Sleepiness Score Research Articles

Effect of serum growth hormone releasing hormone levels on cognitive function in patients with moderate-severe obstructive sleep apnea-hypopnea syndrome

Objective: To investigate the effect of GHRH on the cognitive function of OSAHS patients by detecting the serum GHRH levels and assessing their cognitive function in patients with OSAHS. Methods: A total of 70 moderate-severe OSAHS patientsand 32 adults with snoring from October 2013 to May 2017 were enrolled for overnight polysomnography(PSG) and cognitive function assessment. Blood samples were taken at the next morning and serum GHRH levels were measured by ELISA. Results: There was no significant difference between OSAHS group (318.73±186.66)pg/ml and control group (291.48±147.36)pg/ml. Compared with control group, the serum GHRH levels were significantly increased in OSAHS patients without cognitive impairment (370.31±197.33)pg/ml, and evidently decreased in those with cognitive impairment (193.63±70.97)pg/ml (both P<0.05). The cognitive function of OSAHS patients was influenced by serum GHRH levels (OR=0.42, 95%CI: 0.24-0.73), body mass index (OR=2.23, 95%CI: 1.03-4.79), and daily sleepiness score (OR=1.80, 95%CI: 1.04-3.09). Conclusion: Serum GHRH levels in patients with moderate-severe OSAHS may play a protective role in patients' cognitive function.

Smartphone-based delivery of oropharyngeal exercises for treatment of snoring: a randomized controlled trial.

Upper airway exercises for snoring treatment can be effective but difficult to administer and monitor. We hypothesized that a brief, relatively simple daily upper airway exercise regimen, administered by a smartphone application, would reduce snoring and encourage compliance. Targeted vowel sounds causing tongue base movements were incorporated into a voice-controlled smartphone game application. Participants with habitual snoring, apnea hypopnea index (AHI) ≤ 14events/h, and BMI ≤ 32kg/m2 were randomly assigned to perform 15min of daily gameplay (intervention group) or 5s of daily voice recording (control group) and to audio record their snoring for 2nights/week for up to 12weeks. Sounds above 60dB were extracted from recordings for snore classification with machine learning support vector machine classifiers. Sixteen patients (eight in each group) completed the protocol. Groups were similar at baseline in gender distribution (five males, three females), mean BMI (27.5 ± 3.8 vs 27.4 ± 3.8kg/m2), neck circumference (15.1 ± 1.6 vs 14.7 ± 1.7in.), Epworth Sleepiness Score (8 ± 3.5 vs 7 ± 4.0), and AHI (9.2 ± 4.0 vs 8.2 ± 3.2 events/h). At 8weeks, the absolute change in snoring rate (> 60dB/h) was greater for the intervention group than the control group (- 49.3 ± 55.3 vs - 6.23 ± 23.2; p = 0.037), a 22 and 5.6% reduction, respectively. All bed partners of participants in the intervention group reported reduced snoring volume and frequency, whereas no change was reported for the control group. Smartphone application-administered upper airway training reduces objective and subjective snoring measures and improves sleep quality. ClinicalTrials.gov ; no.: NCT03264963; URL: www.clinicaltrials.gov.

Circadian Preference, Sleep Quality, and Health-impairing Lifestyles Among Undergraduates of Medical University.

Background/AimsHealth-impairing lifestyle during adolescence is an important marker for poor health. An unhealthy lifestyle may lead to physical and psychological problems in adulthood. Most of the prior researches were done among the adult population. Therefore, we assessed the chronotype pattern and correlation of health-impairing lifestyles with sleep quality according to circadian typology in medical students.Material and MethodsIn this cross-sectional research, a total of 203 subjects were enrolled. All subjects were divided into definite evening chronotype (n = 73), intermediate chronotype (n = 87), and definite morning chronotype (n = 43). Electronic media use at bedtime and duration of media use, the timing of dinner, smoking, tobacco chewing, and alcohol consumption were assessed with the help of a preformed proforma. Physical activity, sleep quality, daytime sleepiness, and chronotype were assessed by International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS), and Morningness-Eveningness Questionnaire Self-assessment version (MEQ-SA), respectively.ResultsSubjects of the evening chronotype were suffering more with poor sleep quality. Evening chronotype had a significant (p < 0.05) positive correlation between poor sleep quality and sex, tobacco smoking, alcohol drinking, type of diet, and timing of dinner.ConclusionCircadian typology demonstrated the significant correlation of health-impairing lifestyles with sleep quality. From this observation, it might be a better way to plan their daily activities, in accordance with their chronotypes, benefiting not only their academic performance but also their quality of life.

Evaluation of Traffic Accident Risk in In-City Bus Drivers: The Use of Berlin Questionnaire.

Traffic accidents associated with high mortality rate may produce serious problems especially in highways. Obstructive sleep apnea (OSA) has been associated with a high risk for traffic accidents due to excessive daytime sleepiness even in in-city drivers. In the present study, it was aimed to evaluate the rate of OSA symptoms and to identify risk factors associated with traffic accidents in in-city bus drivers. A self-administered questionnaire including demographic and anthropometric features, sleep and work schedules, Berlin questionnaire, Epworth sleepiness score (ESS), and history of traffic accidents was used. The questionnaire was conducted for 1400 male bus drivers (mean age, 38.0±6.4 y, body mass index, 27.8±3.9 kg/m2). A total of 1058 (75.6%) drivers had one or more accidents while driving bus. According to the Berlin questionnaire, 176 (12.6%) drivers were found to have high OSA risk and the accident rate was 83.0% in high-risk group, whereas 74.5% of low-risk drivers had accidents (p=0.043). The drivers with a history of traffic accident were older (p=0.030), had higher ESS (p=0.019), and were more in the high-risk OSA group according to the Berlin questionnaire (p=0.015). In multivariate linear regression analysis, traffic accident was associated with only Berlin questionnaire (p=0.015). The present results support that city bus drivers with high OSA risk according to Berlin questionnaire have increased accident rates. Therefore, we suggest using Berlin questionnaire for screening sleep apnea not only in highway drivers but also in in-city bus drivers.

Sleep habits and strategies of ultramarathon runners.

Among factors impacting performance during an ultramarathon, sleep is an underappreciated factor that has received little attention. The aims of this study were to characterize habitual sleep behaviors in ultramarathon runners and to examine strategies they use to manage sleep before and during ultramarathons. Responses from 636 participants to a questionnaire were considered. This population was found to sleep more on weekends and holidays (7–8 h to 8–9 h) than during weekdays (6–7 h to 7–8 h; p < 0.001). Work was a mediator of napping habits since 19–25% reported napping on work days and 37–56% on non-work days. There were 24.5% of the participants reporting sleep disorders, with more women (38.9%) reporting sleep problems than men (22.0%; p < 0.005). Mean (±SD) sleepiness score on the Epworth Sleepiness Scale was 8.9 ± 4.3 with 37.6% of respondents scoring higher than 10, reflecting excessive daytime sleepiness. Most of the study participants (73.9%) had a strategy to manage sleep preceding an ultramarathon, with 54.7% trying to increase their opportunities for sleep. Only 21% of participants reported that they had a strategy to manage sleep during ultramarathons, with micronaps being the most common strategy specified. Sub-analyses from 221 responses indicated that sleep duration during an ultramarathon was correlated with finish time for races lasting 36–60 h (r = 0.48; p < 0.01) or > 60 h (r = 0.44; p < 0.001). We conclude that sleep duration among ultramarathon runners was comparable to the general population and other athletic populations, yet they reported a lower prevalence of sleep disorders. Daytime sleepiness was among the lowest rates encountered in athletic populations, which may be related to the high percentage of nappers in our population. Sleep extension, by increasing sleep time at night and daytime napping, was the main sleep strategy to prepare for ultramarathons.

Sleep quality, sleepiness and the influence of workplace breaks: A cross-sectional survey of health-care workers in two US hospitals

ABSTRACTThis study assessed sleep quality, sleepiness and use of workplace break opportunities in 1285 health-care workers via an online questionnaire. Two hospitals were surveyed – one with and one without a fatigue mitigation policy. Across all respondents, 68.9% reported generally taking breaks of at least 30 min and 21.7% had access to a quiet place to rest, with no significant differences between hospitals. The presence of a fatigue mitigation policy was not associated with reduced sleepiness. However, accounting for hospital and shift characteristics, employees with access to a quiet place to rest while on break had significantly lower self-reported sleepiness scores.

The reliability of the Epworth Sleepiness Score in a sleep clinic population.

Despite the Epworth Sleepiness Score being widely used, there are limited studies of its reliability in clinical practice. The aim of this study was to assess the reliability of the Epworth Sleepiness Score in a clinical population. The study included patients referred to Middlemore Hospital sleep service between October and November 2014, aged over 17years, with at least two Epworth Sleepiness Score measurements at up to three different points on the diagnostic pathway: on General Practitioner referral (GP Epworth Sleepiness Score); at overnight oximetry assessment (Oximetry Epworth Sleepiness Score); and at a specialist clinic (Specialist Epworth Sleepiness Score). No treatment was administered between scores. One-hundred and thirty-three patients were included in the study. There was a median of 91days from GP Epworth Sleepiness Score to Oximetry Epworth Sleepiness Score, and 11days from Oximetry Epworth Sleepiness Score to Specialist Epworth Sleepiness Score. There was poor test-retest reliability between GP Epworth Sleepiness Score and Specialist Epworth Sleepiness Score; 72.4% and 17.8% of patients had an absolute difference of more than 2 and 8 Epworth Sleepiness Score points, respectively. A Bland-Altman plot of mean Epworth Sleepiness Score versus the difference between GP Epworth Sleepiness Score and Specialist Epworth Sleepiness Score demonstrated a wide scatter of data and 95% confidence interval for the difference in Epworth Sleepiness Score for an individual patient of -14 to +10. There was similar variability between GP Epworth Sleepiness Score and Oximetry Epworth Sleepiness Score. The reliability of the Epworth Sleepiness Score is unproven in clinical settings. This study shows poor test-retest reliability of Epworth Sleepiness Score, particularly between primary and secondary care, arguing against the use of Epworth Sleepiness Score for clinical decision-making or prioritisation of services without first assessing the reliability of the Epworth Sleepiness Score in the relevant clinical population.

Association Between K10 Psychological Distress Score, Epworth Sleepiness Scores and Physical Health in Fly In–Fly Out Mine Workers

Association Between K10 Psychological Distress Score, Epworth Sleepiness Scores and Physical Health in Fly In–Fly Out Mine Workers

1146 A Pediatric Patient with Familial Type-1-Narcolepsy

Human familial Type-1-narcolepsy was first reported in 1877. Animal models have revealed autosomal recessive pattern of inheritance. Tight genetic association with (HLA)-DQB1*06:02 is evident with up to 98% of patients testing positive1. Other genetic associations including hypocretin receptor mutations, HLA-DR, -DQ subtypes with variable phenotypes have been identified in different ethnic groups. Our patient is a 15-year-old female with a 1-year history of excessive daytime sleepiness and “fainting spells”. The episodes occur at various times of the day. Over the past week, she had 9 episodes during which she was awake but unable to communicate. Episodes were preceded by strong emotions such as laughter. Patient reported hypnagogic hallucinations. She reported daytime sleepiness with a pediatric daytime sleepiness score of 29. Patient takes multiple refreshing naps during the day. The family denied any history of infections or head trauma prior to developing current symptoms. Family history was significant for multiple family members over multiple generations with similar symptoms and her sister had a polysomnography (PSG) and mean sleep latency test (MSLT) confirming a diagnosis of type-1-narcolepsy. Our patient underwent formal testing with an overnight PSG which was negative for sleep disordered breathing. This was followed by a MSLT, revealing >2 SOREMPs and mean sleep latency 6.2 minutes, confirming the diagnosis of type-1-narcolepsy. (HLA)-DQB1*0602 was negative. Family members are currently undergoing genetic testing. Our case demonstrated a strong family history of type-1-narcolepsy symptoms among multiple members spanning over multiple generations with patient testing negative for (HLA)-DQB1*06:02. This suggests possible heterogeneity in the presentation of narcolepsy. One study identified a rare subtype HLA-DPB1*09:01 in negative (HLA)-DQB1*06:02 with low CSF hypocretin2. Although genetic testing is not routinely performed, there is a need to identify genotype and phenotype variations in patients with significant family history of narcolepsy.

Sleep disturbances and their associations with emotional/behavioural problems in 5-year-old boys with autism spectrum disorders

ABSTRACTSleep disturbances are likely to be associated with emotional and behavioural problems in typically and atypically developing children. The study was aimed to evaluate sleep disturbances in children with autism spectrum disorder (ASD) and their associations with emotional/behavioural problems. The study comprised eighteen 5-year-old boys with diagnosed ASD. Control group was made up of matched 54 clinically healthy typically developing boys. The mothers were requested to fill in Child Sleep Habit Questionnaire (CSHQ) aimed to measure certain sleep troubles in children and the Achenbach Child Behaviour Check List (CBCL/1.5–5) aimed to find major emotional/behavioural disturbances. Children with ASD had significantly higher scores on sleep onset delay, night waking, parasomnia, sleep disordered breathing and daytime sleepiness scores. They also presented with statistically significantly higher values on affective, anxiety, pervasive developmental, attention deficit/hyperactivity and oppositional defiant problems subscales. Predictive analysis showed that anxiety problems could be finely predicted by ASD diagnosis, low IQ, sleep delay, sleep anxiety, and daytime sleepines. Affective problems could be predicted by ASD diagnosis, night waking and low IQ. So far as attention deficit/hyperactivity and oppositional defiant problems were concerned, these variables were most dependant on child IQ and gastrointestinal symptoms. Sleep disturbances in children with ASD are common and may be associated with emotional problems.

An on-road study of sleepiness in split shifts among city bus drivers

Bus drivers often work irregular hours or split shifts and their work involves high levels of stress. These factors can lead to severe sleepiness and dangerous driving. This study examined how split shift working affects sleepiness and performance during afternoon driving. An experiment was conducted on a real road with a specially equipped regular bus driven by professional bus drivers. The study had a within-subject design and involved 18 professional bus drivers (9 males and 9 females) who drove on two afternoons; one on a day in which they had driven early in the morning (split shift situation) and one on a day when they had been off duty until the test (afternoon shift situation). The hypothesis tested was that split shifts contribute to sleepiness during afternoon, which can increase the safety risks. The overall results supported this hypothesis. In total, five of the 18 drivers reached levels of severe sleepiness (Karolinska Sleepiness Scale ≥8) with an average increase in KSS of 1.94 when driving in the afternoon after working a morning shift compared with being off duty in the morning. This increase corresponded to differences observed between shift workers starting and ending a night shift. The Psychomotor Vigilance Task showed significantly increased response time with split shift working (afternoon: 0.337s; split shift 0.347s), as did the EEG-based Karolinska Drowsiness Score mean/max. Blink duration also increased, although the difference was not significant. One driver fell asleep during the drive. In addition, 12 of the 18 bus drivers reported that in their daily work they have to fight to stay awake while driving at least 2–4 times per month. While there were strong individual differences, the study clearly showed that shift-working bus drivers struggle to stay awake and thus countermeasures are needed in order to guarantee safe driving with split shift schedules.

Impact of blue-depleted white light on pupil dynamics, melatonin suppression and subjective alertness following real-world light exposure

BackgroundThe non-image forming system, which conveys light information to circadian and sleep centers in the brain, is optimized to respond to short wavelengths of light (blue). Exposure to white light with reduced blue content can cause lower than expected circadian and sleep responses. These findings, however, come from controlled laboratory conditions that may not be entirely accurate when attempting to apply them to most real-world settings. It was our intention to examine whether, under ecologically-valid circumstances, a blue-depleted white light had a diminished impact on sleep and circadian functions as compared to an equiluminant white light.MethodsIn Study 1, seven healthy, young individuals were exposed to a series of one-minute light pulses (32, 100 or 140 lx) produced either by a standard white light emitting diode (LED) or an LED light with reduced blue content. Pupil responses were measured with an infrared pupillometer. In Study 2, ten healthy, young individuals participated in two overnight evaluations. On one of the nights, participants received three hours of 150 lx of a standard white LED starting at habitual bedtime. The protocol on the alternate night was identical except an LED with reduced blue content was used (both lights were identical to those used in Study 1). Saliva samples were collected every 20–30 min for determination of melatonin concentrations and subjective sleepiness was assessed hourly with the Stanford Sleepiness Scale. In both studies, pre-light exposure baseline was real-world ambulatory light exposure.ResultsStudy 1. The post-illumination pupil response (PIPR) to 32 lx was increased in response to the standard as compared to blue-depleted LED (p < 0.05, paired t-test). PIPR did not differ between lighting conditions at higher illuminances. Study 2. Neither salivary melatonin concentrations nor subjective sleepiness scores were different between lighting conditions.ConclusionsWhile the absence or reduction of blue light has the physiologic capacity to reduce the impact of light on non-image forming photoreceptive functions, under a pre-exposure lighting environment closer to that which is found in the real world, no such differences are observed except for pupil responses to moderately dim light.Trial registrationClinicalTrials.gov #NCT02936674, NCT02636140.

Alcohol metabolism in hangover sensitive versus hangover resistant social drinkers

BackgroundPrevious research demonstrated that urinary ethanol concentrations were significantly lower in hangover resistant individuals compared to drinkers who reported having a hangover. This finding suggests that the rate of ethanol metabolism is faster in drinkers who do not experience an alcohol hangover. This study aimed to directly compare alcohol metabolism after administering a low dose of ethanol to hangover sensitive drinkers and hangover resistant drinkers. MethodsSocial drinkers who previously participated in hangover trials at Utrecht University were invited to participate. It was aimed to include 12 hangover resistant drinkers and 12 hangover sensitive drinkers. Participants consumed alcohol to reach a breath alcohol concentration (BrAC) of 0.05%. Every 5 min BrAC was determined, until BrAC reached zero. Every 15 min, the Karolinska Sleeping Scale (KSS) was administered to assess subjective sleepiness, and subjective intoxication was measured. ResultsData of N = 23 participants with a mean age of 22.4 (±1.9) years was included in the analyses. No significant difference in BrAC over time was found between the hangover resistant group and the hangover sensitive group. In line, subjective sleepiness scores and subjective intoxication ratings did not significantly differ between the groups at any point in time after alcohol consumption. ConclusionHangover resistant individuals and hangover sensitive drinkers did not significantly differ on BrAC, subjective sleepiness, and subjective intoxication after consuming a moderate amount of alcohol. These findings suggest that drinkers who usually experience hangovers after a heavy drinking occasion do not experience alcohol intoxication differently than hangover resistant drinkers.

Sleep Abnormalities Among Patients With and Without Diabetes Using Pittsburg Sleep Quality Index and Epworth Sleepiness Scale

IntroductionDiabetes has a great influence on sleep patterns. Several hormonal mechanisms are disrupted in patients with diabetes and, hence, affect their sleep patterns. Sleep disturbances further worsen the state of the disease itself.MethodIn this cross-sectional study, we collected data from 50 healthy adults and 50 patients diagnosed with type 2 diabetes mellitus without comorbidities. Study participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) surveys.ResultsThe mean PSQI score was 8.64 ± 3.96 for patients with type 2 diabetes and 4.24 ± 2.72 for patients without diabetes. The mean Epworth Sleepiness score was 6.3 ± 5.29 among patients with diabetes and 1.94 ± 2.34 for patients without diabetes.ConclusionThe early diagnosis and management of sleep problems can help maintain target blood glucose levels and may help impede the future development of complications.

Quality of life in obstructive sleep apnea is related to female gender and comorbid insomnia.

Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients. World Health Organization Quality of Life Scale short form (WHOQOL-Bref) was used for evaluating QoL in OSA patients undergoing polysomnography in sleep laboratory of a university hospital. Out of 197 patients (age 50.4 ± 12.1years, AHI 38.5 ± 28.4/h), 139 (70.6%) were men and 79.2% had moderate-to-severe OSA. Female gender, increased BMI, higher Epworth sleepiness score (ESS), and lower oxygen saturations were associated significantly with poor QoL in terms of all domains (physical, psychological, social relationship, and environmental) of WHOQOL-Bref questionnaire. The indicators of OSA severity (AHI and ODI) correlated negatively only with the physical domain. The subjects with comorbid insomnia and OSA had lower physical and social scores than subjects with no insomnia, and women with insomnia had significantly worse QoL scores in all domains than the others. In the multivariate linear regression analysis, female gender, comorbid insomnia, increased sleepiness, and higher BMI were significantly associated with poor QoL. Female gender, comorbid insomnia, and daytime sleepiness were the outstanding factors affecting health-related QoL negatively in OSA. Besides, the impact of OSA on QoL may be explained by the presence of daytime sleepiness rather than OSA severity.

Circadian-effective light and its impact on alertness in office workers

A field study was conducted at two U.S. federal government office sites and two U.S. embassies to demonstrate whether circadian-effective lighting (providing circadian stimulus (CS) values of CS ≥ 0.3) could be installed in office buildings, and to determine whether this lighting intervention would reduce sleepiness and increase alertness, vitality and energy in office workers while at work. Desktop and/or overhead luminaires provided circadian-effective lighting at participants’ eyes during a two-day intervention. A pendant-mounted Daysimeter device was used to measure participant-specific CS values during the baseline and the intervention days. Participants also completed questionnaires inquiring about sleep habits, stress and subjective feelings of vitality and energy. The Daysimeter data showed that participants were exposed to significantly higher amounts of circadian-effective light while at work during the two intervention days compared to the baseline day. Self-reported sleepiness scores were significantly reduced during the intervention days compared to the baseline day. As hypothesised, participants also reported feeling significantly more vital, energetic and alert on the intervention days compared to the baseline day. The present results from four independent office environments demonstrate that lighting systems delivering a CS ≥ 0.3 can reduce sleepiness and increase vitality and alertness in office workers.

The impact of melatonin on the sleep patterns of women undergoing IVF: a double blind RCT.

STUDY QUESTIONDoes melatonin result in a dose–response effect on sleep quality and daytime sleepiness in women undergoing IVF?SUMMARY ANSWERMelatonin, even when given at high doses twice per day, does not cause significant daytime sleepiness or change night time sleep quantity or quality.WHAT IS KNOWN ALREADYMelatonin is being increasingly used as an adjuvant therapy for women undergoing IVF owing to its antioxidative effects. It is widely considered to be sedative but there are scant objective data on the effects of melatonin on sleep in the setting of IVF.STUDY DESIGN SIZE, DURATIONThe study was a double-blind placebo-controlled randomized trial of 116 women recruited between September 2014 and September 2016.PARTICIPANTS/MATERIALS, SETTING, METHODWomen who were undergoing their first cycle of IVF at private IVF centers were recruited into the RCT and randomized to receive either placebo, 2 mg, 4 mg or 8 mg of melatonin, twice per day (BD) from Day 2 of their cycle until the day before oocyte retrieval. Each participant wore an accelerometer that provides an estimate of sleep and wake activity for up to 1 week of baseline and throughout treatment (up to 2 weeks). They also kept sleep diaries and completed a Karolinska sleepiness score detailing their night time sleep activity and daytime sleepiness, respectively.MAIN RESULTS AND THE ROLE OF CHANCEIn total, 116 women were included in the intention-to-treat analysis (placebo BD (n = 32), melatonin 2 mg BD (n = 29), melatonin 4 mg BD (n = 26), melatonin 8 mg BD (n = 29)). There were no significant differences in daytime Karolinska sleepiness score between groups (P = 0.4), nor was there a significant dose–response trend (β=0.05, 95% CI −0.22–0.31, P = 0.7). There were no differences in objective measures of sleep quantity or quality, including wake after sleep onset time, sleep onset latency, and sleep efficiency before and after treatment or between groups. There was an improvement in subjective sleep quality scores from baseline to during treatment in all groups, except 8 mg BD melatonin: placebo (percentage change −13.3%, P = 0.01), 2 mg (−14.1%, P = 0.03), 4 mg (−8.6%, P = 0.01) and 8 mg (−7.8%, P = 0.07).LIMITATIONS, REASONS FOR CAUTIONAs this was a subset of a larger trial, the melatonin in ART (MIART) trial, it is possible that the sample size was too small to detect statistically significant differences between the groups.WIDER IMPLICATIONS OF THE FINDINGSWhile this study suggests that melatonin can be used twice per day at high doses to achieve sustained antioxidation effects, with the reassurance that this will not negatively impact daytime sleepiness or night time sleep habits, the sample size is small and may have missed a clinically significant difference. Nevertheless, our findings may have implications not only for future studies of fertility treatments (including meta-analyses), but also in other medical fields where sustained antioxidation is desired.STUDY FUNDING/COMPETING INTERESTSThis study was funded by the Monash IVF Research and Education Foundation (PY12_15). S.F. is supported by the National Health and Medical Research Council (Postgraduate Scholarship APP1074342) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Ella Macknight Memorial Scholarship. E.W. is supported by an National Health and Medical Research Council Program Grant (APP1113902). S.F., E.W., R.H., B.V., N.L., N.H., M.W., M.L., A.L., P.T., K.L. have nothing to declare. L.R. is a Minority shareholder in Monash IVF Group, has unrestricted grants from MSD®, Merck-Serono® and Ferring® and receives consulting fees from Ferring®. S.N.B. reports consulting fees from Johnson & Johnson Consumer Inc®, outside the submitted work.TRIAL REGISTRATION NUMBERThis trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (Project ID: ACTRN12613001317785).TRIAL REGISTRATION DATE27/11/2013DATE OF FIRST PATIENT’S ENROLMENT1/9/2014

Quality of life and mood in children with cystic fibrosis: Associations with sleep quality

BackgroundWe aimed to investigate the relationship between sleep quality, mood and health-related quality of life (HRQOL) in children with CF and controls. MethodsChildren (7–12years) and adolescents (13–18years) with CF and controls completed sleep evaluation: overnight oximetry and 14days of actigraphy. Age-appropriate questionnaires assessed mood (Children's Depression Inventory; CDI or Beck's Depression Inventory), HRQOL (CF Questionnaire-Revised; CFQ-R or PedsQL), and sleepiness (Pediatric Daytime Sleepiness Scale). Results87 CF and 55 controls recruited. Children with CF had poorer sleep quality, more sleepiness and lower mood than controls, with a negative correlation between mood score and sleep efficiency. Sleepiness score was predictive of mood score and multiple CFQ-R domains. Adolescents with CF also demonstrated poorer sleep and more sleepiness than controls, but no difference in mood. Reduced sleep quality predicted lower CFQ-R scores. No correlation between sleep, mood or HRQOL in controls. ConclusionsIn children and adolescents with CF, impaired sleep quality is associated with lower mood and HRQOL in an age-specific manner. Future research will aid understanding of effective strategies for prevention and treatment of mood disorders and sleep disturbance in children with CF.

Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea.

BackgroundContinuous positive airway pressure (CPAP) therapy is an efficacious treatment for patients diagnosed with obstructive sleep apnea (OSA). However, there are only few data on long-term adherence. The aim of this study is to quantify the extent of non-adherence and describe the clinical characteristics.MethodsA retrospective study including 695 patients with newly diagnosed OSA and prescribed CPAP therapy within an inclusion period of 14 months. All patients were offered free of charge individually adjusted CPAP therapy. Data on comorbidity, medication, BMI and Epworth Sleepiness Score (ESS) were obtained by questionnaires and consultation with an otorhinolaryngeal specialist.ResultsThe median follow-up time after initiating CPAP therapy was 3.0 (range 2.4–3.6) years. An adherence rate of 89% was found for severe OSA, 71% for moderate OSA and 55% for mild OSA. 18% initiated humidification. Patients adherent to CPAP had a significantly higher Body Mass Index (BMI), Apnea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI) and ESS compared to non-adherent patients. Furthermore, adherence was associated with a higher frequency of observed interrupted breathing, a less frequent use of hypnotic drugs, fewer smokers, and they were more often offered humidification. Age, gender and comorbidity were not significantly associated with adherence. In a Cox model only AHI (Hazard Ratio (HR) 0.963, p < 0.001), ESS (HR 0.939, p = 0.001) and smoking (HR 1.576, p = 0.022) were independently associated with CPAP non-adherence.ConclusionsThe severity of OSA, subjective daytime sleepiness and smoking status are independently related to adherence to CPAP therapy.

Kamikihito improves cancer-related fatigue by restoring balance between the sympathetic and parasympathetic nervous systems.

BackgroundCancer-related fatigue is one of the most prevalent symptoms that patients with cancer experience, but the mechanisms underlying it are unknown. We aimed to quantify and mechanistically evaluate the improvement in fatigue related to administration of the Kampo medicine, Kamikihito.Materials and methodsInitially, we recruited outpatients with urological diseases and compared fatigue levels of 37 patients with cancer with a control group of 23 volunteers who had recovered completely from cancer or who were being treated for dysuria. Fatigue level was estimated using an autonomic function analyzer. Then, Kamikihito was administered to another 35 patients treated with hormone or antitumor therapy for prostate cancer and metastatic renal cell cancer. Subjective fatigue and other problems of the patients were assessed using the Chalder fatigue scale, the Center for Epidemiologic Studies Depression scale, and the Epworth sleepiness scale. Serum levels of derivatives of reactive oxygen species and biological antioxidant potential were also measured.ResultsPatients in the cancer treatment group experienced more fatigue compared with the control patients when evaluated using an autonomic function analyzer. The group of 35 patients who were administered Kamikihito showed improved scores for fatigue, depression, and sleepiness. Autonomic nervous system balance was also improved with Kamikihito administration. The Kamikihito group also had significantly lower reactive oxygen species metabolite levels and significantly higher antioxidant potential.ConclusionsFatigue was more serious in patients with cancer than in control patients. Kamikihito rescued this fatigue and improved anxiety and sleepiness. It restored autonomic nervous system balance and antioxidant function.