Undiagnosed Sleep Disorders Research Articles

Assessment and management of sleep disorders in shift workers: Challenges and considerations for general practice.

Shift work is characterised by displaced sleep opportunities and associated sleep disturbance. Shift workers often report sleepiness and other wake time symptoms associated with poor sleep. However, clinical sleep disorders are also prevalent in shift workers. Although prevalence rates are similar or higher in shift workers compared with the general population, help seeking in shift workers with sleep disorders is low. This article aims to provide general practitioners with a contemporary overview of the prevalence rates for sleep disorders in shift workers, to clarify the existing evidence relating to mental and physical health consequences of sleep disorders in shift workers and to highlight the need to consider undiagnosed sleep disorders before attributing sleep-related symptoms solely to workschedules. Symptoms of sleep loss associated with shift work overlap with symptoms experienced by individuals living with sleep disorders. Although >40% of middle-aged Australians live with a sleep disorder that requires investigation and management, symptoms in shift workers are often attributed to the work schedule and, as a result, might not be investigated for appropriate diagnosis and treatment. We argue that screening for sleep disorders in shift workers with sleep complaints should be a priority.

Assessment of Sleep Disorders in Patients with CVID.

Inborn errors of immunity have been associated with reduced health-related quality of life and increased fatigue. Sleep disorders, which have been shown to contribute to fatigue and other health concerns, are prevalent in the general population, but there are limited studies evaluating these conditions in patients with common variable immunodeficiency (CVID). Our aim was to evaluate the prevalence of fatigue, sleep disturbances, and sleep-disordered breathing in adults with CVID. Patients completed 4 validated, self-administered questionnaires and a 1-night disposable home sleep apnea test. Our results demonstrated increased median Patient-Reported Outcomes Measurement Information System fatigue scores of 58.7 in patients with CVID in addition to clinically significant fatigue as measured by Fatigue Severity Scale score (median, 5.2) and overall poor sleep quality based on global Pittsburgh Sleep Quality Index score (median, 9.0). For CVID patients who completed the home sleep apnea test, 76.9% met criteria for sleep-disordered breathing with an Apnea-Hypopnea Index score of 5 or greater. The results of our study indicate that patients with CVID may have increased rates of undiagnosed sleep disorders that may contribute to increased fatigue and reduced health-related quality of life.

P075 Strategies to improve sleep disorder diagnosis and management in the workplace: Perspectives of future shift workers living with sleep disorders

Abstract Shift workers with untreated sleep disorders face greater risk of negative health and safety outcomes. A population of particular concern is early-career shift workers, as 20% of young adults live with, largely undiagnosed, sleep disorders. This study aimed to explore what structures and qualities future shift workers would value in prospective workplaces regarding sleep disorder support and management. The study aims to inform the development of interventions that are acceptable to workers. Undergraduate paramedicine students were invited to complete an online survey and participate in a health services trial. The survey included validated sleep disorder screening questionnaires, with those identified at risk of a sleep disorder being offered further diagnostic testing or treatment. Participants completed a qualitative interview upon completion of the trial to discuss their experience and recommendations to improve screening and management of sleep disorders for shift workers. Seventeen paramedicine students (mean age 22.5±8.3 years, 59% female) with an undiagnosed sleep disorder were recruited into the trial. Early thematic analysis identified two key themes: Increasing education and awareness of sleep disorders and supporting access to health services. Almost half of the participants discussed the importance of increased awareness of sleep and sleep disorders during pre-employment training and in the workplace. Participants also identified convenience as an important factor in facilitating the management of sleep disorders. Facilitating access to sleep health services before workers are exposed to shift work and during early employment were suggested to improve sleep disorder identification and management for early-career shift workers.

P026 Feasibility and acceptability of a novel approach to sleep disorder screening and management for prospective shift workers

Abstract Introduction Sleep disorders negatively impact health and occupational safety. Individuals commencing shift work with an undiagnosed sleep disorder may be at an increased risk of negative health and safety outcomes due to the addition of sleep schedule interruption associated with shift work. The aim of this study was to assess the feasibility and acceptability of screening for, and treating, sleep disorders in pre-service shift workers. Methods Paramedic students were invited to participate in an intervention comprising of sleep disorder screening (obstructive sleep apnoea, insomnia, restless legs syndrome) and 15 weeks of non-invasive sleep monitoring (Withings Sleep Analyser) with regular follow-up (3, 6, and 12 weeks). Those at risk of a sleep disorder were contacted by the study physician and offered treatment pathways for their identified disorder (primary care or sleep specialist). Feasibility and acceptability will be assessed by a) reaching recruitment targets, b) participation rates, and c) qualitative interviews at 6 and 12 weeks. Results Thirty participants are currently active in the trial with 63% female and an average age of 23 years. Seventeen participants (57%) met criteria for a sleep disorder based on baseline data and treatment pathways were initiated in July 2022 with a planned completion date of October 2022. Discussion Participation rates, sleep parameters (collected through the sleep monitoring device), objective and subjective sleep disorder severity, and qualitative findings about feasibility and accessibility will be presented. Findings from this study will provide insight into barriers associated with accessing treatment for sleep disorders within pre-service shift workers.

History of the World Sleep Day

Background Sleep has also been cherished by society as a basic human need with a crucial importance for human health. People spend around one third of their lives sleeping. Nowadays, it has never been harder to achieve a restful sleep. When sleep is better understand, that will lessen the drawbacks of the different sleep disorders. Healthy sleep is important for maintaining physical and mental health in adult individuals. Sleep deprivation poses a significant risk for the individual and leads to psychological conditions, such as depression and anxiety. Several sleep disorders are known to the science. If breathing during sleep is not regular, a case of obstructive sleep apnea (OSA) may have been diagnosed. The World Sleep Day is traditionally celebrated in March, on the Friday before the Spring vernal equinox of each year. It is a global awareness and internationally recognized event, organized annually since 2008 by the World Sleep Day Committee of the World Sleep Society. Organizers aim to raise awareness of the problems with proper sleep, sleep disorders and aspects connected to it – medical, social, educational and others. Methods Scientific databases – PubMed, SCOPUS and MEDLINE were used to search for the information targeted. The following keywords – World Sleep Day, history, events, prophylaxis, sleep disorders were used. Information from the official websites of the societies involved in celebrating World Sleep Day was included as well. The aim of the following article is to study the history of the event from its foundation till today, aiming to stress out its usefulness. Results and discussion World Sleep Days has been internationally celebrated since 2008 for 15 years now. Since 2016, Bulgaria actively participates in all events organized by the World Sleep Society – Scientific symposiums, prophylactic check-ups for obstructive sleep apnea, elective disciplines in the teaching of students are organized. Importance is put on informing society about the dangers of undiagnosed and untreated sleep disorders, especially sleep apnea. Sleep medicine and Dental Sleep medicine are not recognized as medical specialties in the Republic of Bulgaria. Conclusions Problems of sleep are extremely common in our days. The situation is continuously being worsened due to the hyperconnectivity people experience with the glowing computer and mobile phone screens. It is admirable that specialists in the field and society try to raise awareness and combat the poor sleep quality consequences. Only by doing the abovementioned, alleviation of the undesirable outcomes of irregular sleep can be reached. Legislative measures should be taken in order to certify Sleep medicine and Dental sleep medicine as medical specialties in the Republic of Bulgaria.

Incremental health care utilization and expenditures for sleep disorders in the United States.

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders. Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons. Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001). Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.

794 Contribution of sleep disorders to dementia incidence following traumatic brain injury: A decade-long retrospective cohort study

Abstract Introduction We aimed to examine the association between sleep disorders and dementia risk in a population-based cohort of adult male and female patients with traumatic brain injury (TBI). Methods We studied a province-wide retrospective cohort of all adult patients (≥ 18 years) free of dementia at the admission to the emergency department or acute care hospital with diagnoses of TBI between May 2003 and April 2013. All patients were followed through until May 2016. The primary exposure was a sleep disorder, and the primary outcome was dementia, both defined by the International Classification of Diseases, tenth revision diagnosis. Associations of sleep disorders with dementia were analyzed in multivariate Cox Proportional Hazard modeling. Results In total, 712,708 patients with TBI of all severities were included in this study. Their median age was 44 years, 59% were males. Over a median follow-up of 52 months (interquartile range, 19–86 months), 32,834 (4.6%) developed dementia. Controlling for age, sex, income level, injury severity, and known comorbidity risks, diagnosed sleep disorder was a significant predictor of incident dementia: hazard ratio (HR), 1.250 [95% CI, 1.146–1.363]. When results were stratified by sex, the association of sleep disorder with dementia remained significant in male: HR 1.255 [95% CI, 1.112–1.415] and in female patients: HR 1.234 [95% CI, 1.088–1.400]. Sensitivity analyses on Alzheimer’s disease case definition and using Fine and Gray competing risk models confirmed the association between sleep disorder and dementia in both sexes. Conclusion In both sexes, sleep disorders were independently associated with dementia onset (adjusted HRs&amp;gt;1.2). Thus, screening for sleep disorders should be part of regular care for TBI patients, as with the steady increase of TBI survivorship and life expectancy, undiagnosed sleep disorders can initiate a new cascade of cognitive deficits independent from TBI. Support (if any) This work was supported by the postdoctoral research grant from the Alzheimer’s Association (AARF-16-442937) to T.Mollayeva. The authors were also supported by the Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development of the National Institutes of Health under Award Number R21HD089106 and the Canadian Institutes for Health Research Grant–Institute for Gender and Health (#CGW-126580).

082 The Association Between Excessive Daytime Sleepiness and Math Performance in Adolescents

Abstract Introduction Excessive daytime sleepiness (EDS) is defined as an increased tendency to fall asleep in a setting where an individual would be expected to stay awake and alert. Previous studies have found that EDS is associated with poor academic performance but fell short of examining the associations between EDS and achievement in specific academic subjects. Academic performance in mathematics is the most prominent predictor of later success. Findings from studies examining the associations of academic achievement in math and EDS have been inconsistent as some studies have found results indicating the EDS negatively impacts math while others found no such relationship. The aim of this study was to investigate the association between EDS and performance in mathematics in high school students. It was hypothesized that higher level of reported EDS would be associated with lower grades in mathematics. Methods 116 typically developing adolescents (38 male) between 12–17 years of age (M=13.87, SD=1.38) participated. EDS was measured by the Sleep Disorder Inventory for Students (SDIS); Academic achievement in mathematics was measured by child’s report cards; Sleep was assessed for seven nights using actigraphy and sleep logs. Results A hierarchical multiple regression analysis was conducted to examine the associations between parent-reported EDS (independent variable) and their child’s academic achievement in mathematics (dependent variable) while controlling for sleep variables (bedtime, waketime, and duration) and sex. Higher levels of EDS was negatively associated with lower grades in mathematics [F(5,109)= 3.60, p&amp;lt;.01; β= -0.21, p= 0.03]. Conclusion EDS was significantly associated with report card grades in mathematics in typically developing adolescents. Given the cross-sectional design of the study, it can not identify what led to EDS in this sample of typically developing adolescents. We propose that future studies examine potential causes for adolescents’ EDS, including factors that could impair sleep quality (e.g., undiagnosed sleep disorders) or restrict sleep duration (e.g., life-style choices such as the use of electronic devices at night). This is important as it could help to identify targets for intervention aiming at decreasing EDS and ultimately improving academic performance in mathematics. Support (if any):

Undiagnosed sleep disorder breathing as a risk factor for critical COVID-19 and pulmonary consequences at the midterm follow-up

IntroductionPatients with severe COVID-19 develops an acute respiratory distress syndrome (ARDS), requiring admission to the intensive care unit. COVID-19 also reports an increased prevalence of comorbidities, similar to patients with Sleep disorder breathing (SDB). ObjectivesTo evaluate the association between undiagnosed SDB and the risk of ARDS and pulmonary abnormalities in a cohort of patients’ survivors of COVID-19 between 3 and 6 months after diagnosis. MethodsProspective cohort study of patients who developed ARDS during hospitalization due to COVID-19 compared with a control group of patients who had COVID-19 with mild to moderate symptoms. All patients were evaluated between the 12th and 24th week after SARS-CoV-2 infection. The evaluation includes persistent symptoms, lung diffusing capacity of carbon monoxide (DLCO), chest CT scan and home sleep apnea test. SDB was diagnosed by the respiratory disturbance index ≥5 ev/h. The association between SDB and ARDS, the hazards of lung impairment and the hazard ratios (HR) were analyzed. ResultsA total of 60 patients were included (ARDS: 34 patients, Control: 26 patients). The mean follow-up was 16 weeks (range 12–24). ARDS reported a high prevalence of SDB (79% vs. 38% in control group). A total of 35% reported DLCO impairment, and 67.6% abnormal chest CT. SDB was independently associated to ARDS, OR 6.72 (CI, 1.56–28.93), p < 0.01, and abnormal Chest CT, HR 17.2 (CI, 1.68–177.4, p = 0.01). Besides, ARDS, days in mechanical ventilation, male gender were also associated with an increased risk of abnormal chest CT. ConclusionUndiagnosed SDB is prevalent and independently associated with ARDS. In addition, undiagnosed SDB increased the hazard of abnormal Chest CT in the midterm. Study registerISRCTN16865246.

Undiagnosed Sleep Disorders Contribute to Physician Burnout

Undiagnosed Sleep Disorders Contribute to Physician Burnout

Automatic scoring of apnea and hypopnea events using blood oxygen saturation signals

The obstructive sleep apnea-hypopnea (OSAH) syndrome is a common and frequently undiagnosed sleep disorder. It is characterized by repeated events of partial (hypopnea) or total (apnea) obstruction of the upper airway while sleeping. To quantify the severity of the pathology, the Apnea Hypopnea Index (AHI) is used. This index is defined as the average number of apnea and hypopnea events per hour of sleep. Discriminating between these two types of events is a very challenging task and in fact most traditional methods fail to do it. A reliable recognition of such events would not only allow for an accurate estimation of the AHI index, but it would also provide useful information regarding the severity of the pathology, which is very important for clinical purposes. In this work we use a method for structured dictionary learning, which is found to be suitable for automatically differentiating between apnea and hypopnea using as a unique input blood oxygen saturation signals. The method is tested for both classification of segments and OSAH screening on the Sleep Heart Health Study database. For OSAH screening, a receiver operating characteristic curve analysis shows an average area under the curve of 0.934 and diagnostic sensitivity and specificity of 89.10% and 86.70%, respectively. These results represent important improvements with respect to all state-of-the-art procedures which where used for comparison purposes. They also provide a solid support for our conclusion that the method can be used for screening OSAH syndrome more reliably and conveniently, using only a pulse oximeter.

Prevalence of Sleep Disorders and Association With Mortality: Results From the NHANES 2009-2010.

To determine the prevalence of sleep disorders in the United States and the association between sleep disorders and all-cause mortality. A cross-sectional analysis of the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) and 2015 National Death Index (NDI) was performed. The 2009 to 2010 NHANES national household survey for adults ≥ 18 years was examined for the prevalence of sleep disorders as well as standard demographics and the presence of comorbidities (coronary artery disease [CAD], stroke, and emphysema). This dataset was linked to the 2015 NDI to associate the presence of sleep disorders with 5-year all-cause mortality. The study sample had a mean age of 46.1 years old, was 48.3% male, and had an average body mass index (BMI) of 28.7 (28.4-28.9). 7.1% (6.5%-7.7%) of adults reported being diagnosed with a sleep disorder, which represents an estimated 15.9 million (13.2-18.6) patients. The estimated mortality rate for those having a sleep disorder was 9.3% (7.2%-11.9%) compared to 5.2% (4.5%-5.9%) without a sleep disorder (odds ratio 1.89, P = <.001). After adjusting for age, sex, BMI, CAD, stroke, and emphysema, having a sleep disorder remained a significant predictor of increased mortality (hazard ratio, 1.5 [1.02-2.18], P = .042). This study reports a high prevalence of self-reported but physician-diagnosed sleep disorders; however, this likely represents an underestimate. Given the association with all-cause mortality, there is a need for increased recognition of undiagnosed sleep disorders within the United States. 2b Laryngoscope, 131:686-689, 2021.

Sleep in hospitalized patients with chronic obstructive pulmonary disease: an observational study.

The aim of this study was to compare the risk of undiagnosed sleep disorders among medical patients with chronic obstructive pulmonary disease (COPD) compared with those without COPD. In a prospective cohort study, hospitalized medical ward patients without a known sleep disorder were screened, using validated questionnaires, for sleep disorders, such as obstructive sleep apnea and insomnia. Daily sleep duration and efficiency in the hospital were measured via wrist actigraphy. Participants were classified into two groups: those with a primary or secondary diagnosis of COPD and those without a history of COPD diagnosis. Sleep outcomes were compared by COPD diagnosis. From March 2010 to July 2015, 572 patients completed questionnaires and underwent wrist actigraphy. On admission, patients with COPD had a greater adjusted risk of obstructive sleep apnea (adjusted odds ratio 1.82, 95% confidence interval 1.12-2.96, P = .015) and clinically significant insomnia (adjusted odds ratio 2.07, 95% confidence interval 1.12-3.83, P = .021); no differences were observed for sleep quality or excess sleepiness on admission. After adjustment, compared with patients without COPD, patients with COPD averaged 34 fewer minutes of nightly sleep (95% confidence interval 4.2-64.0 minutes, P = .026), as well as 22.5% lower odds of normal sleep efficiency while in the hospital (95% confidence interval 3.3%-37.9%, P = .024). No statistically significant differences were observed for in-hospital sleep quality, soundness, or ease of falling asleep. Among hospitalized patients in medical wards, those with COPD have higher risk of OSA and insomnia and worse in-hospital sleep quality and quantity compared with those without COPD.

Estimation of costs and cost-effectiveness of detecting undiagnosed sleep disorders among chronic disease patients : a typical gp setting in Toronto

Estimation of costs and cost-effectiveness of detecting undiagnosed sleep disorders among chronic disease patients : a typical gp setting in Toronto

Can subjective sleep problems detect latent sleep disorders among commercial drivers?

IntroductionLong-haul truck drivers experience poor sleep health and heightened accident rates, and undiagnosed sleep disorders contribute to these negative outcomes. Subjective sleep disorder screening tools may aid in detecting drivers’ sleep disorders. This study sought to evaluate the value of subjective screening methods for detecting latent sleep disorders and identifying truck drivers at-risk for poor sleep health and safety-relevant performance. Materials and MethodsUsing cross-sectional data from 260 long-haul truck drivers, we: 1) used factor analysis to identify possible latent sleep disorders; 2) explored the construct validity of extracted sleep disorder factors by determining their associations with established sleep disorder risk factors and symptoms; and 3) explored the predictive validity of resulting sleep disorder factors by determining their associations with sleep health and safety-relevant performance. ResultsFive latent sleep disorder factors were extracted: 1) circadian rhythm sleep disorders; 2) sleep-related breathing disorders; 3) parasomnias; 4) insomnias; 5) and sleep-related movement disorders. Patterns of associations between these factors generally corresponded with known risk factors and symptoms. One or more of the extracted latent sleep disorder factors were significantly associated with all the sleep health and safety outcomes. DiscussionUsing subjective sleep problems to detect latent sleep disorders among long-haul truck drivers may be a timely and effective way to screen this highly mobile occupational segment. This approach should constitute one component of comprehensive efforts to diagnose and treat sleep disorders among commercial transport operators.

Sleep disorders in patients with erectile dysfunction.

To assess the prevalence of obstructive sleep apnoea (OSA) in men presenting with erectile dysfunction (ED) at a single centre. All men attending a specialised andrology outpatient department with a new diagnosis of ED were included in this prospective study. All patients completed three questionnaires: the International Index of Erectile Function (IIEF) and two sleep questionnaires [the Obstructive Sleep Apnoea Screening questionnaire and the Insomnia Severity Index (ISI)]. Their ED management was subsequently undertaken in accordance with local and European guidelines. An OSA diagnosis was made based on a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire and those patients were referred for specialist management. Between February and September 2016, 129 patients with ED completed the study questionnaires. In all, 71 patients (55%) had a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire, indicating a need for specialist sleep referral. Men who scored ≥3 on the Obstructive Sleep Apnoea Screening questionnaire were significantly older (61.4 vs 46.5years; P < 0.001) and had a significantly higher body mass index (29.4 vs 26.7kg/m2 ; P < 0.001) when compared to the control group (OSA score of <3). The sleep apnoea group (OSA score of ≥3) had significantly worse IIEF-ED scores (6.2 vs 9.1; P = 0.018) and ISI scores (7.9 vs 5.5; P = 0.061). Men presenting to the andrology clinic with ED are at significant risk of having undiagnosed sleep disorders. This has serious adverse health consequences, as well as being associated with potential dangers at work and travel. The patient compliance was high with 78% completing all three questionnaires. It is feasible to screen this population for sleep disturbance and this should be part of the ED assessment.

Staying Awake and Aware: The Importance of Sleep in Psychiatric Nursing Practice

ABSTRACTGiven that approximately 70 million Americans suffer from sleep–wake disorders and their under-recognized role in practice, psychiatric nurses may see, or may be already seeing, patients with undiagnosed sleep disorders. Assessment of sleep–wake disorders can and should be a part of psychiatric nursing education and practice. Many practicing clinicians lack formal training regarding sleep–wake issues and treatment. Even as sleep disturbances are common concerns among psychiatric populations, sleep–wake issues may go unrecognized. The article presents a stylized progression of care to enable clinicians to identify, address, and treat underlying sleep–wake disorders in psychiatric settings. The article recommends instituting screening procedures for sleep–wake issues and follow-up assessments, particularly overnight pulse oximetry and polysomnograms. Just as clinicians already screen for physical conditions that would affect psychiatric care, practitioners can evaluate patients for potential sleep–wake disorders as part of their existing practice and intake procedures. Further, the piece details implications for psychopharmacology as well as evidence from clinical practice. Psychiatric nurses should stay awake to the importance of sleep medicine and aware of how sleep–wake disorders can affect psychiatric populations.

Discriminative methods based on sparse representations of pulse oximetry signals for sleep apnea–hypopnea detection

Abstract The obstructive sleep apnea–hypopnea (OSAH) syndrome is a very common and generally undiagnosed sleep disorder. It is caused by repeated events of partial or total obstruction of the upper airway while sleeping. This work introduces two novel approaches called most dicriminative activation selection (MDAS) and most discriminative column selection (MDCS) for the detection of apnea–hypopnea events using only pulse oximetry signals. These approaches use discriminative information of sparse representations of the signals to detect apnea–hypopnea events. Complete (CD) and overcomplete (OD) dictionaries, and three different strategies (FULL sparse representation, MDAS, and MDCS), are considered. Thus, six methods (FULL-OD, MDAS-OD, MDCS-OD, FULL-CD, MDAS-CD, and MDCS-CD) emerge. It is shown that MDCS-OD outperforms all the others methods. A receiver operating characteristic (ROC) curve analysis of this method shows an area under the curve of 0.937 and diagnostic sensitivity and specificity percentages of 85.65 and 85.92, respectively. This shows that sparse representation of pulse oximetry signals is a very valuable tool for estimating apnea–hypopnea indices. The implementation of the MDCS-OD method could be embedded into the oximeter so as to be used by primary attention clinical physicians in the search and detection of patients suspected of suffering from OSAH.

Randomized, Prospective Study of the Impact of a Sleep Health Program on Firefighter Injury and Disability

Firefighters' schedules include extended shifts and long work weeks which cause sleep deficiency and circadian rhythm disruption. Many firefighters also suffer from undiagnosed sleep disorders, exacerbating fatigue. We tested the hypothesis that a workplace-based Sleep Health Program (SHP) incorporating sleep health education and sleep disorders screening would improve firefighter health and safety compared to standard practice. Prospective station-level randomized, field-based intervention. US fire department. 1189 firefighters. Sleep health education, questionnaire-based sleep disorders screening, and sleep clinic referrals for respondents who screened positive for a sleep disorder. Firefighters were randomized by station. Using departmental records, in an intention-to-treat analysis, firefighters assigned to intervention stations which participated in education sessions and had the opportunity to complete sleep disorders screening reported 46% fewer disability days than those assigned to control stations (1.4 ± 5.9 vs. 2.6 ± 8.5 days/firefighter, respectively; p = .003). There were no significant differences in departmental injury or motor vehicle crash rates between the groups. In post hoc analysis accounting for intervention exposure, firefighters who attended education sessions were 24% less likely to file at least one injury report during the study than those who did not attend, regardless of randomization (OR [95% CI] 0.76 [0.60, 0.98]; χ2 = 4.56; p = .033). There were no significant changes pre- versus post-study in self-reported sleep or sleepiness in those who participated in the intervention. A firefighter workplace-based SHP providing sleep health education and sleep disorders screening opportunity can reduce injuries and work loss due to disability in firefighters.

Obesity and Sleep-Related Breathing Disorders in Middle East and UAE.

A pandemic of obesity is sweeping all across the globe and the Middle East region also does not remain untouched by this prevailing pandemic. In fact, as per WHO report, Kuwait has the second highest obesity prevalence followed closely by other Middle East (ME) countries, namely, Qatar, Saudi Arabia, and United Arab Emirates (UAE). Apart from direct medical, psychological, and quality of life related adverse effects of obesity, many indirect medical comorbidities, namely, obstructive sleep apnea (OSA), obesity hypoventilation syndrome (OHS), diabetes mellitus (DM), hypertension (HTN), and metabolic syndrome, imposes a significant health burden on the individual and community with consequent morbidity and mortality. The purpose of this review is to shed light on the very high prevalence of obesity, undiagnosed sleep apnea, and other obesity related disorders with discussion of the contributing factors specific to the region including the fair insight into the current status of sleep medicine services in Middle East and UAE despite huge number of patients having undiagnosed sleep disorders. We will also suggest to control this epidemic of obesity and OSA so that the corrective measure could be taken at health ministry level to help people of this region to fight against obesity and related disorders, primarily OSA.