Subjective Daytime Sleepiness Research Articles

Effects of Exercise Training and CPAP in Patients With Heart Failure and OSA: A Preliminary Study

Exercise and CPAP improve OSA. This study examined the effects of exercise in patients with heart failure (HF) and OSA. Patients with HF and OSA were randomized to the following study groups: control, exercise, CPAP, and exercise+ CPAP. Sixty-five participants completed the protocol. Comparing baseline vs3months, the mean apnea-hypopnea index (AHI) did not change significantly (in events per hour) in the control group, decreased moderately in the exercise group (28 ± 17 to 18 ± 12; P< .03), and decreased significantly more in the CPAP group (32 ± 25 to 8 ± 11; P< .007) and in the exercise+ CPAP group (25 ± 15 to 10 ± 16; P< .007). Peak oxygen consumption, muscle strength, and endurance improved only with exercise. Both exercise and CPAP improved subjective excessive daytime sleepiness, quality of life, and the New York Heart Association functional class. However, compared with the control group, changes in scores on the 36-item Medical Outcomes Study Short Form Survey and Minnesota Living with Heart Failure Questionnaire were only significant in the exercise groups. In patients with HF and OSA, our preliminary results showed that exercise alone attenuated OSA and improved quality of life more than CPAP. In the landscape treatment of OSA in patients with HF, this analysis is the only randomized trial showing any treatment (in this case, exercise) that improved all the studied parameters. The results highlight the important therapeutic benefits of exercise, particularly because adherence to CPAP is low.

Melatonin secretion following brain midline irradiation is diminished, but not correlated with subjective sleep disturbances.

Cranial irradiation for brain tumours or leukaemias has been related to cognitive, endocrine and psychosocial late effects as well as sleep disturbances and increased daytime sleepiness. Studies suggest that cranial irradiation might impact on pineal melatonin secretion. Melatonin is an important regulator in human circadian rhythms and the sleep-wake cycle. The objective of this study was to investigate melatonin secretion, subjective sleep parameters and their interplay in a cohort of cranially irradiated head and brain tumour and leukaemia survivors at least 3years after radiotherapy. Cross-sectional study. Thirty-eight adults. Melatonin secretion was evaluated by measuring its metabolite 6-sulphatoxymelatonin in collected overnight urine. Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. The Beck Depression Inventory II was used to screen for depressive symptoms because of their impact on sleep. Patients irradiated in the brain midline had significantly lower melatonin secretion (P=0.008). Subjects exhibited a high prevalence of sleeping difficulties, daytime sleepiness and depression, with females and overweight subjects particularly affected. Melatonin values and subjective sleep parameters did not correlate with each other or with treatment and most patient variables. Our data suggest that radiation exposure to the pineal gland negatively affects melatonin secretion. This lack of pineal melatonin does not influence subjective sleep quality. As melatonin has important antioxidant and cancer-protective effects, further research is necessary to elucidate whether these patients have an increased risk of developing secondary neoplasms and other radiation late effects.

The association of smartphone usage with subjective sleep quality and daytime sleepiness among medical students

ABSTRACTAbout a third of adults have sleep problems, while in the student population this number is much higher due to a specific lifestyle. It has been shown that the use of devices with light-emitting diode screens before sleep adversely affects sleep, sleeping and circadian rhythm in respondents. The aim of this study was to assess subjective sleep quality and level of daytime sleepiness among medical students, as well as the correlation of these parameters with the smartphone usage time. Smartphone usage time was determined using the Android Application Quality Time. A statistically significant and strong positive (r = 0.613) correlation between subjective sleep quality and the use of mobile phones has been determined. By correlation analysis of daytime sleepiness and the use of mobile phones, it was found that there was a medium strong negative (r = -0.23) correlation between these parameters, which was not statistically significant. The results of this study have shown that the subjective quality of sleep is significantly impaired and of poor quality; and a significant correlation between the use of mobile phones and the quality of sleep has been demonstrated.

Epworth sleepiness scale in medical residents: quality of sleep and its relationship to quality of life

BackgroundResident doctors are continuously exposed to prolonged working hours and night shifts, making them susceptible to the many physical, psychological, and cognitive side effects of sleep deprivation, which may affect their quality of life. Therefore, this study aimed to determine the prevalence of sleep penury in resident doctors and to assess the association between self-apprehended sleepiness and quality of life.MethodsA cross-sectional study was carried out in the governmental hospitals in the North of the West Bank between May 2017 and September 2017. Doctors enrolled in residency programmes completed questionnaires about general, sociodemographic, and sleep characteristics. The doctors completed the Arabic Version of the Epworth Sleepiness Scale (ArESS) to assess subjective daytime sleepiness and the RAND 36-item short-form health survey (SF-36) to determine quality of life.ResultsA total of 101 participants were enrolled. Daytime sleepiness was observed in 37.6% (n = 38) of the participants with an ESS score of ≥10. There was a notable negative correlation between the ESS and quality of health index in the physical composition (r = − 0.351, p < 0.001) demonstrated in the following four subscales: the physical functioning (p < 0.001), role limitations due to physical health (p = 0.045), body pain (p = 0.036), and general health (p < 0.001) components of the SF-36 scale. Females and residents of the centre region had poorer mental quality (p = 0.006 and 0.020, respectively).ConclusionsMore than one third of the resident doctors suffer from daytime sleepiness according to the ESS. This was proven to significantly affect several aspects of their quality of life, including physical function and health, body pain, and general health. Sleep deprivation and improvement of quality of life require health promotion actions among medical residents.

The relationships between improvements in daytime sleepiness, fatigue and depression and psychomotor vigilance task testing with CPAP use in patients with obstructive sleep apnea

ObjectiveThe purpose of this study was to determine if the subjective improvements in daytime sleepiness, fatigue and depression experienced by patients with obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) therapy predict an objective improvement in vigilance, and whether patients with mild-to-moderate OSA differ from patients with severe OSA in this regard. MethodsA total of 182 patients underwent psychomotor vigilance task (PVT) testing and measurements of subjective daytime sleepiness, fatigue and depression at baseline and after a minimum of one month of adherent CPAP use at an adequate pressure. ResultsPatients with both mild-to-moderate (n = 92) and severe (n = 90) OSA experienced improvements in subjective daytime sleepiness, fatigue and depression, but objective improvement in vigilance was only seen in patients with severe OSA. In patients with severe OSA, while a correlation was found between improvements in daytime sleepiness and some PVT parameters, changes in subjective daytime sleepiness, fatigue and depression scores were not predictive of objective improvement in vigilance while controlling for all these subjective symptoms and for age, gender, body mass index, apnea-hypopnea index/respiratory event index and total sleep time/total recording time with pulse oximetry below 90%. ConclusionsWe found no predictive relationship between subjective improvements in daytime sleepiness, fatigue and depression and objective vigilance with CPAP use in patients with OSA. These results suggest that subjective complaints of daytime impairment and objective measures of vigilance in patients with OSA should be assessed separately while evaluating the efficacy of CPAP therapy on daytime functioning.

Relationship between sleep disturbance and self-care in adults with type 2 diabetes.

Type 2 diabetes (T2D) is a metabolic disorder requiring intensive self-care to maintain optimal glycemic control. Sleep disturbance is common in T2D patients and likely impairs glycemic control. Our aim was to examine the relationship between sleep disturbance and self-care in adults with T2D. This study used a correlational design. Sixty-four adults with T2D were recruited. Validated instruments were used to measure self-care, subjective sleep disturbance, and covariates (e.g., diabetes distress, self-efficacy, fatigue, and daytime sleepiness). Over an 8-day period, the ActiGraph-wGT3X was used to measure objective sleep outcomes (e.g., total sleep time and number of awakenings). Bivariate correlation and multiple linear regression analyses were conducted. The mean age of the participants was 60.6 (SD 6.8)years (range 50-78), and 51.6% were women. Controlling for covariates, subjective sleep disturbance (β=- 0.26), diabetes distress (β=- 0.39), and daytime sleepiness (β=- 0.21) were strong predictors of diabetes self-care (R2 = 0.51, p < 0.001). When objective sleep parameters were used, the number of awakenings (β=- 0.23) also predicted self-care along with diabetes distress, fatigue, and daytime sleepiness (R2 = 0.57, p < 0.001). Subjective sleep disturbance and frequent nocturnal awakenings are associated with worse diabetes self-care in adults with T2D. Healthcare providers are recommended to include comprehensive sleep assessment at every clinical visit. Diabetes educators may consider including sleep-related education in their diabetes self-management classes and/or counseling sessions.

Excessive daytime sleepiness, objective napping and 11-year risk of Parkinson's disease in older men.

It is unknown whether subjective daytime sleepiness or objective napping could precede the risk of Parkinson's disease (PD) in the long term. We studied 2920 men (mean age 76 years) without a history of PD and followed them for 11 years. Excessive daytime sleepiness (EDS) was defined as having an Epworth Sleepiness Scale score >10. Objective naps were defined as ≥5 consecutive minutes of inactivity as measured by actigraphy, and napping duration was the accumulated time of naps outside the main sleep period. We used logistic regression to compare PD risk across four groups: no EDS& napping <1 h/day (N = 1739, 59.5%; referent group), EDS& napping <1 h/day (N = 215, 7.4%), no EDS& napping ≥ 1 h/day (N = 819, 28.1%) and EDS& napping ≥ 1 h/day (N = 147, 5.0%). We identified 106 incident PD cases over 11 years. After multivariable adjustment, men with napping ≥ 1h/day alone were twice as likely [odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.25-3.08], and men with both EDS and napping ≥ 1 h/day were almost three times as likely to develop PD (2.52, 1.21-5.27), compared with the referent group. Compared with those with naps for <30 min, men who napped for ≥1 h/day had more than double the risk of PD. No association was found for EDS alone and PD risk. Further adjustment for chronotype and circadian stability, or excluding PD cases identified within 2 years after napping measurements, showed similar results. Objective long napping rather than subjective EDS was prospectively associated with a higher risk of PD in older men. Objective measures of napping might be valuable as a preclinical marker for PD.

The influence of socio-economic status on the severity of obstructive sleep apnea: a cross-sectional observational study.

Objective There is limited evidence about the effect of socio-economic status (SES) on the severity of obstructive sleep apnea (OSA). We aimed to investigate this relationship in a referral population in Greece, with regards to other established risk factors. Methods: We used a retrospective cross-sectional design to assess socio-economic status based on occupational activity in a sample of 282 OSA patients diagnosed in a public hospital sleep laboratory during one-year period. Demographic, anthropometric and social characteristics, as well as the Epworth sleepiness scale (ESS) scores and apnea-hypopnea indexes (AHI) of subjects in each socio-economic class were recorded and statistically significant differences were explored in univariate and multiple regression analysis. Results: 99 (35.1%) of the subjects were categorized in the upper, 70 (24.8%) in the intermediate and 113 (40.1%) in the working class. Subjects of the intermediate class had significantly larger neck circumference than those of the upper class (p=0.022). Neither class differed significantly in terms of ESS score and intermediate class had a trend for higher AHI than upper class (p=0.075 in univariate and p=0.082 in multivariate analysis). Age (p=0.020) and occasional alcohol consumption (p=0.022) were independent negative and neck circumference (p<0.001) positive correlates of the variance in ESS score, while body mass index (p=0.004), neck circumference (p<0.001), being married (p=0.014) and current smoker (p=0.025) were independent positive correlates of the variance in AHI. Discussion: SES has a minor effect on OSA severity that is only partially accounted for by other known risk factors. Neck circumference was found to be the most useful predictor of both subjective daytime sleepiness and severity of respiratory events during sleep.

Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study

Suspension palatoplasty, a new surgical technique to treat obstructive sleep apnea (OSA), has been developed to correct the retropalatal obstruction in patients with small tonsils (grade I/II) and anterior-posterior palatal (A-P) obstruction. The objecteive of this preliminary study was to investigate the effectiveness and change in retropalatal airway dimensions after suspension palatoplasty. This retrospective case series study included 25 consecutive male adults with OSA. Unique technical features of suspension palatoplasty are exposure of pterygomandibular raphe and suspension of palatopharyngeus muscle to the raphe. Six months after suspension palatoplasty, apnea-hyponea index significantly reduced from 39.8 to 15.1 (effect size = 1.6). None experienced postoperative bleeding and velopharyngeal insufficiency 1 month following surgery. Subjective snoring severity (visual analogue scale) and daytime sleepiness (the Epworth Sleepiness Scale) significantly improved (8.7 vs 2.0 and 10.2 vs 4.9, respectively). A-P dimension of the retropalatal airspace widened significantly on perioperative endoscopy (23.0 units vs 184.6 unites) as well as posterior air space in cephalometry (7.6 mm vs 10.2 mm). Our preliminary findings show that suspension palatoplasty seems to be an effective OSA surgery in the specific patient population with minimal complications, however, further studies including a large number of patients are required to confirm the findings.

Increased CD4 counts, pain and depression are correlates of lower sleep quality in treated HIV positive patients with low baseline CD4 counts

Poor sleep quality leads to increased immune activation and immune activation leads to worse sleep quality. South African HIV positive patients typically have delayed start of treatment, which has been associated with CD4+ effector T cells being more spontaneously activated in chronically treated patients. This cross-sectional study investigated whether subjective sleep quality was associated with CD4+ T lymphocyte reconstitution in treated South African HIV+ patients.One hundred and thirty-nine treated HIV+ patients (109 F, age average (SD) = 43 (9)) were recruited from Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, South Africa. Participants completed questionnaires evaluating their subjective sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth sleepiness scale), pain, and depression severity (Beck Depression Inventory). Univariate and multivariate analyses were run to determine the correlates of sleep quality in this population.Patients had been on antiretroviral treatment for about 4 years and had increased their CD4 counts from a median at baseline of 82 to 467 cells/µL. They had overall poor sleep quality (average (SD) PSQI = 7.7 (±5), 61% reporting PSQI > 5, a marker of lower sleep quality), 41% had clinical depression (average (SD) BDI = 17 (±12)) and 55% reported pain. In two separate multivariate analyses, both the overall CD4 count increase from baseline (p = 0.0006) and higher current CD4 counts (p = 0.0007) were associated with worse sleep quality, when adjusting for depression severity (p < 0.001), daytime sleepiness (p = 0.01) and the presence of pain (p < 0.01).In this cohort of treated South African HIV positive patients, poor sleep quality was associated with higher current CD4 counts, when adjusting for depression severity, daytime sleepiness and pain. Further studies should investigate the temporal relationship between HIV-related poor sleep quality and underlying immune activation.

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.

Dissociation of Objective and Subjective Daytime Sleepiness and Biomarkers of Systemic Inflammation in Sleep-Disordered Breathing and Systolic Heart Failure.

Subjective versus objective sleepiness in heart failure (HF) remains understudied; therefore, we sought to examine the association of these measures and interrelationships with biochemical markers. Participants with stable systolic HF recruited from a clinic-based program underwent attended polysomnography, Multiple Sleep Latency Testing, questionnaire data collection including Epworth Sleepiness Scale (ESS), and morning phlebotomy for biochemical markers. Linear regression was used to assess the association of mean sleep latency (MSL) and ESS (and other reported outcomes) with adjustment of age or body mass index or left ventricular ejection fraction (LVEF) (beta coefficients, 95% confidence interval) and also with biochemical markers (beta coefficients, 95% confidence interval). The final analytic sample comprised 26 participants: 52 ± 14 years with apnea-hypopnea index (AHI): 34 ± 27, LVEF: 34 ± 12%, MSL: 7 ± 5 minutes and ESS: 7 (5, 10). There was no significant association of MSL and ESS (-0.36, -0.81 to 0.09, P = .11), AHI, or other questionnaire-based outcomes in adjusted analyses. Although statistically significant associations of ESS and biomarkers were not observed, there were associations of MSL and cortisol (μg/dL) [-0.05: -0.08, -0.01, P = .012] and interleukin-6 (pg/mL) [-0.11: -0.18, -0.04, P = .006], which persisted in adjusted models. In systolic HF, although overall objective sleepiness was observed, this was not associated with subjective sleepiness (ie, a discordance was identified). Differential upregulation of systemic inflammation in objective sleepiness was observed, findings not observed with subjective sleepiness. These findings suggest that underlying mechanistic pathways of inflammation may provide the explanation for dissonance of objective and subjective sleepiness symptoms in HF, thus potentially informing targeted diagnostic and therapeutic approaches. A commentary on this article appears in this issue on page 1369.

Factors that increase subjective daytime sleepiness in patients with severe OSA

Factors that increase subjective daytime sleepiness in patients with severe OSA

A standardized test to document cataplexy

Objective/BackgroundCataplexy is the pathognomonic symptom of narcolepsy type 1 (NT1). Since it is considered difficult to be directly observed or documented by clinicians, its diagnosis relies mainly on history taking. Our study aimed at testing the feasibility of a standardized video recording procedure under emotional stimulation to document cataplexy in the diagnostic work-up of suspected hypersomnia of central origin. Patients/MethodsTwo-hundred-eight consecutive patients underwent the diagnostic work-up and reached the final diagnosis of NT1 (n = 133), idiopathic hypersomnia or narcolepsy type 2 (IH/NT2 group, n = 33), or subjective excessive daytime sleepiness (sEDS group, n = 42). All subjects underwent a standardized video recording procedure while watching funny movies selected according to individual preferences, and a technician blind to clinical features reviewed the recordings to identify hypotonic phenomena that were finally confirmed by patients. ResultsThe video recording under emotional stimulation captured hypotonic phenomena in 72.2%, 9.1% and 4.8% of NT1, IH/NT2, and sEDS subjects (p < 0.0001), respectively. When tested against CSF hypocretin deficiency, the documentation of a hypotonic episode at the test showed an area under the ROC curve of 0.823 ± 0.033 (p < 0.0001). NT1 patients under anticataplectic medications showed less frequently hypotonic episodes than untreated ones (48.0% vs 77.8%, p = 0.003). ConclusionsA standardized video recording procedure under emotional stimulation can help in the characterization of suspected hypersomnia of central origin. Further multi-center studies are warranted to extend the present findings and integrate a shared procedure for the laboratory work-up of narcolepsy.

Sleep characteristics associated with drowsy driving

ObjectiveThe aim of this study was to evaluate sleep characteristics associated with drowsy driving in an adult population. MethodsThe study subjects consisted of 1675 adults aged 19 years or older who completed a population-based questionnaire survey on sleep habits. Experiences of drowsy driving were obtained from self-reported data. We investigated sleep-related variables including sleep duration, sleep efficiency, chronotype, subjective sleep perception, daytime sleepiness, sleep quality, and snoring. We performed multivariate logistic regression analysis to determine sleep characteristics independently associated with drowsy driving. ResultsThe mean age of the subjects was 43.2 years, and 66.3% were men. The prevalence of self-reported drowsy driving was 23.6% (396 of 1675), and 33.1% of subjects experienced dozing at the wheel at least once a month. Multivariate analysis demonstrated that men, office and manual workers, excessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were independently associated with drowsy driving. Subgroup analyses revealed that reduced weekday sleep duration was a risk factor of drowsy driving in adults with perceived sufficient sleep. On the other hand, frequent alcohol drinking significantly increased risk of drowsy driving in the subgroup with perceived sleep insufficiency. Furthermore, ordinal regression analyses confirmed the association between sleep characteristics and drowsy driving across different drowsy driving frequencies. ConclusionExcessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were sleep-related risk factors for drowsy driving. In addition to maintaining healthy sleep habits, individuals at high risk should be encouraged to evaluate underlying sleep disorders or psychiatric problems to prevent drowsy driving.

Psychomotor Vigilance Test and Its Association With Daytime Sleepiness and Inflammation in Sleep Apnea: Clinical Implications.

Excessive daytime sleepiness (EDS) is a key symptom of obstructive sleep apnea (OSA). The Psychomotor Vigilance Task (PVT) has been suggested as an objective easy-to-use, inexpensive alternative to the Multiple Sleep Latency Test (MSLT) to measure EDS. In patients with OSA, physiological sleepiness, but not subjective EDS (Epworth Sleepiness Scale [ESS]), has been associated with increased levels of the sleep- inducing proinflammatory cytokine interleukin-6 (IL-6). The goal of this study was to assess the association of PVT with objectively measured sleepiness (MSLT) and subjectively measured sleepiness (ESS) and IL-6 levels in patients with OSA. We studied 58 untreated patients with OSA who underwent an 8-hour in-laboratory polysomnography for 4 consecutive nights. MSLT, PVT, and 24-hour serial profiles of IL-6 were assessed on the fourth day. PVT variables included number of lapses, mean reciprocal of the fastest 10% and slowest 10% reaction times, and median of 1/reaction time. ESS was assessed on day 1 of the study. Higher ESS scores were significantly associated with greater number of lapses (β = .34, P = .02) and lower values of 1/RT (β = -.36, P = .01) and slowest 10% RTs (β = -.30, P = .04). No significant association was observed between PVT and MSLT, nor PVT and IL-6 levels. Our findings suggest that PVT is associated with subjectively assessed daytime sleepiness, but not with physiological sleepiness nor IL-6 levels in patients with OSA. It appears that ESS and PVT may be useful in predicting risks associated with impaired performance, such as traffic accidents, in patients with OSA.

Non-amnestic mild cognitive impairment and sleep complaints: a bidirectional relationship?

Prior studies documented that several sleep disorders may coexist in patients affected by Mild Cognitive Impairment (MCI) and Alzheimer disease (AD), and have a strong bidirectional relationship with cognitive decline. To assess the self-reported sleep quality and daytime sleepiness among subjects affected by MCI and AD at early-stage and healthy controls, and to verify if sleep disturbances might be an indicator of specific cognitive deficits. 139 patients (102 MCI, 37AD) underwent comprehensive neuropsychological, functional, and behavioral assessment, which also included Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). 80 healthy elderly subjects were used as controls. MCI patients have been divided into Good Sleepers and Bad Sleepers, depending on their reported sleep quality (PSQI global score ≤5/>5). MCI patients experienced more subjective daytime sleepiness than AD matches. As for the subjective sleep quality among MCI patients, 54% of Bad Sleepers met diagnostic criteria for non-amnestic MCI; vice-versa, 73% of Good Sleepers were diagnosed with amnestic-MCI (p = 0.005), independently of depression and anxiety. MCI patients complain of daytime sleepiness and dysfunction more than AD patients; among MCI patients, Bad Sleepers appear mainly characterized by a non-amnestic cognitive profile.

Frontal Cortex Myo-Inositol Is Associated with Sleep and Depression in Adolescents: A Proton Magnetic Resonance Spectroscopy Study

Aim: This study used proton magnetic resonance spectroscopy (¹H MRS) to evaluate the neurochemistry of the frontal cortex in adolescents with symptoms of sleep and depression. Methods: Nineteen non-medicated adolescent boys (mean age 16.0 years; 9 clinical cases with depression/sleep symptoms and 10 healthy controls) underwent ¹H MRS at 3 T. MR spectra were acquired from the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex, and frontal white matter. Concentrations of N-acetyl aspartate, total creatine, choline-containing compounds, total glutamine plus glutamate, and myo-inositol (mI) were compared in the 2 subgroups, and correlated with sleep and clinical measures in the total sample. Sleep was assessed with self-report questionnaires and ambulatory polysomnography recordings. Results: Concentrations of mI were lower in both frontal cortical regions among the depressed adolescents than in controls. No statistically significant differences in other metabolite concentrations were observed between the subgroups. Frontal cortex mI concentrations correlated negatively with depression severity, subjective daytime sleepiness, insomnia symptoms, and the level of anxiety, and correlated positively with total sleep time and overall psychosocial functioning. The correlations between mI in the ACC and total sleep time as well as daytime sleepiness remained statistically significant when depression severity was controlled in the analyses. Conclusion: Lower frontal cortex mI may indicate a disturbed second messenger system. Frontal cortical mI may thus be linked to the pathophysiology of depression and concomitant sleep symptoms among maturing adolescents. Short sleep and daytime sleepiness may be associated with frontal cortex mI independently from depression.

The Perception and Attention Functions test battery as a measure of neurocognitive impairment in patients with suspected central disorders of hypersomnolence.

The aim of the current study was to evaluate an attention test as a discriminative tool to measure neurocognitive impairment in patients with disorders of hypersomnolence. Chronic excessive daytime sleepiness is the main symptom in central disorders of hypersomnolence. For diagnostic purposes and treatment evaluation, reliable assessment of excessive daytime sleepiness is required. Thirty-six patients with central disorders of hypersomnolence were compared with 20 healthy controls. All participants performed the 'Perception and Attention Functions' (WAF) of the Vienna Test System. Patients underwent polysomnography, Multiple Sleep Latency Test and Maintenance of Wakefulness Test. Patients were divided into two groups: (i) patients who met the criteria of disorder of hypersomnolence (objective excessive daytime sleepiness); and (ii) patients with subjective excessive daytime sleepiness, i.e. with normal Multiple Sleep Latency Test results. Group 1 consisted of 23 patients with objective excessive daytime sleepiness (11 with idiopathic hypersomnia, nine with narcolepsy type 1, three with narcolepsy type 2); group 2 included 13 patients with subjective excessive daytime sleepiness. The results showed cognitive impairment in patients with objective excessive daytime sleepiness and even in patients with subjective excessive daytime sleepiness. WAF tests identified distinct attention profiles in patients with narcolepsy type 1, idiopathic hypersomnia/narcolepsy type 2, and patients with subjective excessive daytime sleepiness. WAF test measures correlated with Maintenance of Wakefulness Test and the Epworth Sleepiness Scale, but not with Multiple Sleep Latency Test and the Fatigue Severity Scale. In conclusion, the multidimensional WAF test battery detects cognitive impairment even in patients that complain of excessive daytime sleepiness but have normal Multiple Sleep Latency Test results. WAF tests offer valuable information that adds to the existing polysomnographic measures in discriminating patients with different types of chronic excessive daytime sleepiness. The results provide new insights into cognitive dysfunction underlying different types of chronic excessive daytime sleepiness.

Excessive daytime sleepiness and metabolic syndrome in men with obstructive sleep apnea: a large cross-sectional study.

PurposeExcessive daytime sleepiness is a common symptom in obstructive sleep apnea (OSA). Previous studies have showed that excessive daytime sleepiness is associated with some individual components of metabolic syndrome. We performed a large cross-sectional study to explore the relationship between excessive daytime sleepiness and metabolic syndrome in male OSA patients.MethodsA total of 2241 suspected male OSA patients were consecutively recruited from 2007 to 2013. Subjective daytime sleepiness was assessed using the Epworth sleepiness scale. Anthropometric, metabolic, and polysomnographic parameters were measured. Metabolic score was used to evaluate the severity of metabolic syndrome.ResultsAmong the male OSA patients, most metabolic parameters varied by excessive daytime sleepiness. In the severe group, male OSA patients with excessive daytime sleepiness were more obese, with higher blood pressure, more severe insulin resistance and dyslipidemia than non-sleepy patients. Patients with metabolic syndrome also had a higher prevalence of excessive daytime sleepiness and scored higher on the Epworth sleepiness scale. Excessive daytime sleepiness was independently associated with an increased risk of metabolic syndrome (odds ratio =1.242, 95% confidence interval: 1.019-1.512). No substantial interaction was observed between excessive daytime sleepiness and OSA/ obesity.ConclusionsExcessive daytime sleepiness was related to metabolic disorders and independently associated with an increased risk of metabolic syndrome in men with OSA. Excessive daytime sleepiness should be taken into consideration for OSA patients, as it may be a simple and useful clinical indicator for evaluating the risk of metabolic syndrome.