Reduced Daytime Sleepiness Research Articles

Hypoglossal Nerve Stimulation Usage by Therapy Nonresponders.

The purpose of this study is to examine differences in therapy usage and outcomes of therapy between responder (R) and nonresponder (NR) groups in an international, multicenter prospective registry of patients undergoing hypoglossal nerve stimulation for obstructive sleep apnea (OSA). Database analysis (level III). International, multicenter registry. The studied registry prospectively collects data pre- and postimplantation, including sleep parameters, Epworth score, patient experience, and safety questions, over the course of 12 months. Patients are defined as a "responder" based on Sher criteria, which require a final apnea-hypopnea index (AHI) of ≤20 and a final AHI reduction of >50% at their 12-month follow-up. Overall, there were 497 (69%) R and 220 (31%) NR. Most patients in both groups experienced improvement in quality of life following implantation (96% of R; 77% of NR) with reductions in oxygen desaturation index and Epworth score. At final follow-up, the R group demonstrated significantly better adherence to recommended therapy (>4 hours/night) (P = .001), average hours of nightly use (P = .001), final Epworth scores (P = .001), and degree of subjective improvement (P < .001). Patients classified as NR to upper airway stimulation continue to use therapy with improvement in percent time of sleep with O2 <90%, reduction in daytime sleepiness, and improvement in quality of life. Therefore, ongoing usage of the device should be encouraged in NR patients who note improvement while integrating additional strategies to lower the long-term effects of OSA.

Factors affecting compliance with positive airway pressure therapy in obstructive sleep apnea.

To investigate the factors affecting compliance with positive airway pressure (PAP) therapy and establish the relationship between compliance and pulmonary function tests (PFT) in patients with OSA. In this prospective study, patients with OSAusing PAP devices were questioned about the complaints related to the device. Depression and anxiety scales along with PFT parameters werealso assessed. Of 98 participants, 63% were men. The mean age was 52.0 ± 9.6years. Sixty-seven percent of the patients were compliant with their devices. A significant difference was observed between the proportion of the participants compliant or non-compliant with the device, based on OSA severity (p < 0.05). Beck depression inventory (BDI) and Beck anxiety inventory (BAI) scores of the compliant patients were significantly lower than those of the non-compliant patients (p < 0.001, p = 0.044, respectively). No statistically significant difference was detected between the groups regarding individual pulmonary function tests (p > 0.05). The rates of nasal mask use, not having difficulty in tolerating CPAP, falling asleep, absence of abdominal distension, no facial sores, no air leakage, patients benefiting from the device, reduction in daytime sleepiness, and the belief that they are receiving appropriate therapy in participants compliant with the device were higher than those in non-compliant participants (p < 0.05). The rates of claustrophobia and discomfort due to pressure were significantly lower in patients compliant with the device than in the non-compliant patients (p < 0.05). While no relationship was detected between PFT parameters and PAP therapy compliance, significant factors affecting the device compliance were detected.

Poor Sleep Quality and Daytime Sleepiness in Health Professionals: Prevalence and Associated Factors.

This study aimed to examine the prevalence rates of poor quality sleep and daytime sleepiness in health professionals and their association with socioeconomic, lifestyle, and anthropometric factors and psychosocial work conditions. This cross-sectional study was performed with health professionals from various public and private hospitals in Rio Verde, Goiás, Brazil. Daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, respectively. The variables were analyzed using multiple hierarchical Poisson regression in the statistical package Stata version 13.0. A total of 244 health professionals participated in this study (women, 78.28%). The rates of abnormal daytime sleepiness and poor sleep quality were 50.41% (n = 123) and 55.74% (n = 136), respectively. Reduced physical activity was associated with poor sleep quality (prevalence ratio (PR) = 1.32; 95% confidence interval (CI) 1.02–1.70, p = 0.035). Age between 20 and 29 years (PR = 2.59; 95% CI 1.37–4.91, p = 0.021) and 30 and 49 years (PR = 2.09; 95% CI 1.12–3.91, p = 0.021), as well as excessive alcohol consumption (PR = 1.29; 95% CI 1.01–1.66, p = 0.048), were risk factors for daytime sleepiness. Conversely, adequate bodyweight (PR = 0.52; 95% CI 0.33–0.82, p = 0.005) was considered a protective factor. The present findings suggest high rates of abnormal daytime sleepiness and poor sleep quality among healthcare professionals. We emphasize the importance of physical activity, adequate weight, and healthy habits for better quality sleep and reduced daytime sleepiness.

Sleep quality, daytime sleepiness and daytime functioning among Thai obstructive sleep apnea patients receiving continuous positive airway pressure therapy

PurposeThe purpose is to assess the effectiveness of continuous positive airway pressure (CPAP) treatment on sleep quality, daytime sleepiness and daytime functioning among Thai obstructive sleep apnea (OSA) patients.Design/methodology/approachA repeated measures clinical intervention design was implemented. Participants were 50 patients first time diagnosed with OSA and prescribed CPAP treatment. The intervention composed of CPAP health education, and follow-up evaluation. Data on CPAP adherence were downloaded from Smartcards of the CPAP device. The Thai PSQI, ESS and FSAQ-10 questionnaires were administered at baseline, 1-month, and 3-months. Descriptive statistics and repeated measure analysis with multilevel mixed-effects modeling approach were used.FindingsThirty-nine participants completed the study. Approximately 53% (n = 25) and 71.1% (n = 27) of the patients adhered to CPAP treatment by the end of the 1- and 3-months, respectively. After controlling for patients’ adherence, at 1-month follow-up, the intervention improved quality of sleep (β = −2.65, 95% CI = −1.60, −4.13), daytime functioning (β = 3.24, 95% CI = 1.87, 4.61) and decreased daytime sleepiness (β = −3.29, 95% CI = −1.85, −4.73). At 3 months, the intervention still improved quality of sleep (β = −3.53, 95% CI = −2.05, −5.01), and daytime functioning (β = 4.34, 95% CI = 2.76, 5.92), and decreased daytime sleepiness (β = −4.82, 95% CI = −3.16, −6.49).Originality/valueAdherence to CPAP treatment is effective in improving sleep quality, daytime functioning and reducing daytime sleepiness. Patient-oriented strategies for enhancing CPAP adherence should be developed and implemented as a standard care in sleep clinics.

Association of Delaying School Start Time With Sleep–Wake Behaviors Among Adolescents

PurposeFew adolescents spend enough time asleep on school nights. This problem could be addressed by delaying high school start times, but does this translate to reduced prevalence of sleep–wake problems like awakening too early or feeling sleepy during the day? MethodsThe START study (n = 2,414) followed a cohort of students from five Minnesota high schools to evaluate impacts of school start time delays. Participants were enrolled in ninth grade (Baseline) when all schools started early (7:30 or 7:45 a.m.). At Follow-Up 1 (10th grade) and Follow-Up 2 (11th grade), two schools had delayed their start times by 50 and 65 minutes while three comparison schools started at 7:30 a.m. Six sleep–wake behaviors were assessed at all three time points via survey. Generalized estimating equation models were used to investigate changes in sleep–wake problems between policy change and comparison schools. ResultsThe prevalence of sleep–wake problems at Baseline ranged from 11% for being late to class due to oversleeping to 48% for needing to be told to wake multiple times in the morning. Compared to students from comparison schools, students at policy change schools reported smaller increases in the prevalence of feeling sleepy daily and oversleeping and being late to class between 9th and 11th grade. After implementation of the delayed start, awakening too early was more common among students at policy change schools compared to the comparison schools. ConclusionsThis longitudinal study provides evidence that delaying high school start times reduces daytime sleepiness and school tardiness.

090 Strategies for Dealing with or Ameliorating Excessive Sleepiness: Beliefs and Attitudes of People with Daytime Sleepiness

Abstract Introduction Sleepiness impacts health and functioning, but despite available treatments, many do not seek care. Beliefs and attitudes about treatments for sleepiness and other sleep problems may be useful to know in designing and targeting interventions. Methods N=28 participants with excessive daytime sleepiness (ESS&amp;gt;=10) but no other major medical problems were recruited from the community. They were administered an Epworth Sleepiness Scale and Fatigue Severity Scale at baseline, and asked about a wide range of beliefs/attitudes about mitigating sleepiness, and whether they Strongly Agree(SA), Agree(A), Disagree(D), or Strongly Disagree(SD) with them. Ordinal logistic regressions examined agreement associated with baseline sleepiness and fatigue, adjusted for age, sex, and race/ethnicity (nominal significance p&amp;lt;0.05). Results When asked which strategies are helpful for dealing with or fixing daytime sleepiness, baseline agreement was as follows: Just “power through it” (SA:9%,A:55%,D:32%,SD:5%). Caffeine (SA:18%,A:55%,D:27%). Vigorous exercise (SA:9%,A:36%,D:55%). Mild or moderate movement or exercise (SA:14%,A:82%,D:5%). Trying to get better sleep at night (SA:36%,A:64%). Eating or drinking something to help “wake you up” (SA:27%,A:45%,D:23%,SD:5%). Napping (SA:27%,A:64%,D:9%). Giving up and letting yourself be sleepy (SA:9%,A:42%,D:45%,SD:5%). Improve your diet/eat healthy (SA:42%,A:55%,D:5%). Relaxing activities at night (SA:27%,A:68%,D:5%). Meditation, breathing exercises, or other relaxation techniques (SA:45%,A:45%,D:9%). Watching TV, browsing the internet, or other distracting activities (SA:5%,A:36%,D:45%,SD:14%). Just keep moving (SA:9%,A:55%,D:42%,SD:5%). Setting alarms (SA:18%,A:68%,D:14%). Take prescription medication to improve sleep (SA:5%,A:27%,D:42%,SD:27%). Take over-the-counter medication to improve sleep (SA:5%,A:27%,D:59%,SD:9%). Take prescription stimulant medication (SA:5%,A:32%,D:45%,SD:18). Take over-the-counter stimulant medication (SA:5%,A:27%,D:55%,SD:14%). Take prescription medication that reduces daytime sleepiness (SA:5%,A:36%,D:41%,SD:18%). Take over-the-counter medication that reduces daytime sleepiness (SA:5%,A:27%,D:50%,SD:18%). Those with higher levels of baseline sleepiness were more likely to endorse the following as good strategies to handle daytime sleepiness, “Take over-the-counter medication to improve sleep” (oOR=1.55, p=0.04), “Take prescription medication to improve sleep” (oOR=1.49, p=0.01), and “napping” (oOR=2.55, p=0.03). Those with higher baseline fatigue were less likely to endorse “just ‘powering_through’” (oOR=0.81, p=0.02) as a good strategy of handling daytime sleepiness. Conclusion Real-world beliefs and attitudes about ways of mitigating effects of sleepiness range from medical to behavioral. Those with greater baseline sleepiness may be more amenable to medication. Support (if any) This work was supported by Jazz Pharmaceuticals

363 The Apnea and Insomnia Research (AIR) Trial: An Interim Report

Abstract Introduction Many sleep apnea patients suffer from comorbid insomnia disorder. Although cognitive behavioral insomnia therapy (CBTI) is recommended as the first line insomnia treatment for such patients, access to trained providers of this treatment remains limited. The current study is testing he efficacy of an online CBTI among CPAP treated sleep apnea patient with comorbid insomnia. Methods Patients enrolled in this trial complete baseline measures and then are randomized to either an online version of Cognitive Behavioral Insomnia Therapy (CBTI) or no additional treatment beyond their CPAP therapy (CTRL). After 8 weeks of treatment all patients are reassessed. The current report considers changes in scores on the ISI and Epworth Sleepiness Scale (ESS) as well as average minutes of nightly CPAP use from pre-treatment to the end of the initial 8 weeks of online treatment relative to the no treatment CTRL. The sample for this report included the first 276 participants enrolled in this trial (mean age = 56.5±12.5 yrs; 58.7% females). Results Those receiving online CBTI showed greater reductions in their ISI scores from baseline to the end of the initial 8-week treatment phase than did those in the CTRL group (p = .0001). Average ISI score improvements among those receiving online CBTI moved patients from moderately severe insomnia to mild insomnia symptoms. In contrast, no differences were noted between the online CBTI and CTRL groups in regard to pre- to post-treatments changes on the ESS (p= .2541) scores or amount of CPAP use (p = .4383). Conclusion Whereas online CBTI does not seem to reduce daytime sleepiness or improve CPAP adherence among patients with comorbid sleep apnea and insomnia, it appears to be an effective intervention for reducing insomnia severity for this patient group. Support (if any) National Heart. Lung and Blood Institute Grant # 1R01HL130559-01A1

Selegiline reduces daytime sleepiness in patients with Parkinson's disease

ObjectivesExcessive daytime sleepiness (EDS) affects a large percentage of Parkinson's disease (PD) patients, and it is enhanced by dopamine agonist drugs. Currently, there is no treatment of choice for EDS in PD. Our aim was to check the clinical impression that some patients who were given selegiline, a selective inhibitor of monoamine oxidase B, experienced an improvement in their daytime somnolence.MethodsIn the present study, we retrospectively identified 45 Parkinson's disease patients (21 females and 24 males) among those referred to the PD Center in Varese that (a) showed excessive daytime sleepiness, usually developed after the introduction of a dopamine agonist, (b) were given selegiline 10 mg to improve their treatment schedule independently of excessive sleepiness, and (c) in whom the Epworth Sleepiness Scale (ESS) and the Parkinson's Disease Sleep Scale (PDSS) scores were available both before and 3 months after the introduction of selegiline.ResultsWe compared the corresponding scores (ESS, PDSS, and UPDRS III) evaluated before and 3 months after the introduction of selegiline by the nonparametric Mann–Whitney U test: The differences showed a statistically significant improvement of somnolence but no change in the UPDRS III scores.ConclusionDespite some limitations, our data suggest that selegiline may be a valuable add‐on therapy in PD patients to reduce their daytime somnolence.

Mood, sleepiness, and weight gain after three years on CPAP therapy for sleep apnoea

ABSTRACT Background: The prevalence of obstructive sleep apnoea syndrome (OSAS) keeps on rising. Daytime sleepiness resulting from fragmented sleep is the prime symptom, and obesity the major risk factor for OSAS. Quality of life with OSAS is often affected by depressive symptoms and anxiety. Nasal continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness, but the results on the effect on mood, physical activity, and weight are controversial especially on long-term therapy. Purpose of this study was to evaluate these factors and predictors of weight gain during long-term CPAP therapy. Methods: Consecutive patients (n = 223), referred to sleep study with suspected OSAS, were enrolled. Patients underwent a cardiorespiratory polygraphy at baseline and a battery of questionnaires was completed, both at baseline, and after three years of follow-up. Total of 149 (67%; M 65, F 84) patients completed the follow-up. Of the 149 patients, 76 (51.0%; M 32, F 44) used CPAP. Results: In this study, depressive symptoms, anxiety, and sleepiness were alleviated during CPAP therapy. However, therapy did not have an influence on cravings of different food categories, or exercise habits and exercise duration. From the various factors studied, solely higher adherence to CPAP therapy was associated with weight gain. Conclusions: This research provides further evidence that long-term CPAP therapy in patients with OSAS not only decreases sleepiness and improves sleep quality but could also alleviate depressive symptoms and anxiety. In addition, our study reinforces that CPAP therapy alone is not sufficient for weight management in patients with OSAS. Regardless of comprehensive battery of questionnaires, we were unable to establish markers predicting weight gain during therapy. We advise on life-style counselling and weight management program to all patients with obesity on CPAP therapy.

The use of perampanel in drug-resistant focal epilepsy: its effect on sleep

Perampanel (PER) is an antiepileptic drug (AED), the effects of which on sleep have not been studied in Russia.Objective: to assess changes in the quality of sleep, the level of daytime sleepiness, and the polysomnographic (PSG) characteristics of nocturnal sleep in patients with drug-resistant focal epilepsy when PER is incorporated into the therapy regimen as an additional AED.Patients and methods. The investigation enrolled 12 patients (4 men and 8 women) aged 21 to 49 years with drug-resistant epilepsy treated with several AEDs, who had initiated therapy with PER as an additional AED. PSG study and questioning survey were done before and 1 month after initiation of PER therapy.Results and discussion. After one month of PER therapy, there was an increase in the quality of night sleep in 5 cases and a reduction in daytime sleepiness in 6 cases. The PSG pattern was stable in 3 patients, worsened in 1, and improved in 8.Conclusion. The preliminary results suggest that PER therapy improves night sleep quality and reduces daytime sleepiness in about half of the cases, as evidenced by the improved PSG pattern in 67% of patients.

Modern methods of treating sleep disorders in patients with Parkinson’s disease and previous radiation exposure

Relevance. Sleeplessness is a non-motor disorder that reduces the daily activity of patients with Parkinson’s disease.Intention. To evaluate the effectiveness of the drug “Melaxen” (melatonin) in the treatment of patients with sleep disorders and daytime sleepiness in patients with Parkinson’s disease and previous radiation exposure.Methodology. Fifty patients with Parkinson’s disease (Stage I–II according to Hen-Yar, duration of 3.5 to 6.5 years), previous radiation exposure and current sleep disorders were examined. On average, patients aged (65.8 ± 5.8) years. Most of them were employees of various departments of the Russian Emercom and Defense Ministry. On average, 38 male patients spent (56.1 ± 27.0) days in the area of radiation exposure, with exposure dose of (21.4 ± 11.9) roentgen equivalent man (rem). Female patients-inhabitants of radiation contaminated areas most likely received mean effective dose of 9 mSv (0.9 rem) per person. During treatment of Parkinson’s disease with “Levodopa” in the average daily dosage of (562.5 ± 62.5) mg (stable dose after the start of melatonin), 39 (78 %) of them also received dopamine receptor agonists at a dose of (1.0 ± 0.25) mg / day, the drug Melaxen (melatonin) was used to correct sleep disordersfor over 28 days at a daily dose of 3 mg taken 30–40 minutes before sleep daily. The clinical and psychological state of the patients was studied twice before and after completion of the course of treatment using scales to study the quality and individual significance of sleep, the hospital anxiety and depression scale (HADS), certain cognitive tests and individual sleep diaries.Results and Discussion. According to the clinical and psychological tests, Melaxen (melatonin) contributed to improving the quality of sleep, mental well-being, activity, some cognitive functions, reducing daytime sleepiness and anxiety. The optimization of the mental state was also reflected in the personal diaries of sleep quality. A number of indicators only tended to improve, probably due to short-term studies.Conclusion. In patients with Parkinson’s disease, “Melaxen” was associaeted with improved sleep quality, decreased daytime sleepiness and severity of anxiety and depression, and also increased concentration.

Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea.

Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea.

Pitolisant for Residual Excessive Daytime Sleepiness in OSA Patients Adhering to CPAP: A Randomized Trial

Excessive daytime sleepiness (EDS) in individuals with OSA syndrome persisting despite good adherence to CPAP is a disabling condition. Pitolisant is a selective histamine H3-receptor antagonist with wake-promoting effects. Is pitolisant effective and safe for reducing daytime sleepiness in individuals with moderate to severe OSA adhering to CPAP treatment but experiencing residual EDS? In a multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was titrated individually at up to 20mg/day and taken over 12weeks. The primary end point was change in the Epworth Sleepiness Scale (ESS) score in the intention-to-treat population. Key secondary end points were maintenance of wakefulness assessed by the Oxford Sleep Resistance Test, Clinical Global Impressions scale of severity, the patient's global opinion, EuroQoL quality-of-life questionnaire score, Pichot fatigue questionnaire score, and safety. Two hundred forty-four OSA participants (82.8%men; mean age, 53.1 years; mean Apnea Hypopnea Index with CPAP, 4.2/h; baseline ESS score, 14.7) were randomized to pitolisant (n= 183) or placebo (n= 61). ESS significantly decreased with pitolisant compared with placebo (-2.6; 95%CI, -3.9 to -1.4; P< .001), and the rate of responders to therapy (ESS≤ 10 or change in ESS≥ 3) was significantly higher with pitolisant (71.0%vs54.1%; P= .013). Adverse event occurrence (mainly headache and insomnia) was higher in the pitolisant group compared with the placebo group (47.0%and 32.8%, respectively; P= .03). No cardiovascular or other significant safety concerns were reported. Pitolisant used as adjunct to CPAP therapy for OSA with residual sleepiness despite good CPAP adherence significantly reduced subjective and objective sleepiness and improved participant-reported outcomes and physician-reported disease severity. ClinicalTrials.gov; No.: NCT01071876; URL: www.clinicaltrials.gov; EudraCT N°: 2009-017248-14; URL: eudract.ema.europa.eu.

The impact of COVID-19 related school shutdown on sleep in adolescents: a natural experiment

ObjectiveDuring the outbreak of the COVID-19 pandemic in 2020, high schools closed or transitioned to remote teaching. The aim of this study was to describe how the COVID-19 related school shutdown impacted the sleep behaviors of typically developing adolescents. MethodsA qualitative study was conducted between April 28 and June 3, 2020 with 45 adolescents using one-on-one semi-structured phone interviews. ResultsThe “natural experiment” caused by the shutdown of schools due to the COVID-19 pandemic led to a 2-h shift in the sleep of typically developing adolescents, longer sleep duration, improved sleep quality, and less daytime sleepiness compared to those experienced under the regular school-time schedule. DiscussionThese findings are consistent with previous studies showing that delaying high school start times could be an effective way to extend sleep duration, improve sleep quality, reduce daytime sleepiness and lower adolescents' stress during the school year. As many countries look for ways to reduce the number of interactions between students in schools so that physical distancing is feasible, following teens’ delayed sleep biology could offer an affordable solution. For example, staggering arrival times by delaying school start time for older adolescents compared with younger adolescents can reduce the total number of students attending school at the same time. This strategy offers a practical means to reduce school density and the number of interactions between students which are needed to reduce the potential transmission of COVID-19 in schools, while improving adolescents sleep health.

Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is caused by upper airway obstruction during sleep and increases risk for stroke and cardiovascular morbidity. It is also related to excessive daytime sleepiness and cognitive dysfunction in affected adults. Additionally, OSA also affects children, manifesting as growth retardation and neurobehavioral abnormalities. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for moderate to severe disease in adults and in some of the pediatric population. CPAP therapy reduces daytime sleepiness, improves quality of life, and reduces risk for cardiovascular morbidity and mortality in individuals with OSA. Although CPAP therapy is effective in these patients, it has significant limitations regarding compliance. Accordingly, the purpose of this review was to investigate factors impacting compliance with treatment including socioeconomic/demographic characteristics, nasal obstruction, previous upper airway surgery, severity of OSA, psychological factors, support/intervention of CPAP, and device-related factors. Additionally, factors associated with CPAP compliance in children are also discussed. Key words: Sleep apnea syndromes, Continuous positive airway pressure, Patient compliance

Predictors of change over time in subjective daytime sleepiness among older adult recipients of long-term services and supports.

Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS. Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months. 470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60-98; 71% women). Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support). Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = -0.006, 95% CI: -0.013 to -0.0001, p = 0.045) and higher number of depressive symptoms (effect size = -0.002, 95% CI: -0.004 to -0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time. Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.

0510 The Apnea and Insomnia Research (AIR) Trial: A Preliminary Report

Abstract Introduction Many sleep apnea patients suffer from comorbid insomnia disorder. Although cognitive behavioral insomnia therapy (CBTI) is recommended as the first line insomnia treatment for such patients, access to trained providers of this treatment remains limited. The current study is testing he efficacy of an online CBTI among CPAP treated sleep apnea patient with comorbid insomnia. Methods Patients enrolled in this trial complete baseline measures and then are randomized to either an online version of Cognitive Behavioral Insomnia Therapy (CBTI) or no additional treatment beyond their CPAP therapy (CTRL). After 8 weeks of treatment all patients are reassessed. The current report considers changes in scores on the ISI and Epworth Sleepiness Scale (ESS) as well as average minutes of nightly CPAP use from pre-treatment to the end of the initial 8 weeks of online treatment relative to the no treatment CTRL. The sample for this report included the first 170 participants enrolled in this trial (mean age = 56.5±12.5 yrs; 60.1% females). Results Those receiving online CBTI showed greater reductions in their ISI scores from baseline to the end of the initial 8-week treatment phase than did those in the CTRL group (p = .0009). Average ISI score improvements among those receiving online CBTI moved patients from moderately severe insomnia to mild insomnia symptoms. In contrast, no differences were noted between the online CBTI and CTRL groups in regard to pre- to post-treatments changes on the ESS (p= .3771) scores or amount of CPAP use (p = .8053). Conclusion Whereas online CBTI does not seem to reduce daytime sleepiness or improve CPAP adherence among patients with comorbid sleep apnea and insomnia, it appears to be an effective intervention for reducing insomnia severity for this patient group. Support National Heart. Lung and Blood Institute Grant # 1R01HL130559-01A1

The Effect of Aromatherapy Application on Cognitive Functions and Daytime Sleepiness in Older Adults Living in a Nursing Home.

Changes in the aging process affect the duration and quality of sleep. Not having a quality night's sleep leads to a reduction in daytime wakefulness in older adults. We examined the effect of aromatherapy on the cognitive functions and daytime sleepiness of older adults living in a nursing home. The research was a pretest and posttest design, which was conducted without a control group. The sample included 39 elders. A rosemary-lemon oil mixture was smelled by elders in the mornings for a week. After a 1-week washout period, lavender oils were smelled in the evenings for a week. After application of the rosemary-lemon oil mixture, the mean score of participants' daytime sleepiness was lower, but that decline was not statistically meaningful (P > .050). After the same application, the mean score of the participants' cognitive functions was significantly lower (P < .001). After application of lavender oil, the scores were significantly lower (P < .001). Lower scores on the scales used indicate lower sleepiness. The results showed that the 2 applications can be used to improve cognitive functions in older adults; in addition, lavender oil has an advantage in reducing daytime sleepiness.

Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.

Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.

GCH1 (rs841) polymorphism in the nitric oxide-forming pathway has protective effects on obstructive sleep apnea

Several studies have recently investigated the contribution of genetic factors in obstructive sleep apnea (OSA). Patients with OSA suffer from a reduction in nitric oxide (NO) serum level. This study investigated rs841, A930G p22phox, and rs1799983 polymorphisms in three critical genes involved in NO formation. A total of 94 patients with OSA and 100 healthy controls were enrolled into the study. Results showed there was no association between rs841, A930G p22phox and rs1799983 polymorphism and the risk of OSA (P = 0.51, P = 0.4 and P = 0.33, respectively). Moreover, rs841 GA genotype had a reverse relationship with the severity of OSA (P = 0.005). On the other hand, rs841 GA and A930G p22phox AA genotypes had a protective effect on daytime sleepiness in OSA patients (P = 0.01and P = 0.02, respectively). Additionally, the combination of rs841 and A930G p22phox (AG/AG and AG/AA) genotypes was significantly associated with a reduction in daytime sleepiness in OSA patients (P = 0.03 and P = 0.03, respectively). According to the results of our study, GA genotype of rs841 and GA/AA genotypes of A930G p22phox polymorphisms significantly reduced the severity of the problem and daytime sleepiness in OSA patients.