Severe Excessive Daytime Sleepiness Research Articles

Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea.

Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) is poorly explained by standard clinical sleep architecture metrics. We hypothesized that reduced sleep stage continuity mediates this connection independently from standard sleep architecture metrics. 1,907 patients with suspected OSA with daytime sleepiness complaints underwent in-lab diagnostic polysomnography and next-day Multiple Sleep Latency Test (MSLT). Sleep architecture was evaluated with novel sleep-stage continuity quantifications (mean sleep stage duration and probability of remaining in each sleep stage), and conventional metrics (total N1, N2, N3 and REM times; and sleep onset latency). Multivariate analyses were utilized to identify variables associated with moderate EDS (5 ≤ mean daytime sleep latency (MSL) ≤ 10 minutes) and severe EDS (MSL < 5 minutes). Compared to those without EDS, participants with severe EDS had lower N3 sleep continuity (mean N3 period duration 10.4 vs 13.7 minutes, p<0.05), less N3 time (53.8 vs 76.5 minutes, p<0.05); greater total sleep time (374.0 vs 352.5 minutes, p<0.05) and greater N2 time (227.5 vs 186.8 minutes, p<0.05). After adjusting for standard sleep architecture metrics using multivariate logistic regression, decreased mean wake and N3 period duration, and the decreased probability of remaining in N2 and N3 sleep remained significantly associated with severe EDS, while the decreased probability of remaining in wake and N2 sleep were associated with moderate EDS. Patients with OSA with EDS experience lower sleep continuity, noticeable especially during N3 sleep and wake. Sleep-stage continuity quantifications assist in characterizing the sleep architecture and are associated with objective daytime sleepiness highlighting the need for more detailed evaluations of sleep quality.

Sleep Hygiene, Daytime Sleepiness, and Coping Mechanisms Amongst US Adults.

Background Excessive daytime sleepiness (EDS) can be measured by the Epworth Sleepiness Scale (ESS) and has been shown to be prevalent in the United States. This study aimed to survey the levels of EDS in US adults and explore factors related to sleep hygiene. Methods An anonymous web-based survey was conducted, polling the frequency of hypersomnia symptoms, sleep quality, and time spent in their occupation. Respondents were at least 21 years of age and United States residents. Participants reported information related to age, gender, education, income, and race in addition to their responses to the survey questions. All data were analyzed using JMP 16.0. Results In our cohort of 200 adults, the median age was 40, with an interquartile range of 34-50 years. 48% were female. More than half of the cohort (53%) had severe or higher-normal EDS. Race (p=0.112), sex (p=0.426), age (p=0.063) shift work/shift timing (p=0.260), and screen time before bed (p=0.785) were not statistically significant for excessive daytime sleepiness. However, the length of participants' workdays (p=0.001) and their income levels (p=0.008) were found to be significantly associated with EDS. In other words, longer workdays and lower income levels were associated with an increased likelihood of falling asleep during inactive periods of the day. Conclusion Sleep deprivation and excessive daytime sleepiness are intertwined with sleep hygiene. This study highlights some of the possible issues that could lead to potential solutions.

0690 People without any sleep complaints achieve results that exceed the cut-off thresholds in standardized sleep assessment

Abstract Introduction With increasing prevalence of sleep problems in the general population, a question arises on whether standardized clinical sleep assessment shows results exceeding the cut-off thresholds in healthy subjects who do not report any sleep complaint. The aim of this ongoing study is to assess a sample of healthy subjects who report good sleep quality, for each gender in age groups 18-30, 31-40, 41-50, 51-60, 61-75 years old. Methods Up to now 70 healthy subjects have taken part in the project (38 females, 32 males, mean age 39.5 ±12.5, median 37 years). Assessment of sleep, and mental health related symptoms was performed using actigraphy, sleep diaries and clinical ratings scales: the Insomnia Severity Index (ISI), Epworth Sleepiness Scale(ESS), Morningness Eveningness Questionnaire(MEQ), Ford Insomnia Response to Stress Test (FIRST), International Physical Activity Questionnaire (IPAQ), STOP-Bang Questionnaire, Sheehan Disability Scale (SDS), Quick Inventory of Depressive Symptoms (QIDS-16SR), Generalized Anxiety Disorders Scale (GAD7), World Health Organization Quality of Life Scale (WHOQOL-BREF). Results In ISI scale 20 subjects (28,6%) reported mild and 2 subject (2,8%) moderate insomnia symptoms. In ESS 7 subjects (10.0%) were found to have mild, 5 (7,1%) moderate and 3 (4,3%) severe excessive daytime sleepiness. Anxiety symptoms reported 15 (21,4%) subjects and depressive symptoms 18 (22,9%) subjects. Moderate for risk for sleep apnea was found in 9 (12,8%) and high in one (1,4%) subject. In sleep diaries sleep latency above 30 minutes was found in 4 (5,6%) subjects, WASO above 30 minutes in 7 (10.0%) subjects, total sleep time below 6,5 hours in 22 (31,4%) subjects. Average time in bed was 474 ±55 minutes and average sleep efficiency 86,8 ±7,5%. ISI correlated with FIRST (r=0.496, p&amp;lt; 0.001), GAD-7 (r=0.445, p&amp;lt; 0,001), QIDS-SR16 (r=0,483, p&amp;lt; 0.001), sleep latency (r=0,313, p&amp;lt; 0,05), WASO (r=0,270, p&amp;lt; 0,05). ESS corelated with FIRST (r=0.316, p&amp;lt; 0,01), GAD-7 (r=0,275, p&amp;lt; 0,05). Conclusion Substantial proportion of subjects from the general population who did not initially report any sleep complaints obtained results exceeding suggested threshold in standard clinical scale and sleep parameters below normal valse in sleep diaries. Poor sleep indices are most related to scales measuring stress, anxiety and depressive symptoms. Support (if any)

0278 Patient Satisfaction with a Novel Sleep Telehealth Platform in the US Military

Abstract Introduction Despite a high prevalence of sleep problems, there is a gross shortage of sleep clinicians within the military health system. To increase access to care, a novel telehealth platform was designed to empower patients and clinicians to make evidence-based sleep treatment decisions. Here, we present initial results from the implementation of this novel sleep telehealth platform in two military treatment facilities (MTFs). Methods Participants (N=305) with sleep complaints were recruited remotely and/or in-person from two MTFs. Participants were predominately men (53.4%), who self-identified as White (55.4%) or Black (24.1%) race and were retired or active-duty military servicemembers (69%). Average age was 45.9 (SD=13.3) years. Participants completed a baseline assessment including standardized research questionnaires via a mobile application (WellTap®). During a 10-day remote monitoring assessment, participants completed daily sleep diaries and twice-daily mood/daytime function surveys, while wearing a commercial-off-the-shelf device (Fitbit®). A personalized sleep report including evidence-based treatment recommendations was provided. Participants completed a satisfaction survey regarding the remote monitoring assessment. Results The most commonly reported sleep problems were difficulty staying asleep (65%), insufficient sleep (61%), and snoring (40%). Most participants described their sleep quality as “a little good” (51%) or “not at all good” (27%). Thirty-nine percent of participants reported moderate to severe insomnia complaints, 38% reported moderate to severe excessive daytime sleepiness, and 22% reported moderate to severe depressive symptoms. In terms of satisfaction, participants reported the sleep assessments were “easy” to complete (92%) and would consider sleep telehealth approaches in the future (95%). The vast majority of participants preferred to continue with sleep telehealth and preferred to combine a mobile app and remote monitoring with either virtual or face-to-face provider support. Conclusion Patients at two military treatment hospitals reported high levels of satisfaction with a novel 10-day intensive remote monitoring assessment including a mobile health assessment and wrist-wearable device. Future studies should evaluate the clinical and economic impact of sleep telehealth and remote monitoring in the U.S. military. Support (if any) Department of Defense (W81XWH1990006) via the Medical Technology Enterprise Consortium) to the University of Maryland, Baltimore (PI: EMW).

The extent of sleep deprivation and daytime sleepiness in young adults.

Sleep deprivation is a condition in which an individual does not get enough sleep, leading to a variety of negative effects on their physical and mental health. In the United States, sleep deprivation is a common problem, with many people not getting the recommended 7-9 hours of sleep per night. Excessive daytime sleepiness is also a common condition in the United States. It is characterized by a persistent feeling of fatigue or drowsiness during the day, despite getting enough sleep at night. The current study aims to document the frequency of sleepiness symptoms amongst the general US population. A web-based survey was conducted to assess the frequency of daily anxiety symptoms amongst adults residing in the United States. Questions from the Epworth Sleepiness Scale were used to quantify the burden of daytime sleepiness. JMP 16.0 for Mac OS was used to perform statistical analyses. Our Institutional Review Board gave the study an exempt determination (#2022-569). In total, 9% of people qualified as having lower normal daytime sleepiness, 34% qualified as having higher normal daytime sleepiness, 26% qualified as having mild excessive daytime sleepiness, 17% qualified as having moderate excessive daytime sleepiness, and 17% qualified as having severe excessive daytime sleepiness. The present findings are based on cross-sectional survey data. Although sleep is one of the most crucial bodily activities, our study of young adults found that more than 60% had moderate to severe sleep deprivation/daytime sleepiness as reported on the Epworth Sleepiness scale.

Effect of Objective Daytime Sleepiness on Heart Rate Variability in Patients With Obstructive Sleep Apnea

Excessive daytime sleepiness (EDS) is associated with cardiovascular events in patients with obstructive sleep apnea (OSA). Our study explored the correlation between objective daytime sleepiness assessed with daytime multiple sleep latency tests (MSLT) and heart rate variability (HRV) in OSA patients. The results may provide insight into possible mechanisms underlying increased risk of cardiovascular events in patients with OSA. A retrospective analysis was conducted with the data of 139 patients with OSA and 35 patients with primary snoring. All subjects underwent polysomnography (PSG) and MSLT at West China Hospital between January 2019 and May 2022. We used mean sleep latency (MSL) to measure the severity of EDS and to categorize OSA patients into three groups, severe EDS, light EDS, and non-EDS, with MSL of less than 5 minutes, 5 to 10 minutes, and greater than 10 minutes as the respective defining criteria for classification. A comparison of sleep structure, clinical characteristics, and HRV parameters was performed in order to evaluate the difference between OSA subgroups with varying levels of objective EDS and the primary snoring group. In addition, we also analyzed the correlation between MSL and HRV parameters. Severe EDS patients had higher values of standard deviation of all N-N intervals (SDNN), total spectral power (TOT), and low-frequency power (LF) as compared to non-EDS patients, which was indicative of sympathetic stimulation ( P<0.05). Additionally, high-frequency power (HF) was also higher in severe EDS patients, which indicated decreased parasympathetic drive. A significantly positive correlation was found between MSL and the values of SDNN, TOT, LF, and HF in OSA patients. OSA patients with objective EDS have elevated sympathetic drive and decreased parasympathetic drive. A positive correlation was found between this change in neural activity and the shortening of MSL.

The effect and relative importance of sleep disorders for all-cause mortality in middle-aged and older asthmatics

BackgroundPrevious studies observed that sleep disorders potentially increased the risk of asthma and asthmatic exacerbation. We aimed to examine whether excessive daytime sleepiness (EDS), probable insomnia, objective short sleep duration (OSSD), and obstructive sleep apnea (OSA) affect all-cause mortality (ACM) in individuals with or without asthma.MethodsWe extracted relevant data from the Sleep Heart Health Study established in 1995–1998 with an 11.4-year follow-up. Multivariate Cox regression analysis with a proportional hazards model was used to estimate the associations between ACM and four sleep disorders among asthmatic patients and individuals without asthma. Dose-response analysis and machine learning (random survival forest and CoxBoost) further evaluated the impact of sleep disorders on ACM in asthmatic patients.ResultsA total of 4538 individuals with 990 deaths were included in our study, including 357 asthmatic patients with 64 deaths. Three multivariate Cox regression analyses suggested that OSSD (adjusted HR = 2.67, 95% CI: 1.23–5.77) but not probable insomnia, EDS or OSA significantly increased the risk of ACM in asthmatic patients. Three dose-response analyses also indicated that the extension of objective sleep duration was associated with a reduction in ACM in asthmatic patients compared to very OSSD patients. Severe EDS potentially augmented the risk of ACM compared with asthmatics without EDS (adjusted HR = 3.08, 95% CI: 1.11–8.56). Machine learning demonstrated that OSSD of four sleep disorders had the largest relative importance for ACM in asthmatics, followed by EDS, OSA and probable insomnia.ConclusionsThis study observed that OSSD and severe EDS were positively associated with an increase in ACM in asthmatic patients. Periodic screening and effective intervention of sleep disorders are necessary for the management of asthma.

Abstract 14839: Clinical, Polysomnographic and Echocardiographic Correlates of Excessive Daytime Sleepiness

Introduction: Excessive Daytime Sleepiness (EDS) has been associated with adverse CVD outcomes. However, the mechanisms of elevated CVD risk in persons with EDS remains uncertain. In this study, we examined polysomnographic and echocardiographic correlates of EDS in a population of adults who underwent both sleep and cardiac stress tests. Methods: We analyzed data from 264 participants who had an in-lab polysomnogram (PSG) and a cardiac stress test between 2016 and 2019. All patients completed the Epworth Sleepiness Scale (ESS) questionnaire. EDS was categorized into 3 groups no EDS (ESS&lt;10), non-severe EDS (ESS 10-14), and severe EDS (ESS ≥15). T90%, the percentage of sleep time spent with oxygen desaturation &lt; 90%, was categorized into severe (≥ 20%) and non-severe nocturnal hypoxemia (&lt;20%). We assessed the relationship between EDS and CV risk factors, and EDS and echocardiographic parameters of diastolic dysfunction such as the E/e’, E/A ratio, left atrial volume index, tricuspid regurgitation jet velocity, and systolic function (ejection fraction, EF). Results: The mean age (SD) of the participants was 59 (11) years, and 59% were female. In logistic regression analysis severe EDS was associated with &gt;3-fold odds of a history of stroke or TIA [a OR 3.2 (95%CI:1.2-8.2), P=0.017] and nearly 4 times the odds of severe nocturnal hypoxemia [aOR 3.8 (95%CI: 1.7-8.6, P=0.002] compared to those with no EDS. We found no other association between EDS and demographic or CV characteristics or PSG variables. In the subset of patients with available echocardiogram data (n=199 - 213), there was no association between EDS and EF or echocardiographic parameters of diastolic dysfunction. Conclusions: EDS is strongly associated with severe nocturnal hypoxia and a history of stroke or TIA in adults with OSA. Further studies are needed to characterize the relationship between EDS and CVD.

Prevalence of Obstructive Sleep Apnea Symptoms Among the Adult Population in Al-Ahsa, Saudi Arabia.

Introduction Obstructive sleep apnea (OSA) is a disorder characterized by repeated episodes of partial or complete obstruction of the airway during sleep. OSA can lead to serious long-term complications if left untreated. Aim This study aims to assess the prevalence of OSA symptomsamong the adult population in Al-Ahsa, Saudi Arabia. Subjects and methods This is a cross-sectional study including the adult population living in Al-Ahsa, Saudi Arabia. A self-administered questionnaire was distributed to the targeted population using an online survey. The questionnaire was divided into two sections, where the first part was about the characteristics of the participant (i.e., age, gender, marital status, etc.), and the second part was the Epworth Sleepiness Scale (ESS) questionnaire to evaluate OSA symptoms. Results Three hundred and sixty adult subjects participated in this study by responding to the questionnaire (58.1% males vs. 41.9% females). The respondents' median age was 30 years old. The prevalence of OSA symptoms was 26.9%. In terms of OSAsymptom severity, mild, moderate, and severe excessive daytime sleepiness were found among 12.5%, 8.3%, and 6.1%, respectively. The prevalence ofOSA symptoms was significantly higher in the older group(>30 years; p=0.004), married participants (p=0.008), and obese or overweight (BMI ≥25 kg/m2; p=0.002). Multivariate regression estimates showed that being obese or overweight (BMI ≥25 kg/m2) was the sole independent significant predictor associated with increased odds of OSA symptoms. Conclusion The prevalence of OSA symptoms among Al-Ahsa residents was 26.9% with prevalence being higher in males than females. Further investigations are needed to establish the prevalence of OSAand understand its influence on the adult population in our region. People who were suspected to have OSA in this study should be reassessed using polysomnography to confirm the diagnosis. Patients with suspected OSA should beencouraged to adopt lifestyle modifications specifically targeted to/focused on weight reduction and smoking cessation.

The Relationship between Excessive Daytime Sleepiness and Cumulative Achievement Index of Medical Student in Atma Jaya Faculty of Medicine Batch 2018

Introduction: Excessive Daytime Sleepiness (EDS) is the inability to maintain wakefulness and alertness during the major waking episodes of the day, with sleep occurring unintentionally or at inappropriate times almost daily for at least three months. Poor concentration is commonly reported as a symptom of EDS and frequently disrupt academic performance in the learning activity. This study aims to determine the relationship between EDS and cumulative achievement index (GPA) among medical undergraduates at Atma Jaya Catholic University of Indonesia.&#x0D; Methods: This research is an analytic observation research with cross-sectional data collection on 180 respondents out of the 2018 class of preclinical students at the Faculty of Medicine of the Atma Jaya Catholic University of Indonesia. The data collection methods used were the ESS (Epworth Sleepiness Scale) and cumulative achievement index (IPK) questionnaires. Demographic variables were also measured. Data were analyzed using the statistic software SPSS with a chi-square test (α ≥0,05).&#x0D; Results: From 180 respondents, 52,8% had EDS, 25% of the total had mild EDS, 16,1% had moderate EDS, and 11,7% with severe EDS. The cumulative achievement index found in respondents mostly ranged from moderate (43,3%) to high (42,3%). The rest had low scores. Furthermore, 25% of respondents had a high IPK score with EDS, 22% had a moderate IPK score with EDS, 5,4% had a low IPK score with EDS, 18,5% had a high IPK score without EDS, 22% had a moderate IPK score without EDS, and the rest 7,1% had low IPK score without EDS. Analysis with chi-square showed no significant relationship between EDS and IPK (P=0,425).&#x0D; Conclusions: There was no relationship between excessive daytime sleepiness and cumulative achievement index of medical students in Atma Jaya Faculty of Medicine and Health Batch 2018.

Exploring the impact of excessive daytime sleepiness caused by obstructive sleep apnea on patient and partner quality of life: a time trade-off utility study in the UK general public.

This study aimed to quantify the impact of excessive daytime sleepiness (EDS) on patient and patient's partner health-related quality of life in the form of utility values typically used in health economic evaluations. A time trade-off study was conducted in a UK general population sample (representing a societal perspective) to elicit utility values, measured on a 0 to 1 scale, for health states with varying obstructive sleep apnea-associated EDS severity. In a time trade-off study, health states are described, and participants "trade off" time in a specific higher severity state for a shorter amount of time in full health. Overall, the sample consisted of 104 participants, who were interviewed and took part in the time trade-off exercise to elicit utility values for patient and partner residual EDS health states. The average utility score declined with increasing obstructive sleep apnea-associated EDS severity for both patient (no EDS, 0.926; mild EDS, 0.794; moderate EDS, 0.614; severe EDS, 0.546) and partner (no EDS, 0.955; mild EDS, 0.882; moderate EDS, 0.751; severe EDS, 0.670) health states. These results demonstrate the high impact that EDS in obstructive sleep apnea is estimated to have on patient and partner health-related quality of life. Tolley K, Noble-Longster J, Mettam S, etal. Exploring the impact of excessive daytime sleepiness caused by obstructive sleep apnea on patient and partner quality of life: a time trade-off utility study in the UK general public. J Clin Sleep Med. 2022;18(9):2237-2246.

Abstract 66: Spectrum of sleep abnormalities in primary hypothyroidism

Background: The spectrum of sleep abnormalities in hypothyroidism includes daytime sleepiness, sleep apnoea, rapid eye movement sleep disorder, restless leg syndrome and periodic limb movement disorder.Aims and Objectives: To assess daytime somnolence, risk of sleep apnoea, quality of sleep, depression, and anxiety in subjects with primary hypothyroidism using Epworth Sleepiness Score (ESS), Berlin questionnaire, Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Hamilton Anxiety Rating Scale (HAM-A).Results: This was a questionnaire-based cross-sectional study that included 55 subjects (females=44, males=11), both treatment naïve (N=41) and on treatment (N=14), who had TSH >4.5 mIU/L. The mean age was 37.09±12.49. Median TSH was 13.5 (IQR-19.781). The Median ESS score was 3/24 (IQR-7), three subjects had severe excessive daytime sleepiness. Seventeen individuals were predisposed to sleep apnoea as assessed by the Berlin Sleep questionnaire. Twenty subjects had a PSQI score of >5, indicating poor sleep quality. The median PHQ-9 score was 4/27 (IQR-7), one individual had severe, and one had moderately severe depression. The Median HAM-A score was 6/56 (IQR-11); two had severe anxiety.Conclusion: Individuals with hypothyroidism need to be screened for sleep abnormalities like sleep apnea, daytime somnolence, REM sleep disorders and neuropsychiatric manifestations like anxiety and depression.

Sex Differences in Excessive Daytime Sleepiness Among Patients With Obstructive Sleep Apnea.

Background and PurposeTo identify sex differences in daytime sleepiness associated with apnea severity and periodic limb movements during sleep (PLMS) in subjects with obstructive sleep apnea (OSA).MethodsThis study used the Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Sleep Hygiene Index (SHI) in logistic regression analyses with interaction terms. Severe OSA, excessive daytime sleepiness (EDS), and PLMS were defined as an apnea-hypopnea index of ≥30, an ESS score of ≥11, and a periodic limb movements index of >15, respectively.ResultsThe 1,624 subjects with OSA (males, 79.1%) comprised 45.3%, 38.2%, and 16.4% with severe OSA, EDS, and PLMS, respectively. Multiple logistic regression without interaction terms showed that sex, severe OSA, and PLMS were not significantly associated with EDS. However, significant interactions were noted between sex and severe OSA and PLMS in EDS in both crude and adjusted models (all p values<0.05). In the adjusted model, severe OSA was associated with EDS in males (p=0.009) but not in females. PLMS were more likely to be associated with EDS in females (p=0.013), whereas PLMS were less likely to be associated with EDS in males (p=0.041). The models were adjusted by the BDI score, SHI, and presence of medical comorbidities.ConclusionsThere are significant sex differences in subjective daytime sleepiness in subjects with severe OSA and PLMS. Severe OSA and PLMS may influence daytime sleepiness more in males and females, respectively.

Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study.

Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents. Participants were 7,072 adolescents (mean age = 14.58 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November-December in 2015 and 1 year later. The Chinese adolescent daytime sleepiness scale was used to measure daytime sleepiness. Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (odds ratio = 2.01, 95% confidence interval = 1.56-2.59), incident EDS (odds ratio = 1.41, 95% confidence interval = 1.03-1.93), and persistent EDS (odds ratio = 2.17, 95% confidence interval = 1.52-3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain. Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents. Liu X, Liu Z-Z, Yang Y, Jia C-X. Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study. J Clin Sleep Med. 2021;17(12):2415-2423.

The effects of Ramadan intermittent fasting on sleep-wake behaviour and daytime sleepiness in team sport referees

ABSTRACT The aim of the present study was to evaluate the impact of Ramadan fasting on sleep quality and daytime sleepiness in team sport referees. Seventy-eight male amateur team sport referees (age: 31.1 ± 10.8 years) participated in this study. Participants responded to the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth sleepiness scale (ESS) questionnaires before (10-days prior) and during (last 7-days) the month of Ramadan. PSQI and ESS scores increased significantly during Ramadan (both p < .001, ES = 0.56 and 0.54, respectively) with 83.3% of participants scoring ≥5 in the PSQI. The percentage of participants suffering from severe excessive daytime sleepiness (ESS score ≥ 16) was 3.8% before vs. 7.7% during Ramadan (p < 0.001). Sleep duration decreased by ~ 1 h during Ramadan (p < .001, ES = 0.61) and was associated with a delay in bedtime of ~ 2 h (p < 0.001, ES = 0.7) and of wake-up time of ~ 1 h (p < 0.001, ES = 0.5). The score for daytime dysfunction and subjective sleep perception, as components of the PSQI, increased (both p < 0.001; ES = 0.79, ES = 0.57, respectively), whereas the score for the use of sleep medication decreased during vs. before Ramadan (p = 0.041, ES = 0.47). Ramadan fasting impaired sleep quality and increased daytime sleepiness in team sport referees. Future studies, using objective assessment tools, are warranted.

543 EEG-Based Deep Neural Network Model for Brain Age Prediction and Its Association with Patient Health Conditions

Abstract Introduction Electroencephalogram (EEG) provides clinically relevant information for personalized patient health evaluation and comprehensive assessment of sleep. EEG-based indices have been associated with neurodegenerative conditions, psychiatric disorders, and metabolic and cardiovascular disease, and hold promise as a biomarker for brain health. Methods A deep neural network (DNN) model was trained to predict the age of patients using raw EEG signals recorded during clinical polysomnography (PSG). The DNN was trained on N=126,241 PSGs, validated on N=6,638, and tested on a holdout set of N=1,172. The holdout dataset included several categories of patient demographic and diagnostic parameters, allowing us to examine the association between brain age and a variety of medical conditions. Brain age was assessed by subtracting the individual’s chronological brain age from their EEG-predicted brain age (Brain Age Index; BAI), and then taking the absolute value of this variable (Absolute Brain Age Index; ABAI). We then constructed two regression models to test the relationship between BAI/ABAI and the following list of patient parameters: sex, BMI, depression, alcohol/drug problems, memory/concentration problems, epilepsy/seizures, diabetes, stroke, severe excessive daytime sleepiness (e.g., Epworth Sleepiness Scale ≥ 16; EDS), apnea-hypopnea index (AHI), arousal index (ArI), and sleep efficiency (SE). Results The DNN brain age model produced a mean absolute error of 4.604 and a Pearson’s r value of 0.933 which surpass the performance of prior research. In our regression analyses, we found a statistically significant relationship between the ABAI and: epilepsy and seizure disorders, stroke, elevated AHI, elevated ArI, and low SE (all p&amp;lt;0.05). This demonstrates these health conditions are associated with deviations of one’s predicted brain age from their chronological brain age. We also found patients with diabetes, depression, severe EDS, hypertension, and/or memory and concentration problems showed, on average, an elevated BAI compared to the healthy population sample (all p&amp;lt;0.05). Conclusion We show DNNs can accurately predict the brain age of healthy patients based on their raw, PSG derived, EEG recordings. Furthermore, we reveal indices, such as BAI and ABAI, display unique characteristics within different diseased populations, highlighting their potential value as novel diagnostic biomarker and potential “vital sign” of brain health. Support (if any):

831 Diagnostic and Treatment Challenges in a Child with Type 1 Narcolepsy

Abstract Introduction The diagnosis and management of Narcolepsy can be challenging in young children. We present a case of abrupt onset severe type 1 narcolepsy complicated by tactile hallucinations with stimulant medication therapy. Report of case(s) A previously healthy 7-year-old African American female presented to us at the beginning of the current pandemic with one week of excessive daytime sleepiness (EDS) with associated enuresis, hyperphagia and two episodes of cataplexy. She also presented with hypnagogic hallucinations and dream enactment behaviors. She was extremely sleepy with a score of 24/24 on the Epworth Sleepiness Scale. Her neurological exam was negative except for facial twitching appearing to be cataplectic facies. Extensive work up including urine toxicology, serology and cerebrospinal fluid (CSF) tests were undertaken to rule out infectious and demyelinating conditions; the results of these tests were negative. Brain magnetic resonance imaging as well as electroencephalogram testing were unremarkable. Overnight polysomnography demonstrated short sleep latency and rapid eye movement (REM) sleep without atonia and a multiple sleep latency test showed a mean sleep latency of less than 2 minutes and 4/4 sleep onset REM periods, highly suggestive of narcolepsy. Her HLA DQB1*0602 haplotype was positive but CSF Hypocretin testing was not done. She was given a diagnosis of Narcolepsy type I and started treatment on low dose Methylphenidate and Venlafaxine to address her EDS and cataplexy, respectively. Her EDS was gradually controlled with a higher dose of Methylphenidate but she developed severe tactile hallucinations. She complained of feeling bugs crawling under her skin and could not keep her clothes on due to constant discomfort. The tactile hallucinations improved with discontinuation of methylphenidate but reappeared with introduction of a different class of stimulants. Modafinil was ineffective in controlling her EDS symptoms. Her EDS, cataplexy and enuresis were better controlled after starting her on Sodium Oxybate. She continues to suffer from moderate to severe EDS with optimally dosed Sodium Oxybate with suboptimal response to various typical and atypical stimulants. Conclusion This case illustrates the difficulties in diagnosing and treating pediatric narcolepsy patients and a unique challenge of tactile hallucinations with stimulant medications. Support (if any):

PRS51 Epidemiology of SLEEP Apnea in Adults: A CROSS-Sectional Study in Europe and the United States

Quantify obstructive sleep apnea (OSA) prevalence and characterize sociodemographic and health characteristics of OSA patients by excessive daytime sleepiness (EDS) severity, in the EU5 (UK, France, Germany, Spain, Italy) and US. Data from EU5 2020 (n=62,319) and US 2019 (n=74,994) National Health and Wellness Survey were utilized, and directly standardized using country-specific weighting. In total, 2,218 EU5 and 5,175 US respondents self-reported both physician-diagnosed OSA and having experienced OSA symptoms in previous 12 months. Respondents were categorized as having normal daytime sleepiness (≤10) or EDS (mild:11-12; moderate:13-15; severe:16-24) using the Epworth Sleepiness Scale (ESS). Results were weighted to be representative of age, sex, (EU5, and US), and race (US). Weighted estimates showed OSA to be more prevalent in the US than EU5, with 6.1% (16.1m) EU5 and 9.8% (24.5m) US adults having experienced OSA symptoms, and 4.2% (11.1m) EU5 and 8.4% (21m) US adults reporting diagnosed OSA. Overall, 3.5% (9.3m) EU5 and 7.1% (17.8m) US had both diagnosed and symptomatic OSA. Average ESS was in the normal range (Mean [SD] among diagnosed/symptomatic OSA respondents: 8.70±5.53 [EU5] and 8.45±5.98 [US]). However approximately one-third of OSA patients in both EU5 and US experienced pathological EDS (EU5/US:35%/33%); around a quarter of patients with OSA reported moderate or severe EDS (EU5/US; mild:10%/9%, moderate:11%/10%, severe:13.0%/15%). The proportion of patients with EDS appeared empirically higher and more severe in the <65 subgroup (EU5/US No EDS 61%/63%, Mild EDS 11%/9%, Moderate EDS 13%/11%, Severe EDS 15%/17%) vs the ≥65 subgroup (No EDS 72%/76%, Mild EDS 9%/8%, Moderate EDS, 9%/7%, Severe EDS 9%/8%). OSA prevalence was higher in the US than EU5; however, EDS prevalence was similar between regions. Despite the average ESS score being in the normal range, a substantial percentage of respondents reported severe EDS. EDS severity appeared higher in younger patients.

Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording.

Hypersomnolence, defined by excessive daytime sleepiness (EDS) or excessive quantity of sleep (EQS), has been associated with increased morbidity. The aim of this study was to determine the clinical and polysomnographic characteristics associated with EQS and EDS assessed objectively during extended polysomnography recording. A total of 266 drug-free subjects (201 women; mean age: 26.5 years [16.08; 60.87]) underwent 32-h bed-rest polysomnography recording preceded by polysomnography and modified multiple sleep latency test (mMSLT). Participants were categorized according to their total sleep time (bed-rest TST ≥19 h, hypersomnia), objective EDS (mean sleep latency on MSLT ≤8 min), and self-reported EDS (Epworth sleepiness scale score >10) and EQS (≥9 h/24 h per week). Subjects with hypersomnia were often younger, with normal sleep architecture, high nighttime sleep efficiency, and severe objective EDS. No association with sex, body mass index, Epworth sleepiness scale, EQS, and depressive symptoms was detected. Subjects with objective EDS had less EQS, higher sleep efficiency, and increased hypersomnia. Discrepancies were observed between objective and self-reported measures of sleep duration and EDS. Finally, 71 subjects were identified who had objective hypersomnia and/or EDS, no medical and psychiatric conditions and normal polysomnography parameters, and therefore met the stringent criteria of idiopathic hypersomnia, an orphan disorder. Sleep duration and EDS should be quantified using self-reported and objective measures in a controlled procedure to differentiate long sleepers, patients with hypersomnia, and patients with idiopathic hypersomnia. This will help to better understand their biology, to identify specific biomarkers, and to assess related health outcomes.

Excessive daytime sleepiness and associations with sleep-related motor vehicle accidents: results from a nationwide survey.

Insufficient sleep can have fatal consequences, and up to 30% of motor vehicle accidents (MVAs) are related to driving when drowsy. The objective of this study was to investigate how sleep quality and excessive daytime sleepiness (EDS) affect falling asleep while driving and sleep-related MVAs/near-misses. A population-wide sample of Saudi adults was surveyed. The questionnaire gathered data on sleep quality, EDS (Epworth Sleepiness Scale), and episodes of falling asleep while driving and sleep-related MVAs/near-misses in the previous year. Univariable and multivariable analyses were used to assess associations. A total of 19% (902/3802) and 10% (474/4229) of respondents had fallen asleep while driving or had a sleep-related MVA/near-miss in the preceding year, respectively. Being male, married, having a shorter sleep duration, being an office worker, having poor subjective sleep quality, and having moderate or severe EDS were associated with an increased risk of having fallen asleep while driving in the previous year. Younger age, male gender, having worse subjective sleep quality [OR 2.11 (95% CI 1.36-3.29); p< 0.0001 for "very bad" sleep quality], and having moderate or severe EDS [ESS ≥ 13; OR 1.90 (95% CI 1.38-2.60); p< 0.0001 and OR 2.39 (95% CI 1.56-3.67); p< 0.0001, respectively] were associated with having had/nearly had an accident due to being tired or falling asleep while driving in the previous year. Sleepy driving and sleep-related accidents/near-misses are common in Saudi Arabia, and sleep quality and EDS contribute to the burden of MVAs. Further efforts are required to quantify the contribution of sleepiness to MVAs to develop and prioritize interventions to prevent MVA-related injuries and death.