD 4.04), mean Global Physical Health from the MOS SF-36 (29.30; SD 12.25) and Global Mental Health from the MOS SF-36 (49.62; SD 18.31) scores corresponded with literature data for similar CFS samples. High mean ESS (10.51; SD 5.52) and global PSQI (10.17; SD 4.02) were observed. No significant relationship was found between ESS and global PSQI. In contrast, regression analysis demonstrated a significant cubic relation between ESS and ‘PSQI without daytime dysfunction’. A subgroup (n = 69) with an insomnia-like phenotype low ESS (< 5), high PSQI (mean 11.51; SD 3.86) was observed.The assessment of subjective sleep quality and daytime sleepiness in a large sample of CFS patients indicated high mean PSQI and ESS values. ESS and ‘PSQI without daytime dysfunction’ were inversely related at the spectral ends of ESS. A distinct subgroup with clinical features of insomnia was identified.

Long-Term Therapy with Continuous Positive Airway Pressure in Obstructive Sleep Apnea: Adherence, Side Effects and Predictors of Withdrawal – A ‘Real-Life’ Study

Background: Long-term adherence to positive airway pressure (PAP) treatment is essential in patients with obstructive sleep apnea syndrome (OSAS). Objectives: The aim of the present study was to analyze treatment adherence under real-life conditions and factors associated with discontinuation of PAP therapy. Methods: Patients newly diagnosed with OSAS and started on PAP therapy were contacted by telephone after a minimum of 1 year. Side effects, quality of life, subjective treatment adherence and Epworth Sleepiness Scale (ESS) scores were assessed. Objective treatment adherence was calculated by reading the built-in run time counter of the PAP device. Anthropometric parameters, level of education, apnea-hypopnea index (AHI), ESS score and the type of PAP therapy prescribed at the time of the first stay in the sleep lab were collected retrospectively. Results: Median follow-up was 13 months (range 7–18 months). Of 303 patients (69 female, 234 male) available for this study, 191 patients (63%) still used the PAP device regularly (‘users’), while 83 (27.4%) had definitively discontinued PAP treatment (‘nonusers’). In the nonusers group, 29 patients (34.9%) discontinued PAP treatment within the first 3 months. In the users group, subjective PAP usage was 6.6 ± 1.5 h/night and objective adherence was 4.7 ± 2.3 h/night. Objective nightly use of PAP treatment correlated significantly with baseline AHI (r = 0.13, p = 0.041) but not with sex, age, body mass index, ESS score or education level. Patients with a low AHI and ESS score and patients without a coexisting medical condition or with more than two comorbidities tended to discontinue PAP therapy more frequently. Conclusions: PAP treatment adherence has to be optimized in OSAS patients. When initiating PAP therapy, clinicians have to focus on those patients at risk for discontinuing treatment. Education sessions and closer follow-up are possible strategies to improve treatment adherence and to avoid treatment discontinuation.

Repeating administration of Epworth Sleepiness Scale is clinically useful

We aimed to verify whether it is clinically useful to repeat the Epworth Sleepiness Scale (ESS) in individuals with suspected sleep-disordered breathing (SDB). In this cross-sectional, prospective study, results of the repeated administration of the ESS were analyzed. In 929 consecutive patients, ESS was obtained as usual in the laboratory routine, immediately before the sleep study (ESS1) and was repeated in the morning, after the polysomnography (ESS2). ROC curve, classical psychometry, and item response theory (IRT) Rasch analysis were used to assess measurement properties of ESS. The ESS1 score was (mean ± SD), 11 ± 5.1, and the ESS2, 13 ± 4.7 (p < 0.001). Change in ESS score is explained in multivariate analysis by age, but not by gender, educational level, change in Stanford Sleepiness Scale, symptoms of sleep disorder, or polysomnography results. Accuracy of an ESS score >10 to predict apnea-hypopnea index ≥5 increased from 56% (ESS1) to 72% (ESS2). IRT psychometric properties (unidimensionality, invariance, local independence) were maintained in ESS2. Repeating the administration of the Epworth Sleepiness Scale in a clinical setting increases its score and diagnostic accuracy and correlation with SDB variables, without changing the psychometric properties of the scale. This experiment indicates the clinical usefulness of repeating the ESS. The scale can be repeated at a negligible cost, before dismissing individual patients on the basis of a low ESS score, discontinuing a potentially lifesaving diagnostic and therapeutic process.

S26-3 Clinical application of PSG to REM sleep behavior disorder and periodic leg movements during sleep

Periodic leg movements during sleep (PLMS) is frequently observed in rapid eye movement (REM) sleep behavior disorder (RBD) especially during REM sleep period. We made a series of studies for investigating the clinical significance and the underlying mechanism of PLMS in RBD. Consecutive 54 patients with idiopathic RBD without PLMS (iRBD w/o PLMS, 65.9±6.9 yrs), 27 patients with iRBD with PLMS (iRBD-PLMS, 67.7±7.1 yrs), and 31 patients with idiopathic PLMS (iPLMS, 63.5±5.9 yrs) were enrolled. Scores of Epworth Sleepiness Scale (ESS) were compared among the three patients groups. PLMS index, mean duration of PLMS, and inter-PLMS interval were calculated during both NREM sleep period and REM sleep period respectively, and compared among the three patient groups. Correlation analysis between ratio of PLMS related arousal index to PLMS index (PLMAI/PLMI) and proportion of REM sleep without atonia to total REM sleep (RWA/REM) were performed in the iRBD-PLMS group. The associated factor for the presence of PLMS during REM sleep period was also investigated in the subject iRBD group. In 15 out of iRBD-PLMS patients, effectiveness of the treatment with pramipexole, a dopamine agonst, was also evaluated. The iRBD-PLMS group showed significantly lower ESS score than the iPLMS w/o PLMS group did. PLMAI/PLMI was negatively correlated with RWA/REM. The iRBD-PLMS group showed significantly higher PLMS index, longer duration of PLMS, and shorter inter-PLMS interval than the iPLMS group did. RWA/REM appeared as a significantly associated factor for the presence of PLMS during REM sleep period among the iRBD patients. However, pramipexole treatment did not show a statistical decrease in the amount of PLMS. Conclusions: RWA could be associated with attenuation of arousal response to PLMS possibly leading to lower daytime sleepiness in iRBD. Our result impresses that PLMS during this sleep period could become an disease process marker of iRBD.