Polysomnographic Differences Research Articles

Polysomnographic changes of obsessive-compulsive disorder: evidence from case-control studies.

To explore the polysomnographic differences between patients with obsessive-compulsive disorder (OCD) and healthy controls. An electronic literature search was conducted in MEDLINE, EMBASE, All EBM databases, Web of Science, and CNKI from inception to Sep 2023. Pooled analyses revealed significant reductions in sleep efficiency, total sleep time, and rapid eye movement (REM) sleep latency, and increases in awakening time, REM density and REM intensity in patients with OCD compared with healthy controls. Meta-regression analyses reveal no significant influence of OCD severity and disease duration on polysomnographic changes of patients with OCD. Significant polysomnographic changes are present in OCD. Our findings underscore the need for a comprehensive PSG assessment of sleep changes in patients with OCD.

Sleep in amyotrophic lateral sclerosis: A systematic review and meta-analysis of polysomnographic findings

BackgroundThis study explores the polysomnographic differences between amyotrophic lateral sclerosis (ALS) patients and healthy controls. MethodsAn electronic literature search was conducted in MEDLINE, EMBASE, All EBM databases, Web of Science, and CNKI from inception to Oct 2022. ResultsMeta-analyses revealed significant reductions in sleep efficiency, total sleep time, N2%, slow wave sleep percentage, minimum SpO2, and mean SpO2, and increases in wake time after sleep onset and N1%, sleep latency, rapid eye movement sleep latency, time spent with SpO2 < 90%, oxygen desaturation index, and apnea hypopnea index in ALS patients compared with controls. Sensitivity analyses showed that some heterogeneity was explained by excluding patients taking medications impacting sleep, whether studies employed an adaptation night, and the use of different PSG scoring rules. ConclusionsSignificant polysomnographic abnormalities are present in ALS. Our findings underscore the need for a comprehensive PSG assessment of sleep changes in ALS patients. When performing PSG examinations in ALS, whether the patients are taking medication impacting sleep and the scoring system used should be considered.

Polysomnographic Differences Following Moderate-Severe Traumatic Brain Injury (TBI) Among Individuals With Chronic Pain

Research Objectives To determine is differences in objectively measured sleep related respiration exists between chronic pain cohorts post-TBI. Design Longitudinal, retrospective cohort study. Setting Six TBI Model Systems inpatient rehabilitation centers. Participants 66 patients (mean age 42, 60% Caucasian, 82% male) admitted for neurorehablitation following injury were recruited to participate in a diagnostic effectiveness trial of polysomnography (PSG) and were followed between one and two-years post-injury as part of the TBIMS Pain Collaboratory study. Interventions Non-intervention study. Fully attended, level-1 PSG, the criterion standard for sleep apnea diagnosis. Main Outcome Measures PSG-derived respiratory indices and chronic pain status. Results Three-quarters of participants met criteria for sleep apnea shortly after injury and approximately 61% endorsed chronic pain following TBI. Pairwise comparisons between those who did versus those who did not endorse chronic pain at follow-up revealed that chronic pain was associated with categorically worse apnea hypopnea indices (AHI) for both obstructive (15.7 versus 11.1 events per hour of sleep) and central sleep apneas (2.6 versus 0.8 events per hour). Additionally, those who went on to experience chronic pain were found to have worse oxygenation indices (19.6 events per hour), relative to their no pain counterparts (7.9 events per hour). Conclusions This study is the first to report on an association between objective, PSG-derived respiratory indices and chronic pain status following moderate to severe TBI, finding that worse sleep-related respiratory indices early in the recovery from TBI is associated with chronic pain at long-term follow-up. Sleep apnea is an important modifiable factor following that may contribute to long-term pain-related outcomes, but further research is needed to determine whether a causal link exists. Author(s) Disclosures PCORI, CER-1511-33005; VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901 To determine is differences in objectively measured sleep related respiration exists between chronic pain cohorts post-TBI. Longitudinal, retrospective cohort study. Six TBI Model Systems inpatient rehabilitation centers. 66 patients (mean age 42, 60% Caucasian, 82% male) admitted for neurorehablitation following injury were recruited to participate in a diagnostic effectiveness trial of polysomnography (PSG) and were followed between one and two-years post-injury as part of the TBIMS Pain Collaboratory study. Non-intervention study. Fully attended, level-1 PSG, the criterion standard for sleep apnea diagnosis. PSG-derived respiratory indices and chronic pain status. Three-quarters of participants met criteria for sleep apnea shortly after injury and approximately 61% endorsed chronic pain following TBI. Pairwise comparisons between those who did versus those who did not endorse chronic pain at follow-up revealed that chronic pain was associated with categorically worse apnea hypopnea indices (AHI) for both obstructive (15.7 versus 11.1 events per hour of sleep) and central sleep apneas (2.6 versus 0.8 events per hour). Additionally, those who went on to experience chronic pain were found to have worse oxygenation indices (19.6 events per hour), relative to their no pain counterparts (7.9 events per hour). This study is the first to report on an association between objective, PSG-derived respiratory indices and chronic pain status following moderate to severe TBI, finding that worse sleep-related respiratory indices early in the recovery from TBI is associated with chronic pain at long-term follow-up. Sleep apnea is an important modifiable factor following that may contribute to long-term pain-related outcomes, but further research is needed to determine whether a causal link exists.

Clinical and Polysomnographic Differences in Elderly Obstructive Sleep Apnea Patients

Clinical and Polysomnographic Differences in Elderly Obstructive Sleep Apnea Patients

Sleep in multiple sclerosis: a systematic review and meta-analysis of polysomnographic findings.

This study aims to explore the polysomnographically measured sleep differences between patients with multiple sclerosis (MS) and healthy control patients. An electronic literature search was conducted in EMBASE, MEDLINE, all EBM databases, CINAHL, and PsycINFO from inception to March 2022. A random-effects model was applied to explore the pooled effect sizes of polysomnographic differences between patients with MS and control patients. Thirteen studies were identified for meta-analysis. The meta-analyses revealed significant reductions in stage N2 sleep and sleep efficiency and increases in wake time after sleep onset, the periodic limb movement index, and the periodic limb movement arousal index in patients with MS compared with control patients. Meta-regression analyses showed that some of the heterogeneity was explained by age and daytime sleepiness of patients with MS. Our study showed that polysomnographic abnormalities are present in MS. Our findings also underscore the need for a comprehensive polysomnographic assessment of sleep changes in patients with MS. Furthermore, the effects of age and daytime sleepiness in patients with MS on sleep changes should also be carefully considered and closely monitored in the management of MS. Zhang Y, Ren R, Yang L, etal. Sleep in multiple sclerosis: a systematic review and meta-analysis of polysomnographic findings. J Clin Sleep Med. 2023;19(2):253-265.

Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration?

The first-choice therapy for adults with moderate/severe obstructive sleep apnea is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. This cross-sectional study was conducted in adults diagnosed with moderate/severe obstructive sleep apnea [baseline apnea-hypopnea index (AHI) ≥ 15.0 events/h] who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep laboratory setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values delineated during the titration; all P-values > .005. However, the median residual AHI was significantly higher in males vs females: 2.7 events/h vs 2.2 events/h (P = .008). Body mass index (β: 0.292, P < .001), baseline AHI (β: 0.167, P < .001), and age (β: 0.065, P = .035) were independent predictors of the therapeutic CPAP level settings. Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95thpercentile CPAP requirement during an auto-adjusting CPAP titration. Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration? JClin Sleep Med. 2021;17(9):1815-1820.

Gender differences of clinical and polysomnographic findings with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is underdiagnosed in females and gender differences in clinical and polysomnographic findings have not been widely investigated in China. We examined clinical and polysomnographic differences between males and females with OSAS in order to determine the influence of gender on clinical presentation and polysomnographic features. Data were collected from 303 adult patients diagnosed with OSAS (237 males and 66 females) from 2017 to 2019. All the patients completed physical examination, Epworth sleepiness scale, and whole night polysomnography. AVONA, univariate and multivariate logistic regression analyses were conducted to assess gender differences of clinical and polysomnographic findings with OSAS. P < 0.05 was statistically significant. The average age was 48.4 ± 12.6 years for females and 43.4 ± 12.4 years for males. Compared with female patients with OSAS, male patients were taller and heavier, had higher systolic blood pressure in the morning, shorter duration of slow wave sleep, more micro-arousal events, greater AHI, and more complex sleep apnea events. There are obvious gender differences of clinical and polysomnographic characteristics with OSAS. Understanding gender differences will contribute to better clinical recognition of OSAS in females as well as the provision of proper health care and therapeutic practice.

Gender differences in clinical manifestations and polysomnographic findings in Chinese patients with obstructive sleep apnea

The gender differences in patients with obstructive sleep apnea (OSA) are not fully understood so far, as previous studies had conflicting results. No reports have addressed the differences in OSA between Chinese men and women. Therefore, the purpose of this study was to investigate the clinical and polysomnographic differences between Chinese men and women with OSA. This case-paired control retrospective study included 580 consecutive Chinese patients (290 males and 290 females) newly diagnosed as OSA by overnight polysomnography from the Sleep Disorders Center of Tangdu Hospital affiliated to the Fourth Military Medical University of China. Demographic, clinical, and polysomnographic data of men and women with OSA were compared. Order logistic regression analysis was used to determine the risk factors for OSA severity. Male and female patients had similar age (57.3 ± 9.2 vs. 58.2 ± 8.9, p > 0.05) and body mass index (BMI) (25.4 ± 3.4 vs. 25.5 ± 3.9, p > 0.05). Women more commonly presented with insomnia (70.3% vs. 40.3%, p < 0.001), poor sleep quality (58.3% vs. 40.7%, p < 0.001), and headache on awakening (23.1% vs. 13.8%, p < 0.01) than men, while men more frequently reported habitual snoring (69.0% vs. 52.1%, p < 0.001) compared with women. The apnea-hypopnea index (AHI) during total sleep time and non-rapid eye movement sleep was higher in men compared with women (25.8 ± 20.4 vs. 19.3 ± 16.8; 22.0 ± 18.2 vs. 15.1 ± 15.4; p < 0.001, respectively), whereas AHI during rapid eye movement sleep was higher in women than in men (4.2 ± 3.6 vs. 3.7 ± 4.3, p < 0.01). Compared with men, women had lower sleep efficiency (75.4 ± 15.7 vs. 78.1 ± 15.5, p < 0.05), longer REM latency (128.9 ± 88.6 vs. 107.7 ± 72.4, p < 0.01), and greater wakefulness after sleep onset (WASO) (98.3 ± 70.2 vs. 88.0 ± 70.3, p < 0.05). No significant differences in the lowest oxygen desaturation and oxygen desaturation index (ODI) were observed between men and women (80.4 ± 10.8 vs. 80.8 ± 9.0; 17.0 ± 20.9 vs. 13.1 ± 16.5; p > 0.05, respectively). In addition, ordinal logistic regression analysis identified neck circumference as an independent risk factor for OSA severity in male patients (OR, 1.161; 95% CI, 1.020-1.325; p < 0.05) and in female patients (OR, 1.163; 95% CI, 1.013-1.338; p < 0.05). Overall, female patients had less severe OSA when compared with male patients. The female patients more commonly reported "atypical" OSA symptoms, while male patients more frequently reported "typical" OSA symptoms. In clinical practices, physicians dealing with OSA need to take the gender disparity into consideration for more precise diagnosis and treatment, as women may be atypically symptomatic at a less severe OSA.

Efficacy of oral appliance therapy in patients following uvulopalatopharyngoplasty failure.

ObjectiveUvulopalatopharyngoplasty (UPPP) is the most common surgical procedure performed to treat obstructive sleep apnea (OSA). This surgery, when performed alone, benefits only a minority of patients. This study was undertaken to determine the efficacy of oral appliance (OA) therapy following unsuccessful UPPP and assess for specific patient and polysomnographic characteristics that may identify those patients most likely to benefit from this combined treatment strategy.Study DesignRetrospective of clinical outcomes in patients undergoing UPPP followed by treatment with an OA.MethodsPolysomnographic results (baseline, status post‐UPPP, and status post‐UPPP with oral appliance use), age, gender, race, and body mass index were subjected to statistical analysis.ResultsThe mean apnea hypopnea index (AHI) decreased from 23.6 at baseline to 8.6 following UPPP and oral appliance therapy. The mean O2 nadir increased from 83% at baseline to 89.9% following UPPP and treatment with an oral appliance. Fifty percent of patients (9/18) achieved an AHI <5 and were deemed “cured” of their disease. Seventy‐three percent of patients (13/18) achieved benefit with an AHI <20 and ≥50% reduction in their baseline AHI, deemed “successful therapy.” No statistically relevant demographic or polysomnographic differences were found between those who were “cured” and those with persistent disease with the exception that the O2 nadir status post UPPP was found to be lower in the “cured” group.ConclusionOral appliance therapy is an effective treatment option for the majority of patients who have persistent obstructive sleep apnea following unsuccessful UPPP.Level of Evidence4

Characteristics of obstructive sleep apnea in myasthenia gravis patients: a single center study.

Recent studies have shown a high prevalence of obstructive sleep apnea in myasthenia gravis compared to the normal population. The aim of this study was to elucidate clinical and polysomnographic differences between clinically stable Korean MG patients with and without OSA. A total of 18 consecutively stable MG patients were included in this prospective study. We compared MG patients with OSA (n = 7) and without OSA (n = 11) with respect to the baseline characteristics and overnight polysomnography (PSG) parameters. Demographic parameters, prescribed medication status, thymectomy status, myasthenia gravis foundation of America score, and antibody status were obtained from their medical records. We performed the Korean version of Pittsburg sleep quality index to assess the subjective quality of sleep. Statistical analyses were performed using SPSS version 18.0 with Wilcoxon rank sum test, chi-square test, Fisher's exact test, and Spearman correlation test. Among the clinical parameters, MG patients with OSA showed a higher proportion of male sex (p = 0.016) and increased body mass index (p = 0.033). The PSG showed an 11-fold higher supine apnea-hyponea index (AHI) in MG patients with OSA. AHI was further analyzed with supine and non-supine position. MG patients with OSA had a higher supine AHI (19.5 ± 15.8) compared to those without OSA (1.9 ± 1.2, P = 0.008). Most of MG patients with OSA (85.7%) showed more than two times higher supine AHI than non-supine AHI. This study showed that the occurrence of OSA in patients with MG is associated with male sex and obesity, which is in accordance with the normal population. Moreover, PSG data showed a high prevalence of supine dominant OSA in MG patients with OSA.

REM sleep behavior disorder in patients with Parkinson’s disease: clinical and polysomnographic characteristics

The objectives of this study were to describe the characteristics of RBD in a group of PD patients and verify the accuracy of the clinical interview in this group, determine the causes of failure of the interview, as well as to verify the clinical and polysomnographic differences between the groups of PD patients with and without RBD. So, a cross-sectional study was conducted in 88 consecutive PD patients from the outpatient clinic, during a period of 21 months. Participants underwent a clinical interview, assessment based on standardized scales (Epworth Sleepiness Scale, Parkinson’s disease Questionnaire, Pittsburgh Sleep Quality Index), and video polysomnography. Out of the 88 participants, 55 underwent vPSG which confirmed a diagnosis of RBD. The clinical interview had a high sensitivity (87.5%) but a low specificity (42.1%) for RBD diagnosis and thus the clinical interview alone may miss those without episodes of dream-enacting behavior. We note in this group a higher proportion of men (54.5%) and an average age of 60.4 years ± 10.6. In 54% of patients, RBD preceded motor symptoms of PD. In addition, patients with PD and RBD had lower Apnea–Hypopnea Index in REM sleep and a higher equivalent dose of levodopa than PD patients without RBD. RBD is a prevalent condition in patients with PD, requiring polysomnography for diagnostic confirmation, and is associated with certain particularities in PD.

Clinical and polysomnographic differences in elderly patients with obstructive sleep apnea (OSA)

Clinical and polysomnographic differences in elderly patients with obstructive sleep apnea (OSA)

Clinical variables determining the success of adenotonsillectomy in children with Down syndrome

ObjectivesTo evaluate the evolution of polysomnographic parameters of children with Down syndrome and obstructive sleep apnea syndrome submitted to adenotonsillectomy and the interaction of comorbidities on therapeutic outcome. MethodsNinety patients with Down syndrome and habitual snoring were identified between 2005 and 2015 in a Pediatric Otorhinolaryngology Clinic. Parent's complaints were evaluated by the test of equality of two proportions. Wilcoxon test was used to examine pre- and post-operative polysomnographic differences. Mann-Whitney test evaluated the influence of comorbidities. A p < 0.05 was considered significant. ResultsA total of 27 patients met the inclusion criteria (55.6% patients were males; mean (SD) age were 6.7 (3.6) years (range, 1.5–16 years). Significant improvement of parent's complaints (p < 0.001), arousal index (p = 0.045), and minimum oxygen saturation were observed post-adenotonsillectomy (p = 0.034). Adenotonsillectomy was able to resolve obstructive sleep apnea syndrome in 29.6% of children with Down syndrome. Nineteen patients (70.4%) remained with obstructive sleep apnea syndrome and 44.4% showed a reduction of at least 50% of obstructive apnea-hypopnea index. Central apnea index post-adenotonsillectomy was worse in patients with heart disease (p = 0.022). Sleep efficiency (p = 0.031), N1 sleep stage (p = 0.001), apnea-hypopnea index (p = 0.023), and central apnea index (p = 0.008) were worse after surgery in patients with hypothyroidism. Patients with severe OSAS showed significant improvement in polysomnographic parameters after surgery. ConclusionAlthough adenotonsillectomy improved symptoms and objective sleep data in children with Down syndrome, it was not able to resolve obstructive sleep apnea syndrome in most patients. Congenital heart diseases and hypothyroidism may affect the outcome.

Polysomnographic, demographic, and clinic differences between male and female obstructive sleep apnea patients

Polysomnographic, demographic, and clinic differences between male and female obstructive sleep apnea patients

Acute Changes in Sleep Duration on Eating Behaviors and Appetite-Regulating Hormones in Overweight/Obese Adults

There is considerable interest in the role of sleep in weight regulation, yet few studies have examined this relationship in overweight/obese (OW/OB) adults. Using a within-subject, counterbalanced design, 12 OW/OB women were studied in lab with two nights of short (5 hr time in bed [TIB]) and two nights of long (9 hr TIB) sleep. Hunger, consumption at a buffet, and fasting hormone levels were obtained. Significant polysomnographic differences occurred between conditions in total sleep time and sleep architecture (ps < .001). Percent energy from protein at the buffet increased following short sleep. No differences were observed for total energy intake or measured hormones. Further research is needed to determine how lengthening sleep impacts weight regulation in OW/OB adults.

Polysomnographic Differences Associated with Pulmonary Hypertension in Patients with Advanced Lung Disease Due to Cystic Fibrosis

Pulmonary hypertension (PH) commonly occurs in patients with cystic fibrosis (CF), but there is no current data regarding alterations of sleep in patients with PH. A single-center, retrospective review was performed in patients with advanced lung disease due to CF who completed both nocturnal polysomnography and right heart catheterization (RHC) from January 2010 to June 2013. For statistical analysis, two-tailed unpaired t tests and Pearson correlation coefficient analysis were performed after normal distribution was confirmed. A total of 18 consecutive CF patients were enrolled with RHC identifying PH in 56 % (10/18) of patients. The PH group had significantly lower mean sleep efficiency (72 ± 4 vs. 87 ± 3 %, p = 0.01), significantly higher ETCO(2) levels (54.5 ± 2.2 vs. 43.8 ± 3.0 mmHg, p = 0.01) on capnography, and significantly lower PO(2) (53.8 ± 3.1 vs. 65.5 ± 3.9 mmHg, p = 0.03) on capillary blood gas. Correlations with poor sleep efficiency included mean PAP (r = - 0.55, p = 0.01), systolic PAP (r = -0.5, p = 0.03), ETCO(2) (r = - 0.53, p = 0.02), and PO(2)) (r = 0.62, p = 0.01); ETCO(2) with systolic PAP (r = 0.47, p = 0.04) and PCO(2) (r = - 0.57, p = 0.01); and PO(2) to 6-min walk distance (r = 0.55, p = 0.02). We found significant differences in sleep efficiency and gas exchange associated with PH in CF patients with advanced lung disease.

Sleep in children with high functioning autism: polysomnography, questionnaires and diaries in a non-complaining sample

Sleep disorders in children with autism are frequently reported on questionnaires filled by parents. The aim of this study was to characterize sleep using objective and subjective measures in the same sample of autistic children without comorbidities and no primary complaints of sleep disorders. Eleven autistic children (10.3 ± 2.2 years) diagnosed with ADI-R and ADOS criteria and 13 typically-developing children (10.2 ± 2.0 years) were recruited. Exclusion criteria comprised the use of psychotropic medication, a full IQ lower than 75, a history of epilepsy and spontaneous complaints of sleep disorders from the parents. After their children were recruited, parents filled a sleep diary for 2 weeks and the Child Sleep Habit Questionnaire (CSHQ); children were then recorded for 2 consecutive nights in a sleep laboratory. Sleep stages of night 2 were scored according to Rechtschaffen and Kales (1968) using 20 s. epochs. Stage 2 sleep spindles and K-complexes were visually scored on bilateral prefrontal and central electrodes; REM sleep rapid eye movements were also scored. Variables were log transformed when abnormally distributed. Groups were compared using t -tests for independent samples. Sleep diaries showed a longer sleep latency in autistic children (43.6 ± 39.0 mn vs. 17.2 ± 17.5 mn, p = .037). The CSHQ showed no significant group differences. Polysomnographically recorded sleep latency was longer in autistic children (33.0 ± 8.3 min vs. 14.4 ± 4.6 min, p = .023), the duration of stages 3 and 4 (slow-wave sleep: SWS) was shorter (18.2 ± 3.2% vs 23.6 ± 5.7%; p = .009) but total sleep time was similar (539.7 ± 54.3 vs. 560.8 ± 60.2; p = .94). Sleep spindle density (per hour of Stage 2) was similar in both groups at central electrodes and Fp1 but it was lower at Fp2 (119.2 ± 97.7 vs. 225.5 ± 122.2, p = .03). The density of K-complexes was lower at the four electrodes (.0001 < p < .01). REM sleep parameters (latency, duration, distribution, eye movement density) were not different between groups. These results show that autistic children without subjectively reported sleep difficulties according to the CSHQ show signs of poor sleep on sleep diaries and polysomnography. Sleep diaries disclosed longer sleep latencies. Most polysomnographic differences were in nonREM sleep, raising the hypothesis of a difficulty for autistics to synchronize their cortical activity, possibly leading to impaired cortical sleep protective mechanisms such as sleep spindles and K-complexes. Canadian Institute for Health Research; ”Fonds de recherche du Québec – Santé”.

The clinical and polysomnographic differences associated with hypertension in the patients that have OSA symptoms and the effect of OSA on hypertension

It has been well known that obstructive sleep apnea (OSA) and hypertension (HT) are closely related. We compared the effect of HT on the clinical and polysomnographic findings on patients who received polysomnography testing for suspicion of OSA. The polysomnographic data of 158 consecutive patients that underwent a sleep study were retrospectively assessed in two groups in respect of HT history. There were 66 patients (26F/38 M) with HT and 92 patients (27F/65 M) who did not have an HT history. The patients with HT were older and more obese (respectively; p = 0.000, 0.008). OSA [apnea hypopnea index (AHI) > 5/sa] was diagnosed in 50 patients (76%) with HT. This rate was 68% (62) in the normotensive patients. Although not statistically significant, HT was 1.5 times greater in patients with OSA (RR = 1.51). Between the two groups, except witnessed apnea and sweating [these symptoms were more in the hypertensive patients ( p = 0.015, 0.019)], there were no differences in other OSA symptoms and sleep stages ( p > 0.05). Although not statistically significant, in the patients with HT the total sleep time was lower and the AHI was higher. It was determined that the 54% of hypertensive patients had high ESS score (ESS > 10), the same rate was 43% in the normotensive patients. In the patients with HT, the average oxygen saturation at sleep was lower ( p = 0.003) and the rate of systemic disease was higher. Although HT was more frequent in the patients with OSA, it was also found that the HT is related to the BMI that is a part of metabolic syndrome. It was shown that alone the presence of HT was not an important guide in the diagnosis of OSA. We are highly indebted to Ankara University School of Medicine Pulmonary Disease Department for their guidance and constant supervision as well as for providing necessary information regarding the project and also for their support in completing the project.

Clinical and polysomnographic differences between OSAH patients with/without excessive daytime sleepiness

The purpose of this study is to describe the clinical and polysomnographic differences found in patients diagnosed with obstructive sleep apnea-hypopnea (OSAH), with or without excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Scale (ESS). A physical examination, ESS, and polysomnography were applied to all the participants, considering an ESS score of >10 to indicate EDS and an ESS score of ≥ 16 to indicate severe EDS. Univariate (chi-squared or Student's t test) and multivariate (multiple logistic regression) analysis approaches were used. A value of p < .05 was considered statistically significant. The study covered 151 OSAH patients, including 129 (85 %) male patients, 66 (44 %) with EDS and 23 (21 %) with severe EDS. In the univariate analysis of demographic and polysomnographic variables, a comparison between patients without and with EDS showed that the latter had a larger neck circumference, maximum O2 desaturation, and increased sleep time at <90 % O2 saturation, with significant statistical differences. In the multivariate analysis, this statistical significance disappears. A comparison between patients without EDS and with severe EDS did not reveal differences in demographic or polysomnographic variables. Patients with OSAH and ESD showed more hypoxemia, but we did not find significant differences between OSAH patients with or without EDS.

Polysomnographic differences between severe depression and schizophrenia

Certain subtypes of major depression, particularly if associated with severe psychomotor retardation or psychotic features, may be difficult to differentiate from schizophrenia due to overlapping symptoms. The aim of this study was to assess the potential role of polysomnography as a tool for differentiating between severe depression with or without psychotic features and schizophrenia. Forty patients aged 18 to 50 years were recruited, comprising 20 with severe depression and 20 with schizophrenia who had defaulted from follow-up visits and had been off their medications for over a week. Two successive overnight polysomnographic recordings were done for all patients. Rapid eye movement latency was 26 ± 6.9 minutes and 43.9 ± 16.9 min in patients with depression and schizophrenia, respectively, with a statistically significant difference between the groups (P < 0.006). Rapid eye movementintensity was 34 ± 14% in depressed patients and 21.4 ± 4.5% in patients with schizophrenia, again with a statistically significant difference between the groups (P<0.015). On the other hand, stage IV intensity was significantly (P < 0.03) lower in patients with schizophrenia (9 ± 7.9%) than in depressed patients (17.8 ± 9.2%). Polysomnographic parameters are different in schizophrenia and severe depression. Further research to assess cutoff scores for different polysomnographic parameters are needed to enable the utilization of polysomnography as a potential electrophysiologic tool for differentiating between these diagnoses. Key words: Depression, schizophrenia, polysomnography, sleep, encephalography.