Mean Epworth Sleepiness Scale Score Research Articles

Existence and pattern of sleep-related breathing disorders in patients diagnosed with bronchial asthma.

Asthma and obstructive sleep apnea (OSA) are commonly prevalent diseases, and both can co-exist to result in an alternate overlap syndrome, where a bidirectional relationship can adversely affect each other. This study aimed to determine the existence and pattern of sleep-related breathing disorders in subjects with bronchial asthma. It was prospectively conducted at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi, in diagnosed cases of bronchial asthma. A subjective assessment of sleepiness was done using the Epworth sleepiness scale (ESS). All subjects underwent overnight polysomnography (PSG) in the Sleep Laboratory of the Institute. A total of 70 subjects were screened, and among them, finally, 30 were enrolled. The mean age of the subjects was 37.53±11.21 years, the mean body mass index (BMI) was 26.4±5.58 kg/m2, the mean ESS score was 3.1, and 80% of the subjects were male. After PSG, OSA (apnea hypopnea index >5/hour) was found in 63% (19/30) of the patients, of whom 43% had mild OSA, 10% had moderate OSA, and 10% had severe OSA. 10% (3/30) had nocturnal oxygen desaturation, while none had sleep hypoventilation. Patients with OSA compared to those without OSA had a higher BMI, more co-morbid allergic rhinitis, severe bronchial asthma, and a worse percentage of predicted forced expiratory volume in the first second. The study showed high detection rates of OSA in bronchial asthma patients. Hence, asthma patients should be evaluated for OSA.

Effectiveness and optimization of low-sodium oxybate in participants with narcolepsy switching from a high-sodium oxybate: data from the SEGUE study.

Low-sodium oxybate (LXB; calcium, magnesium, potassium, and sodium oxybates; Xywav) contains the same active moiety as high-sodium oxybates (sodium oxybate [SXB; Xyrem] and fixed-dose sodium oxybate [Lumryz]), with 92% less sodium, and is approved in the US for treatment of cataplexy or excessive daytime sleepiness in patients 7 years of age and older with narcolepsy, and idiopathic hypersomnia in adults. Patients with narcolepsy have increased cardiovascular risk relative to people without narcolepsy. LXB's lower sodium content is recognized by the US FDA in the narcolepsy population as clinically meaningful in reducing cardiovascular morbidity compared with high-sodium oxybates. The Substitution of Equal Grams of Uninterrupted Xyrem to Xywav (SEGUE) study (NCT04794491) examined the transition experience of patients with narcolepsy switching from SXB to LXB. Eligible participants were aged 18 to 80 years with narcolepsy type 1 or 2 on a stable SXB dose/regimen. After 2 weeks, participants transitioned gram-per-gram to LXB for 6 weeks, with opportunity for subsequent titration. Assessments included the Epworth Sleepiness Scale (ESS), Patient Global Impression of Change (PGIc), ease of switching medication scale (EOSMS), and forced preference questionnaire (FPQ). The study enrolled 62 participants at baseline; 60 transitioned to LXB and 54 completed the study. At baseline and end of the LXB intervention/early discontinuation, respectively, mean total doses were 8.0 and 8.0 g/night; mean ESS scores were 9.4 and 8.8. Most participants reported improvement (45%) or no change (48%) in narcolepsy symptoms on the PGIc, reported the transition to LXB was "easy" (easy, extremely easy, not difficult at all; 93%) on the EOSMS, and preferred LXB compared with SXB (79%) on the FPQ, most commonly due to the lower sodium content. Most participants switched from SXB to LXB with minimal modifications of dose/regimen and reported the transition process was easy. Effectiveness of oxybate treatment was maintained on LXB, and most participants preferred LXB to SXB. No new safety or tolerability issues were identified. Registry: ClinicalTrials.gov; Name: An Interventional Safety Switch Study (Segue Study) of XYWAV in Narcolepsy; URL: https://classic.clinicaltrials.gov/ct2/show/NCT04794491; Identifier: NCT04794491.

Assessment of the Epworth Sleepiness Scale, Pediatric Sleep Questionnaire, and Mallampati Score in Children With Obstructive Sleep Apnea: An Observational Study

Background and Objective Individuals diagnosed with obstructive sleep apnea (OSA) experience recurrent episodes of breathing cessation due to blockage of the upper airway during sleep. This study aimed to assess the Pediatric Sleep Questionnaire (PSQ) scores, Epworth Sleepiness Scale (ESS) scores, and Mallampati score in pediatric patients with OSA, compared with non-OSA.Methods An observational study was conducted on 100 pediatric female patients aged 9-13 years with retrognathic mandible. The participants were subjected to PSQ, ESS, and Mallampati score to assess the size and shape of the patient’s tongue and esophageal airway. Finally, polysomnographic examination was carried out for all the participants and they were divided into two groups: Group 1 (50 patients) who were diagnosed with OSA by polysomnography and Group 2 (50 patients) consisting of non-OSA patients. Chi-square and Mann–Whitney U test were applied to compare scores between the two groups.Results The mean PSQ, ESS, and Mallampati scores of participants were 0.78 ± 0.45, 9.86 ± 2.47, and 2.27 ± 0.98, respectively in Group 1 and 0.24 ± 0.03, 7.27 ± 2.39, and 1.32 ± 0.57, respectively in Group 2, and this difference was statistically significant (p < 0.05). PSQ, ESS, and Mallampati scores had specificity of 100%, 95.5%, and 72.7%, respectively, whereas the sensitivity was 45.5%, 22.7%, and 63.6%, respectively. ESS scores ≥ 10, PSQ scores ≥ 0.3, and Mallampati scores ≥ 2 were indicative of OSA.Conclusions Patients with OSA having retrognathic mandible had higher PSQ, ESS, and Mallampati scores compared to healthy individuals without OSA. Mallampati score can be satisfactorily used for screening OSA patients.

Real-world impact of continuous positive airway pressure on sleepiness in patients with obstructive sleep apnea in a national registry

ObjectiveExcessive daytime sleepiness (EDS) persists in some patients with obstructive sleep apnea (OSA) despite continuous positive airway pressure (CPAP) treatment. This study characterized response to CPAP and factors associated with residual EDS. MethodsDanish National Patient Registry data were analyzed. Patients with OSA diagnosis (1994–2016), Epworth Sleepiness Scale (ESS) scores and apnea-hypopnea index recorded before beginning CPAP (baseline) and after 1–13 months of CPAP use, and CPAP adherence were included. Odds ratios (OR) for residual EDS after CPAP treatment were estimated using multivariate logistic regression. ResultsOf 1174 patients (mean age, 57 years; 75.5% male), 41.1% had baseline EDS (mild, 13.2%; moderate, 14.0%; severe, 13.9%); 58.9% did not. After CPAP treatment, follow-up mean ESS scores were normal (≤10) for all baseline EDS subgroups; however, 15.6% (n = 183) of patients had residual EDS (mild, 6.7%; moderate, 5.5%; severe, 3.4%). Odds of residual EDS were higher for patients with mild (OR, 5.2; 95% confidence interval [CI], 3.2–8.6), moderate (OR, 4.5; 95% CI, 2.7–7.4), and severe (OR, 13.0; 95% CI, 8.0–21.2) EDS at baseline compared with those with normal daytime sleepiness at baseline. Patients adherent with CPAP use were 38.2% less likely to have residual EDS compared with nonadherent patients (OR, 0.62; 95% CI, 0.43–0.88). ConclusionsEDS was common in this cohort of Danish patients with OSA. Baseline EDS severity predicted higher odds of residual EDS. After CPAP treatment, adherence was associated with reduced odds of residual EDS, but EDS persisted in a subgroup of patients.

Longitudinal evolution and plasma biomarkers for excessive daytime sleepiness in Parkinson's disease.

Excessive daytime sleepiness (EDS) is one of the most frequent non-motor symptoms in Parkinson's disease (PD); however, the pathogenesis of EDS is unclear, and there is a lack of information on plasma biomarkers for EDS in PD. We aimed to investigate the plasma biomarkers of EDS in a large PD cohort. A total of 159 PD patients were included in the prospective cohort study and followed up annually for three years. Plasma biomarkers including glial fibrillary acidic protein, amyloid-beta, p-tau181, and neurofilament light chain (NfL), were measured using an ultrasensitive single-molecule array (SimoaTM) technology at each visit. EDS was evaluated using the Epworth Sleepiness Scale (ESS). The frequency of EDS in PD increased from 15.1% at baseline to 25.0% after three years. The mean ESS scores increased from 5.1 [Standard Deviation (SD): 4.8] at baseline to 6.1 [SD: 5.5] at the third year of follow-up. At baseline, compared with patients with PD without EDS, those with EDS were more likely to be male, had poorer cognitive performance, and more severe motor and non-motor symptoms. The adjusted generalized estimating equations models showed that higher plasma NfL levels (OR 1.047 [1.002-1.094], p = 0.042) were associated with EDS during follow-ups. The adjusted linear mixed-effects model showed that higher plasma NfL levels (β 0.097 [0.012-0.183], p = 0.026) were associated with ESS scores during follow-ups. Higher plasma NfL levels were associated with EDS in PD, indicating an association between neuro-axonal degeneration and EDS in PD.

Effect of a digital patient motivation and support tool on CPAP/APAP adherence and daytime sleepiness: a randomized controlled trial

The purpose of this study was to assess the effect of a digital patient support (DPS) tool, complementary to standard care on continuous or automatic positive airway pressure (auto)CPAP adherence and daytime sleepiness after 12 weeks in patients diagnosed with severe obstructive sleep apnea (OSA). All patients with apnea–hypopnea index (AHI) ≥ 30 per hour were prospectively included and randomized to receive standard care (SC) or standard care with personalized DPS via a mobile app prototype version (SC + DPS). Patients in the SC + DPS arm received additionally automated feedback on their therapy, motivational messages and therapy recommendations. 100 patients completed the study (SC: 50, SC + DPS: 50). No differences were found in characteristics of SC vs. SC + DPS (mean ± SD) for age (53.9 ± 10.8 vs. 51.7 ± 12.3 years), initial diagnostic apnea–hypopnea index (51.1 ± 15.5 vs. 50.9 ± 17.7 events/h), BMI (33.8 ± 6.7 vs. 33.5 ± 4.5 kg/m), and Epworth Sleepiness Scale (ESS) baseline score (9.5 ± 4.2 vs. 9.1 ± 5.2). After 12 weeks, mean ESS score was significantly lower (SC: 7.6 ± 4.1 vs. SC + DPS: 5.5 ± 3.9; p = 0.006) in the SC + DPS group vs. standard care group. Therapy adherence was significantly higher (SC: 268.7 ± 122.1 vs. SC + DPS: 338.8 ± 106.8 min; p = 0.002) in the SC + DPS group compared to standard care group. No difference was found in the residual AHI between both groups. However, SC + DPS group showed a trend towards fewer phases with increased leakage compared to SC group. Intention-to-treat analysis (112 (56/56) patients) showed similar results. After 12 weeks, (auto)CPAP adherence and daytime sleepiness improved significantly in patients with severe OSA using the digital patient support tool.Clinical Trial Registration (retrospectively registered): Registry: NCT05440279; Title: Effects of Telemedical Support on Therapeutic Results of CPAP Patients; URL: https://clinicaltrials.gov/ct2/show/NCT05440279; Date of registration: June 30, 2022.

Effectiveness and tolerability in people with narcolepsy transitioning from sodium oxybate to low-sodium oxybate: Data from the real-world TENOR study

ObjectivesThe Transition Experience of persons with Narcolepsy taking Oxybate in the Real-world (TENOR) study was conducted to provide real-world insight into the experience of people with narcolepsy switching from sodium oxybate (SXB) to low-sodium oxybate (LXB; 92% less sodium than SXB). MethodsTENOR is a patient-centric, prospective, observational, virtual-format study. Participants were adults with narcolepsy (type 1 or 2) who were transitioning from SXB to LXB treatment (±7 days from LXB initiation). Effectiveness and tolerability data were collected online from baseline (taking SXB) through 21 weeks (taking LXB) via daily and weekly diaries and questionnaires, including the Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire, short version (FOSQ-10), and the British Columbia Cognitive Complaints Inventory (BC-CCI). ResultsTENOR participants (N = 85) were 73% female with a mean (SD) age of 40.3 (13.0) years. Mean (SD) ESS scores decreased numerically throughout the transition from SXB to LXB (baseline: 9.9 [5.2]; week 21: 7.5 [4.7]), with 59.5% and 75.0% of participants having scores in the normal range (≤10) at baseline and week 21, respectively. Mean (SD) FOSQ-10 scores (baseline: 14.4 [3.4]; week 21: 15.2 [3.2]) and BC-CCI scores (baseline: 6.1 [4.4]; week 21: 5.0 [4.3]) also remained stable. The most common symptoms related to tolerability reported by participants at baseline were sleep inertia, hyperhidrosis, and dizziness (45.2%, 40.5%, and 27.4%, respectively), which decreased in prevalence by week 21 (33.8%, 13.2%, and 8.8%, respectively). ConclusionsFindings from TENOR confirm maintenance of effectiveness and tolerability when transitioning from SXB to LXB treatment.

Switching to lemborexant for the management of insomnia in mental disorders: the SLIM study.

We conducted a retrospective study to investigate the efficacy and safety of switching from other hypnotics, including benzodiazepines and Z-drugs, suvorexant, ramelteon, mirtazapine, trazodone, and antipsychotics, to lemborexant, a dual orexin receptor antagonist, for 3 months. Clinical data obtained from the medical records of 61 patients treated at the Horikoshi Psychosomatic Clinic between December 2020 and February 2022 were analyzed, including the Athens Insomnia Scale, Epworth Sleepiness Scale, and Perceived Deficits Questionnaire-5. The primary outcome was the mean change in Athens Insomnia Scale score after 3 months. Secondary outcomes were the mean changes in the Epworth Sleepiness Scale and Perceived Deficits Questionnaire-5 scores over 3 months. We also compared pre- and post-diazepam equivalents. The mean Athens Insomnia Scale score decreased over 3 months after switching to lemborexant (1 mo: -2.98 ± 5.19, P < .001; 2 mo: -3.20 ± 5.64, P < .001; 3 mo: -3.38 ± 5.61, P < .001). Mean Epworth Sleepiness Scale score did not change from baseline to 1 month (-0.49 ± 3.41, P = 0.27), 2 months (0.082 ± 4.62, P = .89), or 3 months (-0.64 ± 4.80, P = .30). Mean Perceived Deficits Questionnaire-5 score did improve from baseline to 1 month (-1.17 ± 2.47, P = .004), 2 months (-1.05 ± 2.97, P = .029), and 3 months (-1.24 ± 3.06, P = .013). There was also a reduction in the total diazepam equivalent (baseline vs 3 mo: 14.0 ± 20.2 vs 11.3 ± 20.6, P < .001). Our study showed that, by switching to lemborexant from other hypnotics, the risks associated with benzodiazepines and Z-drugs may be reduced. Horikoshi S, Miura I, Suzuki Y, etal. Switching to lemborexant for the management of insomnia in mental disorders: the SLIM study. J Clin Sleep Med. 2023;19(10):1753-1758.

0561 Solriamfetol Real World Experience Study: Safety, Efficacy, and Follow-Up for Patients with Obstructive Sleep Apnea in Germany

Abstract Introduction Excessive daytime sleepiness (EDS) is a symptom of Obstructive Sleep Apnea (OSA) that can persist despite primary airway therapy and can be managed with wake-promoting agents. Solriamfetol (Sunosi®) is a wake-promoting agent approved to treat EDS associated with OSA (37.5–150 mg/day). This real-world study characterizes dosing/titration strategies among European physicians initiating solriamfetol and patient outcomes following initiation. Methods This is an ongoing retrospective chart review conducted by physicians in Germany and France. Data are reported from 52 German patients with OSA. Eligible patients (≥18 years old, diagnosed with EDS due to OSA, reached a stable solriamfetol dose, and completed ≥6 weeks of treatment) were classified into 1 of 3 groups based on solriamfetol initiation strategy: changeover (switched/switching from existing EDS medication[s]), add-on (added/adding to current EDS medication[s]), or new-to-therapy (no current/previous EDS medication). Results Patients’ mean±SD age was 50.0±13.1 years; 65% were male. All patients used primary airway therapy. Obesity was the most common comorbidity (56%). New-to-therapy was the most common initiation strategy (n=39), then add-on (n=9), and changeover (n=4). The most common starting doses of solriamfetol were 37.5 (n=34; 65%) and 75 mg/day (n=17; 33%). Solriamfetol was titrated in 30 patients (58%); the majority were titrated within 7 days. Mean±SD Epworth Sleepiness Scale (ESS) score was 15.5±3.2 (n=52) at initiation and 10.7±3.7 at follow-up (n=48), with a mean decrease of 5.0± 3.2 points. Across subgroups, mean ESS scores at initiation and follow-up ranged from 15.2–16.8 and 10.3-11.6, with mean decreases from 4.5–6.5 points. Improvements in EDS after solriamfetol initiation were reported for most patients (patient-reported, 90%; physician-reported, 88%). Most patients reported the effects of Solriamfetol to last ≥6 hours (81%) with no change in their night-time sleep quality (86%). Common adverse effects were headache, insomnia, and irritability. Conclusion These real-world data describe the use of solriamfetol in a cohort of German patients with OSA. Solriamfetol was typically initiated at 37.5 mg/day; titration was common. ESS improvements were greater than the minimum clinically important difference (MCID) of 2-3, and most patients and physicians perceived improvement in EDS. Common adverse events were consistent with those previously reported for solriamfetol. Support (if any) Axsome Therapeutics and Jazz Pharmaceuticals

0592 Efficacy of Lower-Sodium Oxybate by Baseline Sleep Inertia in a Phase 3 Clinical Study in Patients With Idiopathic Hypersomnia

Abstract Introduction Idiopathic hypersomnia is a debilitating neurologic sleep disorder. Sleep inertia (difficulty awakening) is a common symptom that can significantly impair functioning and quality of life. This post hoc analysis evaluated response to lower-sodium oxybate (LXB; Xywav®) by baseline sleep inertia in a phase 3 trial (NCT03533114). Methods Eligible participants began LXB treatment with an open-label treatment titration and optimization period (10–14 weeks), followed by a 2-week stable-dose period (SDP). Participants were randomized to placebo or continued LXB treatment during a 2-week, double-blind, randomized withdrawal period (DBRWP). Using the visual analog scale for sleep inertia (VAS-SI), participants rated their difficulty awakening during baseline, SDP, and DBRWP on a 100-mm line with anchors at 0 (very easy) and 100 (very difficult). VAS-SI terciles comprised score segments of &amp;lt; 44 (group A), ≥44 to &amp;lt; 70 (group B), and ≥70 (group C). Efficacy assessments included the Epworth Sleepiness Scale (ESS), Idiopathic Hypersomnia Severity Scale (IHSS), Clinical Global Impression of Severity (CGIs), and Patient Global Impression of Change (PGIc). Results Participants (A, n=34; B, n=33; C, n=32) were a mean (SD) 40.7 (13.5) years of age and primarily female (74%). At baseline, participants with the highest VAS-SI scores had numerically higher mean (SD) ESS (A=16.0 [3.1], B=15.6 [2.6], C=17.1 [2.4]) and IHSS (A=26.7 [7.7], B=34.5 [5.9], C=36.3 [5.5]) scores. Participants with the highest baseline sleep inertia were more frequently rated severely ill on the CGIs (A=17.6%, B=12.1%, C=34.4%). Baseline total sleep time trended higher with increasing VAS-SI scores. From baseline to end of SDP, mean (SD) scores decreased (improved) on the ESS (A=−9.9 [5.1], B=−9.8 [3.5], C=−10.0 [5.1]) and IHSS (A=−14.1 [9.9], B=−19.0 [9.0], C=−18.1 [9.9]), regardless of baseline sleep inertia; nearly all (99%) participants reported improvement on the PGIc. Mean (SD) VAS-SI scores decreased by 9.3 (11.9), 31.5 (14.8), and 42.8 (22.9) in groups A, B, and C, respectively, at end of SDP. Spearman correlation coefficients for VAS-SI and IHSS items assessing sleep inertia were moderate (≥0.3) to strong (≥0.6). Conclusion Participants with higher baseline sleep inertia generally had greater baseline disease burden. LXB treatment was efficacious across subgroups regardless of baseline sleep inertia. Support (if any) Jazz Pharmaceuticals.

0875 Self-Reported Sleep Indices in Veterans Exposed to Deleted Uranium

Abstract Introduction During Gulf War I, a group of veterans sustained exposure to deplete uranium (DU) through a series of “friendly fire” incidents. This resulted in both inhalational and traumatic injuries, with a subset having retained fragments and ongoing systemic exposure to DU. These veterans have undergone biennial surveillance assessments to monitor for DU-related health effects. While effects of DU on bones and kidneys have been consistently shown, less is understood about the effect of DU on sleep. In rat models, exposure to DU affected sleep architecture by increasing both sleep fragmentation and quantity of REM sleep. We therefore sought to characterize the effect of DU on self-reported sleep complaints among this unique veteran cohort. Methods Of a dynamic cohort of 81 DU-exposed veterans, 37 completed medical history, exposure, and sleep questionnaires and 24-hour urine uranium collections. Responses on the sleep questionnaires -which included subjective assessment of sleep quality and quantity as well as an Epworth Sleepiness Scale (ESS) score – were compared in veterans with elevated (&amp;gt;0.1 mcg U/g creatinine) vs low urine uranium (uU). Results The 37 veterans assessed were all male, mostly white, and had a mean age of 54 ± 2.8 years. 10 were identified as having elevated urine DU levels. The mean ESS score for the group overall was in the pathologic range (13 ± 4) and did not differ significantly between the high and low uU groups. The most frequent complaints in the group overall were of difficulty falling asleep, awakening frequently throughout the night, restless sleep, and frequent tossing and turning. Among all self-reported sleep indices, there were no significant differences among the two groups. Conclusion In this group of DU-exposed veterans, excessive daytime sleepiness and several other sleep complaints were observed. Although there were no differences in the frequency or severity of self-reported sleep indices among this group of DU-exposed veterans, the group was overall pathologically sleepy. More work is needed to further characterize the possible impact of DU exposure on sleep. Support (if any) Funded by the US Department of Veterans Affairs and supported by the University of Maryland General Clinical Research Center.

Symptom Severity and Treatment Satisfaction in Patients with Idiopathic Hypersomnia: The Real World Idiopathic Hypersomnia Outcomes Study (ARISE).

Idiopathic hypersomnia is a debilitating sleep disorder characterized by excessive daytime sleepiness, sleep inertia, and prolonged sleep duration. The patient burden of idiopathic hypersomnia is poorly understood. The Real World Idiopathic Hypersomnia Outcomes Study (ARISE) evaluated symptoms and treatment effectiveness/satisfaction in participants with idiopathic hypersomnia. ARISE was a United States-based virtual cross-sectional survey. Participants were adults 21-65 years of age with idiopathic hypersomnia recruited from social media, the Hypersomnia Foundation website, and a patient panel. Self-assessments included the Epworth Sleepiness Scale (ESS), Idiopathic Hypersomnia Severity Scale (IHSS), Treatment Satisfaction Questionnaire for Medication, version II (TSQM-vII), and additional treatment questions. Data were analyzed for all participants and for subgroups with/without long sleep time (LST; ≥11 hours in 24 hours). Of 75 participants enrolled, most were female (81.3%). The mean (SD) age was 34.1 (10.7) years and 49% had LST. Most participants took off-label prescription medications (89.3%) and/or used other measures (93.3%) to manage their symptoms. The mean (SD) ESS score was 14.5 (3.5) and the mean IHSS score was 35.2 (7.6). Treatment satisfaction was low (mean [SD] TSQM-vII score: overall, 61.9 [21.2]; with LST, 57.9 [21.4]; without LST, 66.7 [20.3]), primarily driven by dissatisfaction with treatment effectiveness. The most common classes of prescription medications used were stimulants (61.3%), wake-promoting agents (28.0%), and antidepressants (18.7%); non-prescription measures used to manage symptoms included caffeine (73.3%), planned naps (34.7%), and individual accommodations (32.0%). Overall, participants with idiopathic hypersomnia, with or without LST, had substantial symptom burden despite most of the study population taking off-label medications and using nonprescription measures to manage symptoms.

Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients—a randomized controlled trial

BackgroundObstructive sleep apnea (OSA) is quite common among the adult population, according to recent epidemiological studies. The most frequently suggested alternate treatment for mild to moderate OSA is oral appliances (OA). The purpose of the present study was to assess as well as compare the effectiveness of custom-made maxillary oral appliances against mandibular advancement appliances in the care of individuals suffering from moderate obstructive sleep apnea.MethodsA prospective interventional research was carried out with 40 participants. Polysomnography (PSG) was done and the participants with an apnea-hypopnea index (AHI) >15–30 were involved in the research. Study participants were randomly split up into two test groups: group I was the “Control Group” (group treated with a mandibular advancement device (MAD), n=20), while group II was exposed to a “customized maxillary oral appliance” (CMOA, n=20). Both groups had reference measures for AHI, blood oxygen saturation (SpO2), oro-nasal airflow via respiratory disturbance index (RDI), and the Epworth Sleepiness Scale (ESS). Appliances were fabricated and delivered to the respective study group participants. PSG was again conducted after a period of 1 and 3 months of appliance delivery and re-evaluation was done for all the parameters and was compared with reference measurements. The facts were analyzed using descriptive and analytical statistical methods. The statistical program utilized in the study was “SPSS (Statistical Package for Social Sciences) Version 20.1.” After 1 and 3 months, the statistical significance between the two study groups was assessed at P<0.05.ResultsThe analysis of mean AHI, SPO2, RDI, and ESS for both test groups manifested statistically significant measures (P<0.001). The study results revealed a statistically significant depletion in mean AHI scores, improvement in mean SPO2 scores, and reduction in mean RDI scores and ESS scores when compared with reference measurements to 1 month, 1 to 3 months, and between reference measurements and 3 months.ConclusionThe CMOA was effective in managing moderate OSA and has great therapeutic potential. It can be an option for the MAD for treating patients suffering from moderate obstructive sleep apnea.Trial registrationThe study was registered under Clinical Trials Registry-India and the registration number is CTRI/2020/07/026936. Registered on 31 July 2020

The Prevalence and Risk Factors For Poor Sleep Quality Amongst Medical Students: A Cross Sectional Study

Introduction: Undergraduate medical students have consistently been shown to have high prevalence of mental health disorders in comparison to their peers from non-medical backgrounds and sleep quality is a critical aspect for maintaining mental wellbeing. The aim of this study is to compile prevalence on poor sleep quality and analyze its potential risk factors. Methodology: A cross sectional study was conducted at the Aga Khan University. Undergraduate medical students asked to fill out a self-reported questionnaire that was sent via email which included the 14-point Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). 302 students responded and the data was analyzed using chi square and logistic regression to determine their association with Sex, BMI, Year of Study and Academic Score. Results: The mean age of study participants was 21.58 + 1.41 years and majority were males (58%). The mean PSQI, ESS and PSS scores were 6.35 + 3.28, 7.72 + 4.58 and 28.38 + 7.81 respectively. 11.3% of participants reported poor sleep quality, which was significantly associated with female sex and academic performance. 28.5% of students had excessive daytime sleepiness, which was significantly associated with female sex and academic year (first year). “Stress” and “Overthinking/Anxiety” were the two most common self-reported reasons for Poor Sleep Quality. 85.4% of students were stressed with an average PSS score of 28.38 + 7.81. Conclusion: This study therefore shows a high prevalence of stress with moderate sleep disturbance prevalence, which was associated with female sex and academic performance.

Office-Based Multilevel Radiofrequency Ablation for Mild-to-Moderate Obstructive Sleep Apnea.

Investigate multilevel radiofrequency ablation (RFA) as an alternative therapy for patients with mild-to-moderate obstructive sleep apnea (OSA). Prospective, open-label, single-arm, nonrandomized clinical trial. Multicenter academic and private clinics. Patients with mild-to-moderate OSA (apnea-hypopnea index[AHI] 10-30; body mass index ≤ 32) were treated with 3 sessions of office-based RFA to the soft palate and tongue base. The primary outcome was a change in the AHIand oxygen desaturation index (ODI 4%). Secondary outcomes included subjective sleepiness level; snoring level; and sleep-related quality of life. Fifty-six patients were enrolled, with 43 (77%) completing the study protocol. Following 3 sessions of office-based RFA to the palate and base of the tongue, the mean AHI decreased from 19.7 to 9.9 (p = .001), while the mean ODI (4%) decreased from 12.8 to 8.4 (p = .005). Mean Epworth Sleepiness Scalescores declined from 11.2 (±5.4) to 6.0 (±3.5) (p = .001), while Functional Outcomes of Sleep Questionnaire scores improved from a mean of 14.9 at baseline to 17.4 (p = .001). The mean visual analog scale snoring scale was reduced from 5.3 (±1.4) at baseline to 3.4 (±1.6) at 6 months posttherapy (p = .001). Office-based, multilevel RFA of the soft palate and base of the tongue is a safe and effective treatment option with minimal morbidity for properly selected patients with mild-to-moderate OSA who are intolerant or refuse continuous positive airway pressure therapy.

The Association between Obstructive Sleep Apnea and Glycated Haemoglobin A1c (Hba1c) Level in Diabetes Mellitus Type II Patient

Abstract Background: Obstructive sleep apnea (OSA) is a chronic condition characterized by repetitive episodes of upper airway collapse, apnea, and arousal during sleep. OSA and type 2 diabetes mellitus (T2DM) are common comorbid conditions. Haemoglobin A1c (HbA1c) is an approximation of an individual’s average blood glucose level for the prior two to three months, and therefore is considered to be a major index for monitoring glycaemic control in diabetic patientsObjective: This study aimed to examine the association between OSA and HbA1c levels in T2DM patients.Methods: This was a cross-sectional study. The study assesses the association between OSA and HbA1c levels in 75 T2DM patients. OSA in the patient was asses with Epworth Sleepiness Scale (ESS) questionnaire. HbA1c values were obtained from the patient’s records. Data presented in mean ± SD, max, and min. Correlations analyses using Pearson correlation coefficient with p &lt; 0.05 were considered statistically significant.Results: A total of 75 T2DM has a mean BMI were 25.26 ± 48.31 kg/m2 with mean HbA1c levels of about 7.1 ± 0.19%. The mean ESS score was 5 ± 0.429. The very weak correlation between OSA and BMI was statistically significant, r = 0.213; p = 0.047. Meanwhile, a very weak correlation between OSA and HbA1c levels was not statistically significant, r = 0.137; p = 0.242Conclusion: Among adults with T2DM, the correlation between OSA with HbA1c was not statistically significant

Association between various breathing indexes during sleep and the Epworth Sleepiness Scale score in adults

Some breathing indexes during sleep, including the apnea-hypopnea index, oxygen desaturation index, and oxygen saturation during sleep, can be recorded by overnight polysomnography. We aimed to investigate the association of various breathing indexes during sleep with the Epworth Sleepiness Scale (ESS) score in adults. We retrospectively collected the clinical and overnight polysomnography data of 2829 adults aged 20 years or older from November 2011 to June 2017. The association of various breathing indexes during sleep and ESS score was analyzed using univariate and multivariate logistic regression analysis for all adults (20-91 years), and in each sex and of body mass index (<26 kg/m2 vs ≥26 kg/m2). The mean ESS score was 6.2 (standard deviation = 4.3; range = 0-24) for all adults. After adjustment for age, sex, many common diseases, and health-related habits, apnea-hypopnea index, oxygen desaturation index, percentage of oxygen saturation below 90% during sleep, and percentage of oxygen saturation below 85% during sleep were significantly positively associated with ESS score in all adults, whereas mean oxygen saturation during sleep, minimal oxygen saturation during sleep, and awake oxygen saturation during sleep were significantly negatively associated with ESS score in all adults. In subgroup analysis, we found that the association between breathing indexes during sleep and ESS score was similar in both sex, but was significant in subjects of body mass index ≥ 26 kg/m2. All breathing indexes during sleep had significant positive or negative correlation with ESS score in all adults, especially in obese subjects.

Association of sleep duration and quality with depression Among University Students and Faculty.

Highly competitive and demanding environments in educational institutions led to reduced sleep time for both students and faculty globally. The primary objective of this study was to determine the duration and quality of sleep among students and faculty of Imam Abdulrahman Bin Faisal University (IAU). The secondary objective was to explore the relationship between depression and sleep duration and quality among students and faculty. The study was conducted during 2021 in Dammam, Saudi Arabia. An online survey was disseminated among the university students. The survey form included: demographic data, Patient Health Questionnaire (PHQ9), Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness scale (ESS). The responses were analyzed using bivariate and multivariate analysis. A total of 509 responses satisfying the inclusion criteria were included (323 student and 186 faculty). The average sleep duration for the entire cohort was 6.21 ± 1.32 hours, with 6.5% sleeping less than 5 hours per night. The mean PSQI score was 7.61 ± 3.09, with 73.1% falling in the poor sleep quality category (PSQI score >5). The mean PHQ9 score was 8.86 ± 6.20, with 63.9% falling in the mild depression category. The mean ESS score was 6.59 ± 4.02, with 11% having a score >10 (corresponding to excessive daytime sleepiness). A significant proportion of surveyed students and faculty IAU suffer from sleep insufficiency, poor sleep quality, and mild degree of depression. Initiatives to tackle the issue of poor sleep quality and quantity among university students and faculty are required.

Efficacy and Safety of Lower-Sodium Oxybate in an Open-Label Titration Period of a Phase 3 Clinical Study in Adults with Idiopathic Hypersomnia.

PurposeTo report the efficacy and safety of lower-sodium oxybate (LXB; Xywav®) during the open-label titration and optimization period (OLT) and stable-dose period (SDP) in a clinical study for the treatment of idiopathic hypersomnia.Patients and MethodsData were collected during treatment titration and optimization in a phase 3 randomized withdrawal trial in adults (18–75 years of age) with idiopathic hypersomnia who took LXB treatment (once, twice, or thrice nightly, administered orally) in the OLT (10–14 weeks), followed by the 2-week, open-label SDP. Endpoints included the Epworth Sleepiness Scale (ESS), Idiopathic Hypersomnia Severity Scale (IHSS), Patient Global Impression of Change, Clinical Global Impression of Change, Functional Outcomes of Sleep Questionnaire (FOSQ)-10, and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP).ResultsThe safety population included 154 participants; the modified intent-to-treat population comprised 115 participants. During open-label treatment, mean (SD) ESS scores improved (decreased) from 15.7 (3.8) at baseline to 6.1 (4.0) at end of SDP, and IHSS scores improved (decreased) from 31.6 (8.3) to 15.3 (8.5). Improvements were also observed during OLT in each individual IHSS item and in FOSQ-10 and WPAI:SHP scores. Thirty-five (22.7%) participants discontinued during OLT and SDP, 22 (14.3%) due to treatment-emergent adverse events (TEAEs) during OLT and SDP. The most frequent TEAEs in the first 4 weeks were nausea, headache, dizziness, and dry mouth; TEAE incidence decreased throughout OLT and SDP (weeks 1–4, n = 87 [56.5%]; weeks 13–16, n = 39 [31.7%]).ConclusionDuring open-label treatment with LXB, participants showed clinically meaningful improvements in idiopathic hypersomnia symptoms and in quality of life and functional measures. TEAE incidence declined over LXB titration and optimization.

Sleep disorders in Wilson's disease: a questionnaire study.

To examine the clinical characteristics and influencing factors related to sleep disorders in patients with Wilson's disease (WD), and investigate its potential mechanisms. A total of 150 patients with WD (76 hepatic, 42 neurological, 32 asymptomatic form) and 150 age- and sex-matched control subjects were investigated using 3 standardized sleep questionnaires. Differences among 3 subtypes were discussed. The mean Parkinson's disease sleep scale (PDSS) score of WD was lower than the controls (Z = - 4.426, P = 0.000), and their mean Epworth Sleepiness Scale (ESS) score as well as Pittsburgh sleep quality index (PSQI) score of WD was higher than that of the controls (t = 2.005, P = 0.048; t = 3.342, P = 0.001). The incidence of excessive daytime sleepiness (EDS) in WD group were significantly higher than the controls (X2 = 6.064, P = 0.014). Further analysis showed that total PDSS score of neurologic presentation group was lower than others (X2 = 6.131, P = 0.047), while the ESS score was higher (F = 3.817, P = 0.029). UWDRS showed a negative correlation with PDSS (r = - 0.440, P = 0.022) and has a higher negative correlation with PDSS in neurologic presentation group (r = - 0.732, P = 0.000). Patients with WD often suffer from sleep disturbances, mainly characterized by difficulty falling asleep, difficulty staying asleep, nocturnal motor symptoms (numbness, cramps, tremor), and daytime dozing. And the incidence of EDS is significantly higher than that of the controls. Sleep quality is worse in patients with WD of neurologic presentation than the other two groups. Furthermore, the worse of the symptoms, patients with WD suffer more serious of the sleep disorders especially in neurologic presentation group.