Symptoms Of Sleepiness Research Articles

Changes in emotional state of bed partners of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation: a pilot study

To test the hypothesis that obstructive sleep apnea/hypopnea syndrome (OSAHS) and snoring affect not only the patients but also their bed partners, resulting in increased severity of symptoms of depression and sleepiness that may improve after the patients receive radiofrequency tissue ablation (RFTA) treatment. Thirty-six snoring and/or OSAHS patients from 24 to 63 years of age (mean age 41.67 +/- 9.86 years) underwent full-night polysomnography (PSG) and two sessions of RFTA at palatal or palatal and tongue base levels. Follow-up PSG was carried out within the period of 2-3 months after the second RFTA session. The baseline and posttreatment clinical tests battery consisting of Spielberg's Trait-State Anxiety Inventory, Beck Depression Inventory-Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess the changes in emotional state of study group patient's bed partners. Mean apnea/hypopnea index decreased from 13.16 +/- 10.76 preoperatively to 10.69 +/- 8.28 postoperatively (p = 0.043) for the entire group of the patients. A statistically significant decrease of the mean BDI-II scores (12.69 +/- 7.66 preoperatively to 9.17 +/- 6.88 postoperatively, p < 0.005) for the entire group of the patients' bed partners was observed. There was no statistically significant difference between pre- and posttreatment mean daytime sleepiness scores in both OSAHS and in simple snoring patients' bed partners when measured with ESS. Based on present study results, we conclude that RFTA therapy results in improved depression scores for the bed partners of snoring and OSAHS patients during a short follow-up period, as measured with BDI-II.

Sleep timing and circadian phase in delayed sleep phase syndrome.

Delayed sleep phase syndrome (DSPS) is a circadian rhythm sleep disorder in which the timing of the sleep episode occurs later than desired and is associated with difficulty falling asleep, problems awakening on time (e.g., to meet work or school obligations), and daytime sleepiness. The phase relationship between the timing of sleep and endogenous circadian rhythms is critical to the initiation and maintenance of sleep, and significant alteration leads to impairment of sleep quality and duration. The aim of this retrospective study was to determine the phase relationship between sleep-wake times and physiological markers of circadian timing in clinic patients with DSPS. Objective and subjective measures of sleep timing and circadian phase markers (core body temperature and melatonin) were measured in patients with DSPS and compared with age-matched controls. As expected, significant delays in the timing of the major sleep episode and circadian phase of body temperature and melatonin rhythms were seen in the DSPS group when allowed to sleep at their own habitual schedules, but the phase relationship between sleep-wake times and circadian phase was similar between the 2 groups. These results suggest that the symptoms of insomnia and excessive daytime sleepiness in DSPS patients living under entrained real-life conditions cannot be explained by an alteration in the phase relationship between sleep-wake patterns and other physiological circadian rhythms.

Healthy older adults better tolerate sleep deprivation than young adults.

To determine whether healthy aging is associated with increased sleepiness and whether healthy older adults experience more sleepiness when acutely sleep deprived. A 5-day inpatient circadian rhythm-sleep study consisting of 3 baseline nights followed by an extended 26-hour wake episode under constant conditions. Intensive Physiological Monitoring Unit, General Clinical Research Center, Brigham and Women's Hospital. Thirty-seven healthy participants without medical, psychological, or sleep disorders: 26 young (7 women, 19 men; mean age 21.9 +/- 3.3, range 18-29) and 11 "young-old" adults (3 women, 8 men; mean age 68.1 +/- 3.6, range 65-76). An extended 26-hour wake episode under constant conditions. Electroencephalographic-verified wakefulness, slow eye movements, sustained attention, subjective sleepiness. During the first 16 hours corresponding to the usual waking day, both groups rated themselves as alert and had similar levels of vigilance and little evidence of sleepiness. As the wake episode continued, the older subjects were less impaired, showing faster reaction times, fewer performance lapses and attentional failures, and less frequent unintentional sleep episodes than the younger subjects. This small study suggests that excessive sleepiness is not normal in healthy older adults. Symptoms of excessive sleepiness in this population, including reliance on caffeine to maintain alertness, should be evaluated and treated. Further study is needed to determine whether daytime sleepiness in middle-old (75-84 years) and old-old (> or = 85) adults is normal or is instead associated with sleep restriction, undiagnosed sleep disorders, medication side effects, mood disorders, or other medical disorders that disrupt sleep.

The Relationship Between Home Nursing Coverage, Sleep, and Daytime Functioning in Parents of Ventilator-Assisted Children

This descriptive study examined the relationship between home-care nursing support, sleep, and daytime functioning in familial caregivers of ventilator-assisted children. Thirty-six primary caregivers (27 mothers, 7 fathers, 1 foster mother, and 1 grandmother) of ventilator-assisted children completed measures of home nursing support, sleep, depression, fatigue, and daytime sleepiness. Daytime nursing coverage was not related to caregiver sleep or daytime functioning, but caregivers with less nighttime nursing coverage had significantly shorter sleep onset latency than caregivers with some night nursing (16-48 hours/week). Caregivers with regular night nursing (>48 hours/week) had a total sleep time of almost 1 hour more than caregivers without regular night nursing (<or=48 hours/week). Caregivers with clinically significant symptoms of depression and sleepiness received significantly fewer hours of night nursing per week than caregivers without significant symptoms of depression or sleepiness. Home nursing support, in particular night nursing, is important for the health and well-being of familial caregivers of ventilator-assisted children.

Maintenance of wakefulness test in military personnel with upper airway resistance syndrome and mild to moderate obstructive sleep apnea

Sleep-disordered breathing (SDB) and the associated symptom of excessive daytime sleepiness (EDS) in military personnel has influential consequences in both the garrison and the deployed environments. The maintenance of wakefulness test (MWT) is a daytime study used to evaluate the tendency to stay awake. We evaluated consecutive patients diagnosed with mild to moderate obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) to provide an objective measure of their EDS using the MWT. All military personnel referred between February 2004 and March 2005 with a clinical evaluation suspicious for SDB were evaluated with an overnight polysomnography (PSG). After overnight PSG, military personnel with mild to moderate OSA and UARS were evaluated with a 40-min protocol MWT. Abnormal MWT was defined as sleep onset latency mean below 19.4 min (<2 SD below the mean). Sixty-two military personnel met entry criteria. Fifty-nine were men. Nineteen patients (32%) were diagnosed with UARS with a mean respiratory disturbance index of 11/h (5-20/h). Forty-one (68%) of the military personnel had OSA with a mean apnea-hypopnea index of 12/h (5-29/h). As a collective group, the mean Epworth Sleepiness Scale was elevated at 13/24 (1-24). This subjective excessive sleepiness was assessed with the MWT test, which resulted in a group mean MWT sleep onset latency of 27 min (5-40 min). Eighteen soldiers (30% of the total patients) had abnormal MWTs [six patients (33.3%) with UARS and 12 (67%) with OSA]. Military personnel with mild to moderate OSA and UARS often have abnormal MWTs and therefore have a pathological tendency to fall asleep. This EDS could pose a safety hazard in those personnel, military or civilian, who operate dangerous vehicles, machinery, or carry a firearm. Military personnel with untreated SDB are also at risk for the consequences of decreased mental alertness and decreased cognitive functioning due to daytime sleepiness.

An Assessment Of Postanaesthetic Morbidity In Day-Case Surgical Patients In Enugu, Nigeria

Aim: To examine the incidence of post-anaesthetic morbidity in day-case surgical patients in Enugu, Nigeria. The study was undertaken to assess what happened to patients when they left hospital after day-case surgery under general anaesthesia. Materials And Method: A total of 120 outpatients who received general anaesthesia for minor surgical and diagnostic procedures at the University of Nigeria Teaching Hospital, Enugu from January 1, 2000 to June 30, 2000 were studied. Before discharge, outpatient questionnaires were distributed to the patients to fill and return to the outpatient clinics a week after operation. Results: Thirty-six (30%) of patients travelled home unaccompanied by a responsible person. Seventy percent of care owners drove within 24 hours of the operation. Fifty persons hail symptoms. Postoperative symptoms of drowsiness (25%), headache (20%), Nausea (20%), vomiting (15%), dizziness (10%), and sorethroat (5%) were recorded. A higher incidence of symptoms was recorded when surgery exceeded 20 minutes. There was no major morbidity. Conclusion: The study showed that there was a high incidence (42%) of minor morbidity after general anaesthesia for minor day-case surgical procedures. It is therefore, recommended that outpatients should adhere strictly to preoperative instructions. Keywords: Postanaesthesia morbidity, day-case surgerTropical Journal of Medical Research Vol. 10 (2) 2006: pp. 9-12

Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea–hypopnoea syndrome: a systematic review and economic analysis

To determine the clinical effectiveness, safety and cost-effectiveness of continuous positive airway pressure (CPAP) devices for the treatment of obstructive apnoea-hypopnoea syndrome (OSAHS), compared with the best supportive care, placebo and dental devices. The main search was of fifteen electronic databases, including MEDLINE, EMBASE and the Cochrane Library, up to November 2006. Randomised controlled trials (RCTs) comparing CPAP with best supportive/usual care, placebo, and dental devices in adults with a diagnosis of OSAHS were included. The primary outcomes of interest were subjective daytime sleepiness assessed by the Epworth Sleepiness Scale (ESS) and objective sleepiness assessed by the Maintenance of Wakefulness Test (MWT) and the Multiple Sleep Latency Test (MSLT). A new economic model was developed to assess incremental cost per quality-adjusted life-year (QALY). The cost-effectiveness of CPAP was compared with that of the use of dental devices and conservative management. The costs and QALYs were compared over a lifetime time horizon. Effectiveness was based on the RCT evidence on sleepiness symptoms (ESS), which was 'mapped' to utilities using individual patient data from a subset of studies. Utilities were expressed on the basis of generic HRQoL instruments [the EQ-5D (EuroQoL-5 Dimensions) in the base-case analysis]. The base-case analysis focused on a male aged 50. A series of subgroup and scenario analyses were also undertaken. The searches yielded 6325 citations, from which 48 relevant clinical effectiveness studies were identified, 29 of these providing data on daytime sleepiness. The majority of the included RCTs did not report using an adequate method of allocation concealment or use an intention-to-treat analysis. Only the studies using a sham CPAP comparator were double blinded. There was a statistically significant benefit with CPAP compared with control (placebo and conservative treatment/usual care) on the ESS [mean difference (MD) -2.7 points, 95% CI -3.45 to -1.96]. However, there was statistical heterogeneity, which was reduced when trials were subgrouped by severity of disease. There was also a significant benefit with CPAP compared with usual care on the MWT. There was a non-statistically significant difference between CPAP and dental devices (six trials) in the impact on daytime sleepiness (ESS) among a population with moderate symptom severity at baseline (MD -0.9, 95% CI -2.1 to 0.4). A review of five studies evaluating the cost-effectiveness of CPAP was undertaken. All existing cost-effectiveness studies had limitations; therefore a new economic model was developed, based on which it was found that, on average, CPAP was associated with higher costs and benefits than dental devices or conservative management. The incremental cost per QALY gained of CPAP was below 20,000 pounds in the base-case analysis and most alternative scenarios. There was a high probability of CPAP being more cost-effective than dental devices and conservative management for a cost-effectiveness threshold of 20,000 pounds per QALY gained. CPAP is an effective and cost-effective treatment for OSAHS compared with conservative/usual care and placebo in populations with moderate to severe daytime sleepiness, and there may be benefits when the disease is mild. Dental devices may be a treatment option in moderate disease but some uncertainty remains. Further research would be potentially valuable, particularly investigation of the effectiveness of CPAP for populations with mild sleepiness and further trials comparing CPAP with dental devices.

Assessment of Depression in Multiple Sclerosis

Signs and symptoms of multiple sclerosis (MS) may overlap with those of depression, a common comorbidity. This study explored whether inclusion of somatic items on the Beck Depression Inventory-II (BDI-II) falsely elevated scores in a clinical sample of 557 adults with MS evaluated by the health psychology service within an MS center. Our sample's BDI-II responses were subjected to exploratory factor analysis, and the results were compared with those reported in the BDI-II manual. Analyses were then conducted to compare patients who identified fatigue as their worst MS symptom with those who did not and to compare those with high and low levels of fatigue and daytime sleepiness in terms of total BDI-II score, percentage contribution of specific somatic items (ie, tiredness or fatigue) to total BDI-II score, and the sum contribution of the somatic-affective factor to the BDI-II score. Respondents who reported fatigue as their worst MS symptom and those who did not had almost identical BDI-II scores. Among patients reporting fatigue as their worst symptom, only the “loss of energy” item was significantly higher, as was the “tiredness or fatigue” item among patients with severe fatigue. Percentage contribution of the somatic-affective factor to the total BDI-II score did not differ significantly by the presence of fatigue as the worst MS symptom or level of daytime sleepiness. In conclusion, somatic items do not necessarily confound depression scores for individuals with MS and should be retained when using the BDI-II to assess depression in this population.

How much sleep apnea is too much? Authors' response

Our study [1] had two main purposes: first, to examine the occurrence of sleep-disordered breathing (SDB) in patients with chronic fatigue syndrome (CFS), and then to exclude patients with this confound in order to evaluate the structure of sleep in a group of patients with pure CFS to look for relations with the symptoms of fatigue and sleepiness. In order to do this, we had to define an upper limit for the occurrence of respiratory events that might explain the daytime symptoms. Martinez and Cassol are correct that the currently accepted cutpoint for abnormality proposed by the American Academy of Sleep Medicine (AASM) and Centers for Medicare & Medicaid Services (CMS) in the US is an apnea-hypopnea index (AHI) ≥ 5 per hour but less than 15 per hour – but only if symptoms such as EDS are present. However, the AHI is an insensitive measure of the severity of mild respiratory events (such as respiratory event-related arousals (RERAs)) as it requires either a 3 or 4% desaturation for the definition of hypopnea and this is frequently not present in respiratory events that cause arousal and may contribute to sleep disruption (RERA). For this reason, our cutpoint for SDB is based on a respiratory disturbance index (RDI) of 18 events per hour and not the AHI. The RDI includes RERAs along with the AHI, although we used a slightly different definition of hypopneas beginning with any event showing flow limitation rather than the current amplitude based entry criterion. The rationale for this is from an earlier paper by our group [2] that shows that the sensitivity and specificity for explaining EDS in a group composed of symptomatic but mild SDB and non-complaining controls were greater using the RDI criterion than the AHI criterion. Since that paper, it has become customary to use a cut-off of 15 events per hour for RDI in many applications. It is important to note that for RDI, using 5 events per hour will include essentially 80% of the normal population. Furthermore, as pointed out in our current paper [1], although we chose 18 events per hour as a cut-off to exclude three subjects (one with CFS and two normal subjects) when defining the final group for our sleep analysis who might have SDB, in fact the highest RDIs we saw in the non-SDB group were 10.4, 10.8, 10.1, and 9.5 events per hour; we feel these numbers are within a range seen in many normal subjects without EDS [2]. Thus, our cut-off of 18 is not effectively different from the more recently accepted number of 15 events per hour. And after excluding those subjects with high RDI values, there was no significant difference in the AHI of patients with only CFS, those with CFS and fibromyalgia and healthy controls (1.7 ± 1.6, 2.8 ± 2.6, and 2.2 ± 1.7, respectively). In fact, the above logic is not fundamentally different from the choice made by Martinez and Cassol in their own work [3-6], where they define SDB as present in fibromyalgia when the AHI <5 and when more than 10 RERAs per hour occurred (5 + 10 events = 15 per hour, similar to our cut-off of 18 per hour).

Effects of Mometasone Furoate Administered Via a Dry Powder Inhaler Once Daily in the Evening on Nocturnal Lung Function and Sleep Parameters in Patients with Moderate Persistent Asthma

Nocturnal symptoms are common in asthma patients and have the potential for considerable clinical effects due to a lack of sleep and persistent daytime symptoms of somnolence and activity impairment. The primary objective of this investigation was to determine the effect of a 14-day course of once-daily evening administration of mometasone furoate 400 microg administered via a dry powder inhaler (MF-DPI 400 microg qd pm) on the overnight decline in pulmonary function observed in patients with nocturnal asthma. Eligible enrollees were between the ages of 18 and 60 years and had established mild to moderate asthma, with an improvement in forced expiratory volume in 1 second (FEV(1)) of >15% after administration of inhaled salbutamol (albuterol) 200 microg. All enrolled patients had a history of nocturnal asthma. Enrollees were randomized to receive MF-DPI 400 microg qd pm or placebo administered between 6 pm and 8 pm for 14 days. The primary outcome evaluated in the study was reduction in nocturnal decline in evening (8 pm) to morning (6 am) FEV(1) values. Secondary outcomes included reduction in nocturnal decline in evening to morning peak expiratory flow rate (PEFR), polysomnographic indices of sleep, and psychometric indices (Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire [NRQLQ], 36-item Short Form of the Medical Outcomes Survey [SF-36], and Asthma Quality of Life Questionnaire [AQLQ]). A total of 20 patients were randomized and completed all phases of the study. No significant differences were observed between treatment groups in the primary outcome of nocturnal decline in FEV(1) from pretreatment to end of treatment. Likewise, there was no significant difference between treatment groups in polysomnographic indices of sleep or quality-of-life assessments. However, there was a trend toward improvement in the activity scale of the AQLQ assessment in the MF-DPI 400 microg qd pm treatment group. No significant treatment effect on nocturnal pulmonary function, sleep indices or quality of life was observed with 14-day administration of MF-DPI 400 microg qd pm. These findings are limited by the small sample size and the short treatment period evaluated. Future studies are warranted to study the effects of MF-DPI therapy in patients with nocturnal asthma.

Restless Legs Syndrome Is Common among Female Patients with Fibromyalgia

Background: The prevalence of restless legs syndrome (RLS) among the general population is 2–15%, and with fibromyalgia syndrome (FMS) 2%. Both RLS and FMS are more common among women. The aim of our study was to evaluate the prevalence of RLS in a group of female patients diagnosed with FMS and to compare the occurrence of symptoms of daytime sleepiness and experienced sleep disorders between fibromyalgia patients with or without RLS. Method: Three hundred and thirty-two female patients, 20–60 years old, diagnosed with FMS at Skönviks Rehab between 2002 and 2006, answered a questionnaire mailed to their home address. The questionnaire consisted of the international RLS study group criteria as well as of questions concerning symptoms of insomnia and daytime sleepiness measured according to the Epworth Sleepiness Scale. Results: Nearly 64% of the women were also suffering from RLS. More patients suffering from both RLS and FMS were affected by problems of initiating and maintaining sleep than those suffering from FMS only. More patients suffering from both RLS and FMS did not feel refreshed on awakening compared with those suffering from FMS without RLS. The patients with concomitant RLS and FMS were more often hypersomnolent than those suffering from FMS only. Conclusion: This study shows that 64% of a group of female patients diagnosed with fibromyalgia also concurrently suffered from RLS. Compared with patients who suffer from FMS only, patients with both FMS and RLS more often experience sleep disturbances and pronounced daytime sleepiness.

ETHNIC VARIANCE IN SYMPTOMS OF SLEEP APNEA AMONGST HISPANICS AND CAUCASIANS

PURPOSE: Ethnic as well as gender differences have been reported in symptoms of obstructive sleep apnea (OSA). These differences have not been well-characterized amongst Hispanics. The purpose of our study was to evaluate the two common symptoms of excessive daytime sleepiness (EDS) as assessed by the Epworth sleepiness score (ESS) as well as that of witnessed apneas between Hispanic and Caucasians in a large cohort of patients with OSA.

Obstructive sleep apnoea syndrome: current status

Obstructive sleep apnoea syndrome (OSAS) is a prevalent condition that covaries with cardiovascular complications and most likely with arterial hypertension and diabetes mellitus. The present paper is a review of the current status of OSAS. Definitions and diagnostic criteria as well as known risk factors, prevalence, symptoms, covariance with other diseases and consequences as traffic accidents are described. OSAS is characterised by daytime sleepiness symptoms that range from mild to severe. Risk factors such as anatomical upper airway abnormalities, overweight, smoking, excessive alcohol intake and use of muscle relaxants are related to the development of sleep apnoea. Various diagnostic procedures and treatment modalities are considered. Overnight polysomnography is the reference standard for sleep apnoea recording. Treatment modalities include mechanical [continuous positive airway pressure (CPAP), oral appliances], surgical, pharmacological and 'conservative' lifestyle modifications. Finally, Nordic accreditation guidelines for sleep medicine clinics and sleep medicine specialists are described. The diagnosis of OSAS should be performed with a polygraph, and the first-line treatment of moderate to severe OSAS is CPAP. Lastly, compliance for this treatment should be optimised with regular clinical controls.

Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort

Sleep-disordered breathing (SDB) is a treatable but markedly under-diagnosed condition of frequent breathing pauses during sleep. SDB is linked to incident cardiovascular disease, stroke, and other morbidity. However, the risk of mortality with untreated SDB, determined by polysomnography screening, in the general population has not been established. An 18-year mortality follow-up was conducted on the population-based Wisconsin Sleep Cohort sample (n = 1522), assessed at baseline for SDB with polysomnography, the clinical diagnostic standard. SDB was described by the number of apnea and hypopnea episodes/hour of sleep; cutpoints at 5, 15 and 30 identified mild, moderate, and severe SDB, respectively. Cox proportional hazards regression was used to estimate all-cause and cardiovascular mortality risks, adjusted for potential confounding factors, associated with SDB severity levels. All-cause mortality risk, adjusted for age, sex, BMI, and other factors was significantly increased with SDB severity. The adjusted hazard ratio (HR, 95% CI) for all-cause mortality with severe versus no SDB was 3.0 (1.4,6.3). After excluding persons who had used CPAP treatment (n = 126), the adjusted HR (95% CI) for all-cause mortality with severe versus no SDB was 3.8 (1.6,9.0); the adjusted HR (95% CI) for cardiovascular mortality was 5.2 (1.4,19.2). Results were unchanged after accounting for daytime sleepiness. Our findings of a significant, high mortality risk with untreated SDB, independent of age, sex, and BMI underscore the need for heightened clinical recognition and treatment of SDB, indicated by frequent episodes of apnea and hypopnea, irrespective of symptoms of sleepiness.

Sleep Duration and Risk of Ischemic Stroke in Postmenopausal Women

Many studies have shown a U-shape association between sleep duration and mortality, but epidemiological evidence linking cardiovascular diseases with habitual sleep patterns is limited and mixed. We conducted a prospective study on 93 175 older women (aged 50 to 79 years) in the Women's Health Initiative Observational study cohort to examine the risk of ischemic stroke in relation to self-reported sleep duration. Cox models were used to investigate the putative associations, adjusting for multiple sociodemographic and lifestyle factors, depression, snoring, sleepiness symptoms, and other cardiovascular disease-related clinical characteristics. At baseline, 8.3% of subjects had reported their sleep duration as <or=5 hours per night and 4.6% reported long duration of sleep (>or=9 hours/night). After an average of 7.5 years of follow-up, 1166 cases of ischemic stroke had occurred. Multivariable-adjusted relative risk (RR) and 95% CI for ischemic stroke (using a sleep time of 7 hours/night as the reference) were 1.14 (0.97, 1.33), 1.24 (1.04, 1.47), and 1.70 (1.32, 2.21) for women reporting <or=6, 8, and >or=9 hours of sleep. A modestly stronger association with sleep duration <or=6 hours per night (RR, 1.22; 1.03, 1.44) was noted among women without prevalent cardiovascular disease at baseline. Our analyses also reveal that the adverse effect of long sleep is likely independent of the increased risk for ischemic stroke associated with frequent snoring and sleepiness (RR, 1.31; 1.00, 1.72). Habitual sleep patterns are important neurobehavioral determinants of risk for ischemic stroke in postmenopausal women. The underlying neurobiology and mechanistic mediators for the putative adverse effect of long sleep (>or=9 hours/night) need further elucidation.

Predictors of health‐related quality of life in patients with obstructive sleep apnoea

This paper is a report of a study to identify the common symptoms and demographic and physiological factors of obstructive sleep apnoea that are predictive of health-related quality of life in a Chinese population. Health-related quality of life impairment in obstructive sleep apnoea is an increasingly important consideration, but little is known about the factors that influence quality of life in this population. A total of 108 Chinese patients with newly diagnosed obstructive sleep apnoea were recruited in 2003 and assessed for health-related quality of life, daytime sleepiness, depression and anxiety. Associations between symptoms, demographic and physiological factors and quality of life were examined by Pearson linear correlation. Hierarchical multiple regression were used to determine predictors of overall quality of life and its dimensions. Forty-six patients (42.6%) had depressed mood and 21 (19.4%) were anxious. Fifty-nine (54.6%) were hypersomnolent. The severity of symptoms of sleepiness, depression, and anxiety was statistically significantly inversely correlated with each domain and the total score for health-related quality of life. No statistically significant correlation was observed between disease severity and quality of life. Controlling for age and gender, anxiety and sleepiness predicted 45.2% of the variance of overall quality of life (R(2) = 0.452, P < 0.001). Anxiety was the strongest predictor of overall and each domain of health-related quality of life. Assessment of mood in patients with obstructive sleep apnoea should be an essential part of nursing practice. Comprehensive evaluation of symptoms, especially mood disturbance, is important for improving quality of life for these patients.

Management of narcolepsy

Background: Narcolepsy is a rare chronic sleep disorder classically characterized by excessive daytime sleepiness. Other symptoms of the disease, including cataplexy, sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep, may follow later. The disease can be incapacitating and frequently results in impaired psychosocial interaction. In the absence of a cure for narcolepsy, medical therapy is directed at symptom control. Objectives: The aim of this study was to review the current approach to the treatment of narcolepsy. Methods: A search of three bibliographic databases (MEDLINE/PubMed, EMBASE and the Cochrane Library Database) was conducted from 1966 to January 2008 using the National Library of Medicine MeSH search terms narcolepsy and cataplexy. Relevant studies, case reports, review articles, editorials, short communications and chapters from selected textbooks were then extracted and manually cross-referenced. Results/conclusions: Traditionally, stimulants have been used to improve the symptoms of excessive daytime sleepiness. However, the treatment of narcolepsy has evolved recently with the widespread use of newer drugs, including modafinil for daytime sleepiness, newer antidepressants for cataplexy and γ-hydroxybutyrate (sodium oxybate) for both excessive daytime sleepiness and cataplexy.

The hypocretin neurotransmission system in myotonic dystrophy type 1

Patients with myotonic dystrophy type 1 (DM1) frequently have symptoms of excessive daytime sleepiness (EDS). Some patients with DM1 show sleep-onset REM, similar to that observed in narcolepsy. Narcolepsy is characterized by impaired hypocretin (Hcrt) neurotransmission. To test for dysregulation of Hcrt neurotransmission in a prospective cohort of patients with DM1. Hcrt levels in CSF were measured by radioimmunoassay. Sleep physiology was assessed by overnight polysomnography (PSG) and a multiple sleep latency test (MSLT). Splicing of Hcrt receptor 1 and 2 (HcrtR1 and HcrtR2) mRNA was examined in postmortem samples of temporal cortex. Seventeen of 38 patients with DM1 reported symptoms of EDS. Among patients with DM1 with EDS who underwent PSG/MSLT, 7 of 13 showed reduced sleep latency, sleep-onset REM, or both. However, CSF Hcrt levels in DM1 (mean 277 pg/mL, n = 38) were not different from controls (mean 277 pg/mL, n = 33). Also, splicing of HcrtR1 and HcrtR2 mRNA in patients with DM1 was similar to controls. Excessive daytime sleepiness and dysregulation of REM sleep occur frequently in patients with myotonic dystrophy type 1 (DM1). However, the pathophysiologic basis is distinct from narcolepsy, as patients with DM1 do not have a consistent defect of Hcrt release or receptor splicing.

The tired teen: A review of the assessment and management of the adolescent with sleepiness and fatigue

The symptoms of sleepiness and fatigue are frequently encountered when caring for adolescents. Up to 40% of healthy teens experience regular sleepiness, defined as an increased tendency to fall asleep. Fatigue is the perception of low energy following normal activity and is reported by up to 30% of well teens. Chronic fatigue syndrome is an unusual syndrome with severe fatigue accompanied by other physical and neurological symptoms. A thorough assessment is required for all teens with sleepiness and fatigue; however, a treatable underlying medical condition is rarely found. Most fatigue and sleepiness in teens is attributable to lifestyle issues, notably too little time spent sleeping. Physicians are in a position to screen for, assess and manage these common conditions in teens.

Exhaled NO and iNOS expression in sputum cells of healthy, obese and OSA subjects

Obstructive sleep apnoea (OSA) is associated with airways inflammation; a key role in this regard seems to be played by nitric oxide (NO). The aim of this study was to measure exhaled NO and expression of its enzyme, the inducible nitric oxide synthase (iNOS) in cells of induced sputum in OSA patients and in obese subjects without sleep apnoea and to correlate these inflammatory markers with severity of OSA. We enrolled 18 obese patients with OSA (10 men, age 48.2 +/- 8.4 years), 15 obese patients without OSA (eight men, age 52.8 +/- 11 years) and 10 healthy subjects (five men, age 42 +/- 4 years). Exhaled NO was measured using a chemiluminescence analyser; iNOS expression was measured in the sputum cells by immunocytochemistry. Exhaled NO resulted significantly increased in OSA and in obese patients (23.1 +/- 2.1 and 17.9 +/- 2.1 p.p.b.) than in healthy subjects (7.2 +/- 0.6 p.p.b.; P < 0.001). OSA and obese patients showed a higher percentage of neutrophils and a lower percentage of macrophages in the induced sputum compared to healthy subjects. In addition, OSA and obese patients showed higher iNOS expression in neutrophils and in macrophages with respect to healthy subjects. A positive correlation between exhaled NO, iNOS expression and AHI was observed. These data confirm the presence of airway inflammation in OSA and in obese patients, and suggest the possible role for NO and iNOS expression in neutrophils of the induced sputum as noninvasive markers to identify and monitor the airway inflammation in these subjects.