Reduced Daytime Sleepiness Research Articles

The contribution of orofacial myofunctional reeducation to the treatment of obstructive sleep apnoea syndrome (OSA): a systematic review of the literature

Obstructive sleep apnoea syndrome (OSA) is a widespread and under-diagnosed condition, making it a major public health and safety problem. Orofacial myofunctional reeducation (OMR) has been shown to be effective in the multidisciplinary treatment of OSA in children, adolescents and adults and is prescribed at several stages of OSA management. The main objective of this systematic literature review was to evaluate the effectiveness of active or passive orofacial myofunctional reeducation (OMR) in the treatment of obstructive sleep apnoea syndrome in children, adolescents and adults. The systematic literature review was undertaken from the three electronic databases: Medline (via PubMed), Cochrane Library, Web of Science Core Collection, and supplemented by a limited grey literature search (Google Scholar) in order to identify the studies evaluating the effectiveness of the OMR on OSA. The primary outcome of interest was a decrease in the Apnea-Hypopnea Index (AHI) of at least five episodes per hour compared to the baseline state. Secondary outcomes were an improvement in subjective sleep quality, sleep quality measured by night polysomnography and subjectively measured quality of life. Only ten studies met all the inclusion criteria. Eight were randomized controlled clinical trials, one was a prospective cohort study and another was a retrospective cohort study. Six studies were devoted to adult OSA and four to pediatric OSA. All included studies were assessed as "low risk of bias" based on the 12 bias risk criteria of the Cochrane Back Review Group. Based on the available evidence, RMO allows a significant reduction in AHI, up to 90.6% in children and up to 92.06% in adults. It significantly reduces the intensity and frequency of snoring, helps reduce daytime sleepiness, limits the recurrence of OSA symptoms after adenoamygdalectomy in children and improves adherence to PPC therapy. Passive RMO, with the assistance provided to the patient by wearing a custom orthosis, increases adherence to reeducation, significantly improves snoring intensity, AHI and significantly increases the upper airway. Published data show that orofacial myofunctional rééducation is effective in the multidisciplinary treatment of OSA in children, adolescents and adults and should be widely prescribed at several stages of OSA management. Passive RMO, with the pearl mandibular advancement orthosis designed by Michèle Hervy-Auboiron, helps to compensate for the frequent non-compliance observed during active RMO treatments.

A randomized, double-blind, placebo-controlled trial of blue wavelength light exposure on sleep and recovery of brain structure, function, and cognition following mild traumatic brain injury

Sleep and circadian rhythms are among the most powerful but least understood contributors to cognitive performance and brain health. Here we capitalize on the circadian resetting effect of blue-wavelength light to phase shift the sleep patterns of adult patients (aged 18–48 years) recovering from mild traumatic brain injury (mTBI), with the aim of facilitating recovery of brain structure, connectivity, and cognitive performance. During a randomized, double-blind, placebo-controlled trial of 32 adults with a recent mTBI, we compared 6-weeks of daily 30-min pulses of blue light (peak λ = 469 nm) each morning versus amber placebo light (peak λ = 578 nm) on neurocognitive and neuroimaging outcomes, including gray matter volume (GMV), resting-state functional connectivity, directed connectivity using Granger causality, and white matter integrity using diffusion tensor imaging (DTI). Relative to placebo, morning blue light led to phase-advanced sleep timing, reduced daytime sleepiness, and improved executive functioning, and was associated with increased volume of the posterior thalamus (i.e., pulvinar), greater thalamo-cortical functional connectivity, and increased axonal integrity of these pathways. These findings provide insight into the contributions of the circadian and sleep systems in brain repair and lay the groundwork for interventions targeting the retinohypothalamic system to facilitate injury recovery.

Aging effect on sleepiness and apneas severity in patients with obstructive sleep apnea syndrome: a meta-analysis study.

Different authors have reported that aging could be associated with changes in obstructive sleep apnea (OSA) related parameters (apnea/hypopnea index, SpO2, reduction of daytime sleepiness, etc.), type of sleep and pattern of collapse. Regarding OSA severity in elderly patients, it is commonly believed that the AHI score tends to increase with aging. In this paper, we reviewed the literature regarding the studies which compared older (>65years old) and young (<65years old) OSA patients regarding the effect of aging on daytime sleepiness (ESS evaluation) and OSA severity (AHI evaluation). A meta-analysis to evaluate the effect of age on daytime sleepiness and OSAS severity was also performed to corroborate previously reported experience. Meta-analysis showed no statistical (p = 0.8) differences regarding AHI differences emerged from the comparison of the two groups of patients. Elderly patients (>65years old) showed less daytime sleepiness, showing a statistical difference in the meta-analysis of data (p = 0.004) CONCLUSION: Although a direct correlation between aging and AHI values would seem to be present, no significant differences in baseline AHI between young (<65-years-old) and elderly (>65-years-old) patients emerged in this meta-analysis study. The effects of OSAS on daytime sleepiness seem to be much more prominent in young or middle-aged patients than in elderly patients.

Is improving sleep and circadian problems in adolescence a pathway to improved health? A mediation analysis.

The present study tested whether improvements in sleep and circadian problems mediate the effect of a novel transdiagnostic sleep and circadian intervention (TranS-C) on improvements in 5 health domains (emotional, cognitive, behavioral, social, and physical) in community-residing, evening chronotype adolescents who were at risk for problems in these 5 health domains. Participants were 176 adolescents (age mean [SD] = 14.77 [1.84] years; 58% female) who were randomized to receive 6 sessions of TranS-C or psychoeducation. Putative mediators tested were eveningness, weekday-weekend discrepancy in total sleep time and waketime, daytime sleepiness, Pittsburgh Sleep Quality Index score, and parent-reported sleep-wake problems. Risk in 5 health domains was measured using adolescent self-reported questionnaires, parent-reported Child Behavior Checklist, and ecological momentary assessment (EMA) of problems in the 5 health domains. Reduced eveningness mediated the effects of TranS-C on reducing both self-reported and parent-reported risk in the 5 health domains. Reduction in daytime sleepiness mediated the effects of TranS-C on parent-reported risk in the 5 health domains. Reduction in parent-reported sleep-wake problems mediated the effects of TranS-C on self-reported, parent-reported, and EMA-assessed risk in the 5 health domains. Results did not support the other hypothesized mediators. TranS-C exerts effects on reducing risk in multiple mental and physical health domains through reducing sleep and circadian problems in evening chronotype adolescents. Further research of TranS-C in other samples to assess its benefits for sleep and circadian problems as well as mental and physical health is warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The contribution of orofacial myofunctional reeducation to the treatment of obstructive sleep apnoea syndrome (OSA): a systematic review of the literature

Obstructive sleep apnoea syndrome (OSA) is a widespread and under-diagnosed condition, making it a major public health and safety problem. Orofacial myofunctional reeducation (OMR) has been shown to be effective in the multidisciplinary treatment of OSA in children, adolescents and adults and is prescribed at several stages of OSA management. The main objective of this systematic literature review was to evaluate the effectiveness of active or passive orofacial myofunctional reeducation (OMR) in the treatment of obstructive sleep apnoea syndrome in children, adolescents and adults. The systematic literature review was undertaken from the three electronic databases: Medline (via PubMed), Cochrane Library, Web of Science Core Collection, and supplemented by a limited grey literature search (Google Scholar) in order to identify the studies evaluating the effectiveness of the OMR on OSA. The primary outcome of interest was a decrease in the Apnea-Hypopnea Index (AHI) of at least five episodes per hour compared to the baseline state. Secondary outcomes were an improvement in subjective sleep quality, sleep quality measured by night polysomnography and subjectively measured quality of life. Only ten studies met all the inclusion criteria. Eight were randomized controlled clinical trials, one was a prospective cohort study and another was a retrospective cohort study. Six studies were devoted to adult OSA and four to pediatric OSA. All included studies were assessed as "low risk of bias" based on the 12 bias risk criteria of the Cochrane Back Review Group. Based on the available evidence, RMO allows a significant reduction in AHI, up to 90.6% in children and up to 92.06% in adults. It significantly reduces the intensity and frequency of snoring, helps reduce daytime sleepiness, limits the recurrence of OSA symptoms after adenoamygdalectomy in children and improves adherence to PPC therapy. Passive RMO, with the assistance provided to the patient by wearing a custom orthosis, increases adherence to reeducation, significantly improves snoring intensity, AHI and significantly increases the upper airway. Published data show that orofacial myofunctional rééducation is effective in the multidisciplinary treatment of OSA in children, adolescents and adults and should be widely prescribed at several stages of OSA management. Passive RMO, with the pearl mandibular advancement orthosis designed by Michèle Hervy-Auboiron, helps to compensate for the frequent non-compliance observed during active RMO treatments.

0935 Daily Blue Light Therapy Reduces Daytime Sleepiness and Post-concussion Symptoms After Mild Traumatic Brain Injury

0935 Daily Blue Light Therapy Reduces Daytime Sleepiness and Post-concussion Symptoms After Mild Traumatic Brain Injury

Actigraphy as a marker for therapy efficacy in patients with restless legs syndrome against the background of diabetic polyneuropathy

Objective — to determine the effectiveness of complex treatment in patients with restless leg syndrome due to diabetic polyneuropathy by means of actigraphy and diagnostic scales. Methods and subjects. 43 patients with diabetic polyneuropathy, demonstrating the absence of gabapentin treatment effectiveness, were diagnosed with restless legs syndrome using the main and auxiliary diagnostic criteria. Patients were divided into 2 groups. Patients of the I group (n = 21) received pramipexole, patients of the second group (n = 22) received pramipexole in combination with zopiclone. The patients were interviewed on the international restless legs scale and the Epworth drowsiness scale. To objectify the manifestations and the treatment effectiveness all patients underwent actigraphy on admission and 30 days after the treatment. Results of the research and their discussion. While determining the dynamics of periodic limb movement index during sleep, it was found that it decreased in both groups and was 6.87 ± 0.02 versus 16.29 ± 0.13 before treatment in I group (p < 0.05) and 4.79 ± 0.04 versus 17.34 ± 0.12 before treatment in ІІ group (p < 0.05). According to the Epworth scale, the reduction of the scale score in both groups was found. In patients of the I group after treatment it was 7.86 ± 0.12 points, that is typical for the moderate drowsiness, as opposed to the ІІ group, where the scale score reduced to the 4.43 ± 0.13 points, which is typical for normal sleep (p < 0.05). Conclusions. The findings proved that the monotherapy with pramipexole improves the condition of the patients with restless leg syndrome, reducing the motor component of the disease, but does not significantly affect sleep. Therefore, the combination of pramipexole with zopiclone is more effective, which improves the sleep, reduces daytime sleepiness and positively affects the quality of patients life.

Morning Bright Light Treatment for Sleep-Wake Disturbances in Primary Biliary Cholangitis: A Pilot Study.

Patients with Primary Biliary Cholangitis (PBC) exhibit delayed sleep-wake habits, disturbed night sleep and daytime sleepiness/fatigue. Such combination of symptoms is reminiscent of delayed sleep-wake phase disorder (DSPD), which benefits from morning light treatment. The aim of the present pilot study was to test the effect of morning light treatment in a group of 13 well-characterized patients with PBC [all females; (mean ± SD) 53 ± 10 years]. Six healthy individuals (4 females, 57 ± 14 years) and 7 patients with cirrhosis (1 female, 57 ± 12 years) served as controls and diseased controls, respectively. At baseline, all participants underwent an assessment of quality of life, diurnal preference, sleep quality/timing (subjective plus actigraphy), daytime sleepiness, and urinary 6-sulphatoxymelatonin (aMT6s) rhythmicity. Then they underwent a 15-day course of morning bright light treatment, immediately after getting up (light box, 10,000 lux, 45 min) whilst monitoring sleep-wake patterns and aMT6s rhythmicity. At baseline, both patients with PBC and patients with cirrhosis had significantly worse subjective sleep quality compared to controls. In patients with PBC, light treatment resulted in an improvement in subjective sleep quality and a reduction in daytime sleepiness. In addition, both their sleep onset and get-up time were significantly advanced. Finally, the robustness of aMT6s rhythmicity (i.e., strength of the cosinor fit) increased after light administration but post-hoc comparisons were not significant in any of the groups. In conclusion, a brief course of morning bright light treatment had positive effects on subjective sleep quality, daytime sleepiness, and sleep timing in patients with PBC. This unobtrusive, side-effect free, non-pharmacological treatment is worthy of further study.

The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome

To evaluate, using drug-induced sleep endoscopy (DISE), sites of upper airway obstruction and pattern of collapse in patients over 65years old affected by obstructive sleep apnea. To compare sites and pattern of collapse of elderly patients with a group of patients younger than 65years. A group of 55 patients aged over 65years were enrolled in this prospective study. Fifty patients under 65years old were collected in the control group. Polysomnographic data and clinical parameters such as the daytime sleepiness, and body mass index were evaluated for both groups of patients. All patients underwent DISE examination with VOTE classification. The AHI value increased with aging whereas elderly patients presented a reduction in daytime sleepiness. Elderly patients showed a higher incidence of total collapse in the velum region compared to younger patients (90.9% vs 70%;); the older patients showed a lower degree of total oropharyngeal lateral wall collapse with respect to younger patients, (20% vs 50%). No difference in tongue base collapse emerged between the two subgroups of patients. Elderly patients showed a higher incidence of total collapse in the velum and a lower incidence in the oropharyngeal lateral wall compared to younger patients.

“Sleep Well, Think Well” Group Program for Mild Cognitive Impairment: A Randomized Controlled Pilot Study

ABSTRACTObjective/Background: Sleep-wake disturbance is associated with poor cognitive functioning and several other adverse outcomes that increase dementia risk in older adults. Targeting sleep-wake disturbance in individuals at risk for dementia may be an important treatment. This study evaluated the efficacy of a four-session multicomponent group intervention for participants with mild cognitive impairment (MCI). Participants: Thirty-five older adults with MCI (mean age = 69.7 years, SD = 9.1), were recruited. MCI was determined via consensus from neuropsychological, medical, and neurological review. Methods: Participants were randomized to the “Sleep Well, Think Well” (SWTW) group condition or a passive control group. The SWTW group received four fortnightly face-to-face sessions conducted by an experienced sleep psychologist and neuropsychologist. The control group received written material detailing strategies to improve sleep quality. Both groups received fortnightly coaching phone calls. The primary outcome was subjective sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included actigraphy sleep measures, daytime sleepiness, cognitive functioning, and depression severity. Results: The SWTW intervention was associated with a large and statistically significant improvement in subjective sleep quality (Cohen’s d = 0.83, p < 0.02). A moderate nonsignificant effect was evident in reducing daytime sleepiness (Cohen’s d = 0.70, p = .08). No significant effects were found on actigraphy markers, depressive symptoms, or tests of cognitive functioning. Conclusions: The eight-week SWTW group intervention for MCI significantly improved subjective sleep quality when compared with a passive control condition. The program also had a moderate (nonsignificant) effect on reducing daytime sleepiness.

Cognitive training for freezing of gait in Parkinson\u2019s disease: a randomized controlled trial

The pathophysiological mechanism of freezing of gait (FoG) has been linked to executive dysfunction. Cognitive training (CT) is a non-pharmacological intervention which has been shown to improve executive functioning in Parkinson’s disease (PD). This study aimed to explore whether targeted CT can reduce the severity of FoG in PD. Patients with PD who self-reported FoG and were free from dementia were randomly allocated to receive either a CT intervention or an active control. Both groups were clinician-facilitated and conducted twice-weekly for seven weeks. The primary outcome was percentage of time spent frozen during a Timed Up and Go task, assessed both on and off dopaminergic medications. Secondary outcomes included multiple neuropsychological and psychosocial measures. A full analysis was first conducted on all participants randomized, followed by a sample of interest including only those who had objective FoG at baseline, and completed the intervention. Sixty-five patients were randomized into the study. The sample of interest included 20 in the CT group and 18 in the active control group. The primary outcome of percentage time spent frozen during a gait task was significantly improved in the CT group compared to active controls in the on-state. There were no differences in the off-state. Patients who received CT also demonstrated improved processing speed and reduced daytime sleepiness compared to those in the active control. The findings suggest that CT can reduce the severity of FoG in the on-state, however replication in a larger sample is required.

Impact of Positive Pressure Treatment of the Airway on Health-Related Quality of Life in Elderly Patients With Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a chronic illness that increases in prevalence with age. Treatment includes continuous positive airway pressure (CPAP) devices. Studies about the use of CPAP in the elderly are scarce. The main objective of this study is to determine whether CPAP contributes to improvement in health-related quality of life (HRQL) in elderly patients with OSA. This was a prospective, pre-/postintervention assessment of a cohort of patients ≥65 years of age with OSA diagnosis by polysomnography who were being treated with CPAP and were physically independent and had good cognitive status. We determined HRQL before and after 3 months of CPAP treatment using the Short Form-36 Health Survey (SF-36, a 36-item, patient-reported survey) and Sleep Apnea Quality of Life Index (SAQLI). The effect of CPAP on daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Of the 103 participants with a mean age of 71.5 ± 4.19 years, 66% were male. After 3 months of therapy, the mean CPAP usage was 6.3 ± 1.41 hr/day. The effectiveness of CPAP in controlling the OSA was demonstrated (mean difference pre- and posttherapy: 34.30 ± 18.52 events/hr, p < .001). Postintervention, the categories of the SF-36 improved meaningfully ( p < .001). Moreover, all categories of SAQLI improved ( p < .001) with the exception of "symptoms" ( p = .073). ESS scores also improved significantly (difference = 5.2 ± 4.47, p < .001) postintervention. Therapy with CPAP in elderly patients with OSA helps improve their HRQL and reduces daytime sleepiness.

Daytime microsleeps during 7 days of sleep restriction followed by 13 days of sleep recovery in healthy young adults.

We investigated the consequences of sleep restriction (SR) on maintenance of wakefulness capacities and diurnal sleepiness through microsleeps monitoring. 12 healthy males (20-36 years old) were sleep restricted (4 h per night) during 7 nights followed by 13 nights of recovery sleep. Participants completed Karolinska Sleepiness Scale (KSS) and Maintenance of Wakefulness Test (MWT) at baseline (B), during SR (SR1, SR4 and SR7) and during recovery (R3 and R13), while continuously recorded for EEG analysis. During SR, MWT latencies decreased (SR7: -24.4%), whereas the number, the cumulative duration of microsleeps and KSS scores increased. Recovery nights allowed MWT latencies, KSS scores and all sleep values to return to baseline levels, while a rebound in N3, N3% and REM% sleep stages occurred. During SR, the maintenance of N3 sleep duration seems not sufficient to reduce daytime sleepiness and MWT results did not reflect the sleepiness levels characterized by persistent sleep attacks.

F165. OBSTRUCTIVE SLEEP APNOEA IS COMMON IN SCHIZOPHRENIA AND RESPONDS WELL TO TREATMENT – A NOVEL AND PRACTICAL MEANS TO IMPROVE COGNITION AND METABOLIC HEALTH?

BackgroundObstructive sleep apnoea (OSA) is characterised by repeated collapse of the upper airway during sleep, causing hypoxia, frequent arousals and disruption to sleep architecture. OSA is more likely in people who are obese, smoke tobacco, and use alcohol and sedating medications – all these factors are more common in schizophrenia. OSA is likely to be underdiagnosed in schizophrenia as symptoms such as non-restorative sleep, depression and daytime somnolence may be attributed to chronic mental illness. OSA in the normal population is associated with cognitive deficits and poor cardiovascular health, both of which are common in schizophrenia, so comorbid OSA in schizophrenia may be exacerbating these problems.Treatment of OSA with continuous positive airway pressure (CPAP) reduces daytime sleepiness, and improves quality of life, cognitive function, and cardiovascular risk factors. There are no published studies of CPAP treatment of OSA in schizophrenia, so it is not known whether these benefits also occur in the patient population.MethodsPrevious research into OSA in schizophrenia has utilised subjective screening instruments and there are no large studies using polysomnography (PSG), the gold standard method to diagnose OSA. We undertook home sleep studies using polysomnography in 30 people with schizophrenia, treated with clozapine. Participants cooperated well and all studies were of good quality.We treated 6 participants with severe OSA with CPAP. Treatment adherence was good with mean CPAP usage of of 7.7 hours/night.ResultsWe found that 14/30 (40%) of our participants with schizophrenia had OSA and 8/30 (27%) had severe OSA; twice the prevalence of severe OSA in the general population.After six months CPAP treatment there was significant improvement in cognition, especially verbal memory, working memory and motor skills. Average weight loss was 7.2kg (SD 9k) with a 12mmHg (SD 18) reduction in systolic blood pressure. Normal sleep architecture was restored: on average the percentage of the night spent in restorative slow wave sleep increased from 4.8% to 31.6%, and the percentage in REM sleep from an average of 4.1% to 31.4%. The mean percentage of the night spent in a hypoxic state with oxygen saturation less than 90% reduced from an average of 27.6% to 2%.DiscussionImproved awareness of the high prevalence of OSA in schizophrenia and access to diagnostic screening by home PSG should ensure this important comorbid condition is not missed. CPAP treatment for OSA in people with schizophrenia is feasible and has the potential to improve both cognition and cardiovascular health, resulting in better functioning and reduced cardiovascular morbidity.

Effects of Trampoline Exercise on Attentional Control and Daytime Sleepiness among Young Adults with Anxiety Disorders in Malaysia

Purpose: Anxiety disorder has been linked to deficient attentional control and sleep problems in young adults. This study aimed to investigate the possible effects of trampoline exercise on attentional control and daytime sleepiness among young adults with anxiety disorders. Method: This single-blinded randomised controlled trial involved 40 young adults with anxiety disorders. All the participants were initially screened for eligibility using Beck Anxiety Inventory and Physical Activity Readiness Questionnaire, and randomly assigned to either an experimental group (n=20) or a control group (n=20). While the experimental group was subjected to trampoline exercise for 4 weeks, all the participants in both the groups were taught deep breathing exercise. Attentional control and daytime sleepiness of the participants were evaluated using Attentional Control Scale and Epworth Sleepiness Scale respectively. Results: The experimental group showed statistically significant improvement in Attentional Control Scale (p=0.009) and Epworth Sleepiness Scale (p=0.005) compared to the control group. Conclusion: Trampoline training resulted in reduction in daytime sleepiness and improvement in attentional control after 4 weeks of trial. This highlights the potential of trampoline exercise training as an adjunct to established clinical treatment.

Dynamics of clinico-psychological characteristics in patients with obstructive sleep apnea syndrome and arterial hypertension after one month of the use of CPAP therapy

Objective. To determine the dynamics of the clinical and psychological characteristics on the background of 1 month of CPAP therapy in patients with obstructive sleep apnea syndrome (OSA) and arterial hypertension (AH), both adherent and non-adherent to the treatment. Methods. The study included 180 patients with OSA and AH. Upon enrollment, anthropometric data, the results of polysomnography and cardiorespiratory studies, Beck depression scale, Spielberger personal and situational anxiety scale, Epworth daytime sleepiness scale, Pittsburgh sleep quality questionnaire and Quality of Life (WHO QOL-100) questionnaire were analysed. Out of 40 patients undergoing CPAP therapy, 30 patients were adherent to the treatment within a month. The adherence criterion was considered to be the usage of the CPAP device more than 4 hours per night, more than 5 days a week. In this article, the dynamics of the questionnaire scales is given only for those who were adherent to CPAP therapy. Results. Patients with OSA and AH adherent to CPAP therapy showed a statistically significant reduction in daytime sleepiness and depression, as well as improved quality of sleep and quality of life in the physical domain within 1 month of using CPAP therapy. Conclusion. Even short-term use of CPAP therapy in patients with OSA and AH leads to a reduction in daytime sleepiness and depression, improved quality of sleep and quality of life in the physical domain.

Neurological Deficits in Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive episodes of complete or partial obstruction of the upper airway. The prevalence of this disorder is strictly dependent on its gravity. At ≥15 events/h apnea-hypopnea index (AHI), it ranges from 6 to 17% in the general population, with higher rates in men and increasing with age. The hypoxia induced by OSA severely affects the structure and function of blood vessels, culminating in mortality and morbidity. Its negative impact influences also cognitive functioning. Recent papers showed the relationship between OSA and some neurological disorders, such as neurodegenerative diseases, stroke, epilepsy, and headache. OSA may accelerate the onset of mild cognitive impairment and Alzheimer's disease (AD) and might also represent an independent risk factor for Parkinson's disease (PD). OSA is also frequent in multisystem atrophy. In the early stages of AD, continuous positive airway pressure (CPAP) treatment might slow down the progression of the disease, thus highlighting the potential importance of OSA screening and a timely intervention in these patients. Moreover, CPAP is effective in reducing daytime sleepiness in PD. OSA may induce seizures by means of sleep disruption and deprivation, as well as cerebral hypoxemia with consequent oxidative stress. It has been demonstrated that CPAP treatment is efficacious in controlling epileptic seizures. OSA can represent a risk factor for stroke and death, mainly related to the endothelial dysfunction, with the formation of atherosclerosis caused by hypoxia through oxidative stress. CPAP treatment in patients with OSA and stroke, if delivered in the early stages, is able to increase the magnitude of neurologic improvement after the vascular accident. There is a strong association between OSA and headache. In particular, there is a "sleep apnea headache" described as a recurrent morning headache, with resolution after effective treatment of sleep apnea. This review clearly shows the importance of taking a sleep history in neurological patients and considering the diagnosis and specific treatment of OSA in these patients.

The comparison of nasal surgery and CPAP on daytime sleepiness in patients with OSAS.

Residual sleepiness after continuous positive airway pressure (CPAP) is a critical problem in some patients with obstructive sleep apnea syndrome (OSAS). However, nasal surgery is likely to reduce daytime sleepiness and feelings of unrefreshed sleep. The aim of this study is to clarify the effects of nasal surgery and CPAP on daytime sleepiness. This is a retrospective and matched-case control study. The participants were consecutive 40 patients with OSAS who underwent nasal surgery (Surgery group) and 40 matched patients who were treated with CPAP (CPAP group). In the Surgery group, although the nasal surgery did not decrease either apnea or hypopnea, it improved oxygenation, the quality of sleep. In the CPAP Group, the CPAP treatment reduced apnea and hypopnea, and improved oxygenation, quality of sleep. The degree of relief from daytime sleepiness was different between the two groups. The improvement of Epworth Sleepiness Scale was more significant in the Surgery Group than those in the CPAP Group (Surgery from 11.0 to 5.1, CPAP from 10.0 to 6.2). These findings suggest that the results of the nasal surgery is more satisfactory for some patients with OSAS than CPAP on daytime sleepiness.

Sleep quality and daytime sleepiness in patients treated with adjunctive perampanel for focal seizures.

The purpose of this study was to evaluate subjective sleep quality and daytime sleepiness in patients receiving adjunctive perampanel for focal seizures. We conducted a multicenter, prospective, interventional, open-label study in patients aged >16 with focal seizures who received adjunctive perampanel (flexible dosing: 2-12mg). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Sleepiness Scale (ESS) at baseline and 3 and 6months after initiating perampanel. Patients with modifications in their baseline AEDs or sleep medications were excluded. In 72 patients with drug-resistant focal seizures, mean baseline PSQI score (±standard deviation) was 7.26 (±4.6), and ESS was 6.19 (±4.2). At 3months (median perampanel dose: 4mg), there was no significant mean change from baseline in ESS score (n=61) and a significant improvement in PSQI (-1.51 points; n=44; p=0.007), driven mainly by improved sleep efficiency (p=0.012). In the 31 patients with 6-month data, ESS (but not PSQI) improved significantly at 6months vs baseline (p=0.029). The only factor significantly correlated with sleep parameters was number of baseline AEDs (higher number correlated with worse daytime sleepiness). Seizure frequency was reduced significantly from baseline at 3 and 6months. In bivariate analysis, neither PSQI nor ESS was associated with seizure frequency, suggesting that the changes in daytime sleepiness and sleep quality may be independent of the direct effect on seizures. Adjunctive perampanel did not worsen sleep quality or daytime sleepiness at 3months and reduced daytime sleepiness in patients continuing perampanel for 6months. Perampanel may be a suitable AED in patients with sleep disorders, in addition to refractory focal seizures.

Change in daytime sleepiness and cognitive function in a 6-month, double-blind study of lurasidone and quetiapine XR in patients with schizophrenia

Daytime sleepiness is a commonly reported adverse effect associated with psychotropic agents that may impair cognitive performance and functioning. The objective of this post-hoc analysis was to evaluate the long-term effects of lurasidone and quetiapine XR on daytime sleepiness and neurocognitive performance during a 6-month, double-blind continuation study, in subjects who completed an initial 6-week, randomized, placebo-controlled trial comparing these agents. Daytime sleepiness, cognitive performance, and health-related quality of life were assessed with the Epworth Sleepiness Scale (ESS), CogState computerized battery, and the Quality of Well-Being (QWB-SA) Scale, respectively. Treatment with flexible-dose lurasidone 40–160mg/d, administered once daily in the evening, was associated with significantly reduced daytime sleepiness compared with flexibly dosed quetiapine XR 200–800mg/d (p=0.03, effect size=0.36) at week 32 (month 6 of the continuation study endpoint). Incidence of markedly high sleepiness (ESS >10) was significantly higher in the quetiapine XR (200–800mg/d) group compared with the lurasidone (40–160mg/day) group at both months 3 and 6 visits (p<0.05). Lurasidone (40–160mg/d) significantly improved neurocognitive performance compared to quetiapine XR (200–800mg/d) before (effect size=0.49) and after adjustment (effect size=0.45) for sleepiness effect (p=0.008 and 0.010, respectively). Increased daytime sleepiness was significantly associated with reduced neurocognitive performance (p=0.019) and quality of well-being (p=0.05). Our findings suggest that clinicians should actively monitor patients for the presence of daytime sleepiness due in part to its potential impact on neurocognitive performance and well-being.