Spatial clusters of daytime sleepiness and association with nighttime noise levels in a Swiss general population (GeoHypnoLaus)

Introduction

Daytime sleepiness is highly prevalent in the general adult population and has been linked to an increased risk of workplace and vehicle accidents, lower professional performance and poorer health. Despite the established relationship between noise and daytime sleepiness, little research has explored the individual-level spatial distribution of noise-related sleep disturbances. We assessed the spatial dependence of daytime sleepiness and tested whether clusters of individuals exhibiting higher daytime sleepiness were characterized by higher nocturnal noise levels than other clusters.

Ovary and uterus-sparing procedures for low-grade endometrial stromal sarcoma: A retrospective study of 153 cases

Objective

To discuss the optimal treatment options for low grade endometrial stromal sarcoma (LG-ESS).

Methods

Medical records of consecutive patients with LG-ESS in our institute were collected. The pertinent data, including clinicopathological characteristics, treatment and prognostic information were evaluated.

Results

A total of 153 cases of LG-ESS were included. The 5-year relapse free survival (RFS), overall survival (OS) and survival after relapse (SAR) rates were 66.1%, 95.8% and 82.9%, respectively. Ovary-sparing procedures, positive resection-margins, and myomectomy were the independent adverse factors for relapse (P < 0.0001, = 0.0041, and = 0.0075, respectively). Post-menopause, cervical involvement, and positive lymphovascular space involvement were significantly associated with survival (P < 0.0001, = 0.0020, and = 0.0163, respectively). Distance recurrence and macroscopically residual tumors negatively affected SAR (P = 0.0137 and = 0.0004, respectively). No benefit was found for lymphadenectomy in terms of both RFS and OS (P = 0.1187 and = 0.5138, respectively). Initial ovary-sparing procedures and myomectomy had no impact on OS (P = 0.0810 and = 0.8845, respectively). Adjuvant treatment had a slightly beneficial effect both on OS and SAR.

Conclusion

Hysterectomy with bilateral salpingo-oophorectomy and complete resection of the macroscopic lesion should be treated as the initial and salvage mainstay treatments for LG-ESS patients. Ovary-sparing procedures could be considered for young women without cervical involvement; however, long-term follow-up should be mandatory. Myomectomy should only be conserved for young patients with a strong desire for future fertility, with fully informed consent; hysterectomy was recommended after the completion of pregnancy and delivery. However, the roles of lymphadenectomy and adjuvant treatment deserve further investigation.     

The use of an online pictorial Epworth Sleepiness Scale in the assessment of age and gender specific differences in excessive daytime sleepiness

Background

Excessive daytime sleepiness (EDS) is a non-specific but highly prevalent cardinal symptom of sleep disorders. We hypothesized that with modern media and an online pictorial Epworth Sleepiness Scale (ESS) age and gender specific differences of EDS could be identified on a large scale. This could be helpful in the screening of patients with sleep disorders.

Patients and methods

In 8,098 subjects, age and gender were recorded in addition to an online pictorial ESS (range 0-24 points). The cut-off for EDS (ESS >10 points) was chosen in line with the traditional ESS.

Results

The prevalence of EDS was slightly higher in male subjects (45% vs. 43%, P=0.033). When age was considered, female subjects tended to be sleepier in their 3^rd and 4^th lifetime decade (P=0.01 and P=0.003, respectively), whilst male subjects scored significantly higher in their 7^th decade (P<0.0001); there was a trend to more daytime symptoms with higher age (P for trend <0.001).

Conclusions

The online pictorial ESS identifies gender differences in EDS and reveals increased levels of sleepiness associated with higher age. The use of modern media facilitates reaching out to the general population to raise awareness of conditions associated with EDS such as sleep apnoea.