Predictors of symptoms of anxiety and depression in obstructive sleep apnea

BACKGROUND AND PURPOSE: To assess factors associated with anxiety and depression in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: The study was comprised of a postal survey with a hospital chart review. Questionnaires were mailed to 242 previously hospitalised patients with OSAS. We assessed anxiety and depression with the Hospital Anxiety and Depression scale (HAD). Scores on the two HAD scales (0-21 scale, higher scores represent poor health) were categorized as normal/borderline (< or =10), and corresponding to a clinical diagnosis of anxiety or depression (> or =11). In logistic regression analysis, we assessed the association with HAD scores > or =11, using variables from the chart review and self-reported data on demographics, disease history, smoking status, CPAP/BiPAP use, and daytime sleepiness as assessed with the Epworth Sleepiness Scale (ESS), as potential predictors. RESULTS: One hundred and seventy-eight patients (74%) with mean (SD) age 55 (11) years and body mass index (BMI) of 31 (5) kgm(-2) responded to the questionnaire. In multivariate logistic regression analysis, only low compliance with CPAP therapy (odds ratio (OR) 5.60, P=0.005) predicted high level of anxiety, and low compliance with CPAP therapy (OR 3.59, P=0.03) and daytime sleepiness (OR 1.14 per unit increase in ESS score, P=0.02) were the only predictors of high level of depression. CONCLUSIONS: High anxiety score was associated with non-compliance with CPAP therapy. High depression score was associated with daytime sleepiness and non-compliance with CPAP therapy.     

Epworth Sleepiness Scale and sleep studies in patients with obstructive sleep apnea syndrome

Excessive daytime sleepiness (EDS) is the major symptom of patients with obstructive sleep apnea syndrome (OSAS). In this study, we examined the relationship between subjective EDS scored with the Epworth Sleepiness Scale (ESS), objective EDS measured with the multiple sleep latency test (MSLT) and sleep variables evaluated with polysomnography for patients with OSAS. Subjects were 10 patients (51.7+/-19.0 years old). The average ESS and MSLT scores were 10.6+/-5.6 and 7.7+/-5.6, respectively. There was no significant relationship between ESS and MSLT. The Multiple Sleep Latency Test had a significant negative relationship with the number of awakenings and the apnea/hypopnea index. No relationship was found between nocturnal hypoxia and either ESS or MSLT. Our findings suggest that objective EDS in OSAS is related with fragmentation of sleep, and that several patients are not aware of their EDS.     

Daytime sleepiness and automobile accidents in patients with obstructive sleep apnea syndrome

Abstract We evaluated the rate of automobile accidents and daytime sleepiness using the Epworth sleepiness scale (ESS) in 44 patients with obstructive sleep apnea syndrome (OSAS). We defined the automobile accident score as a sum of two points for every one automobile accident and one point for every near-miss accident. Automobile accidents and near-misses were found in 54.5% and 50.0% in patients with OSAS. Automobile accident score was significantly correlated with the ESS score ( r = 0.56, P < 0.01). Our findings suggest that ESS score may be useful in detecting patients with the potential risk of automobile accidents associated with daytime sleepiness.     

Correlates of daytime sleepiness in patients with asthma

BACKGROUND AND PURPOSE: Patients with asthma often complain of daytime sleepiness, which is usually attributed to a direct effect of asthma on nocturnal sleep quality. We investigated this and other potential explanations for daytime sleepiness among asthmatics. PATIENTS AND METHODS: One hundred fifteen adult asthmatics were assessed for perceived daytime sleepiness (one question item), subjective sleepiness (Epworth Sleepiness Scale score, ESS), obstructive sleep apnea risk (Sleep Apnea scale score within Sleep Disorders Questionnaire, SA-SDQ), asthma severity step, relevant comorbid conditions, and current asthma medications. RESULTS: Among all subjects, 55% perceived excessive daytime sleepiness and 47% had ESS>10. Most subjects reported snoring (n=99, or 86%) and many snored habitually (n=44, 38%). The ESS correlated with SA-SDQ (P<0.0001), male gender (P=0.01), and asthma severity step (P=0.04). In a multiple regression model, the ESS was independently associated with SA-SDQ (P=0.0003) and male gender (P=0.02), but not with asthma severity step (P=0.51). There were no correlations between ESS and age, body mass index (BMI), forced expiratory volume in one second as percent of predicted value (FEV(1)%), comorbidities, or medication used to treat asthma. CONCLUSIONS: Sleepiness is common in asthmatics and may reflect occult obstructive sleep apnea more often than effects of asthma itself, other comorbid conditions, or asthma medications.     

Sleep and sleepiness in patients with Parkinson''s disease before and after dopaminergic treatment

Sleep disturbances and daytime sleepiness are well-known phenomena in Parkinson's disease (PD). Fifteen previously untreated PD patients underwent clinical evaluation, subjective sleep evaluation and polysomnographic evaluation (PSG) before and after a treatment period of mean 8+/-3.1 months with dopaminergic drugs. Both mean Unified Parkinson's Disease Rating Scale (UPDRS) total score and mean subset III of the UPDRS were significantly improved with dopaminergic treatment. PSG revealed that administration of dopaminergic drugs resulted in significant increase in mean percentage of stages 1 and 2. The mean Epworth Sleepiness Scale (ESS) score was significantly increased and mean Multiple Sleep Latency Test (MSLT) score was significantly decreased after dopaminergic treatment indicating subjective and objective daytime sleepiness. The differences in MSLT scores were best explained by a higher dose of L-dopa, whereas other variables such as disease duration, treatment duration, Hoehn and Yahr stage, sleep efficiency index or dopamine agonists did not increase the significance. In contrast, any of the variables appeared to explain ESS score variability. This study demonstrates that daytime sleepiness is not present in untreated patients but emerges later during dopaminergic treatment. Total daily L-dopa dose is predictive of objective daytime sleepiness. Furthermore, subjective assessment of sleepiness may cause underestimation of the severity of daytime sleepiness.     

Use of the Epworth Sleepiness Scale in Chinese patients with obstructive sleep apnea and normal hospital employees

OBJECTIVE: To determine the use of the Epworth Sleepiness Scale (ESS) in Chinese patients with obstructive sleep apnea syndrome (OSA) and normal hospital employees. METHODS: Our sample consisted of 61 healthy controls and 100 patients with OSA. The test-retest reliability, internal consistency, and concurrent validity of the Chinese version of the ESS were analyzed. We also compared the ESS scores between controls and patients, studied the association between the ESS score and the apnea-hypopnea index (AHI) and minimum oxygen saturation (mO(2)), and examined to what extent the ESS score was predictive of mean sleep latency of the Multiple Sleep Latency Test (MSLT). RESULTS: The Chinese version of the ESS was found to have satisfactory reliability and validity. The mean+/-S.D. of ESS scores in normals was 7.5+/-3.0; in patients, it was 13.2+/-4.7. The ESS score had a negative association with mean sleep latency of the MSLT (rho=-0.42, P=0.0001) but no correlation with the AHI and mO(2). ESS scores of 14 and above significantly predicted a low mean sleep latency of the MSLT. CONCLUSION: The ESS should be included as one of the methods for assessing sleepiness in clinic samples of patients with OSA. Our data showed that the ESS was useful to separate patients with and without pathological degree of objective daytime sleepiness as determined by the MSLT.     

Sleep disturbances in relation to fatigue in major depression

Objective

This study aimed to investigate the independent correlations of subjective sleep disturbances (insomnia and daytime sleepiness) with the severity of fatigue in patients with major depression.

Methods

Eighty-one currently depressed patients (70 females and 11 males), aged between 23 and 65 years, with a DSM-IV diagnosis of major depressive disorder were studied. Patients with physical diseases or other conditions associated with prominent fatigue were excluded. The 17-item Hamilton Depression Rating Scale (HDRS), the Athens Insomnia Scale (AIS), and the Epworth Sleepiness Scale (ESS) were used for the cross-sectional assessment of the severity of depression, insomnia, and sleepiness, respectively. Severity of fatigue was measured with the Fatigue Severity Scale (FSS). Pearson's and Spearman's coefficients were used in bivariate correlations between FSS score and the independent variables (age, gender, inpatient/outpatient status, HDRS score, AIS total score, AIS individual item scores, and ESS score). A stepwise multiple regression analysis was then performed, with FSS score as the dependent variable.

Results

The severity of fatigue was significantly correlated with female sex, HDRS score, AIS total score, awakenings during the night (AIS item 2), compromised sleep quality (AIS item 5), and ESS score. Sleep quality (AIS item 5) and daytime sleepiness (ESS) were the only significant predictors of the severity of fatigue in the multiple regression analysis.

Conclusions

Both sleep quality and daytime sleepiness correlate independently with fatigue severity, as measured with the FSS, in patients with major depression. The FSS does not appear to be a ‘pure’ measure of fatigue in depressed patients, a finding with potential implications for the choice of appropriate fatigue measures in this population.     

Prevalence and determinants of subjective sleepiness in healthy elderly with unrecognized obstructive sleep apnea

ObjectiveObstructive sleep apnea (OSA) is associated with behavioral consequences such as excessive daytime sleepiness (EDS). The aim of this study was to establish the presence of sleepiness in elderly with unrecognized OSA and the factors explaining its occurrence.MethodologyA total of 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory polygraphy, and heart-rate variability analysis were studied. According to the apnea–hypopnea index (AHI), the subjects were stratified in four categories: no-OSA (AHI <5), mild (5 > AHI <15), moderate (15 ≥ AHI <30), and severe OSA (AHI ≥30). Participants with EDS were defined on the basis of the Epworth Sleepiness Scale (ESS) score ≥10.ResultsOverall, the mean ESS score was 5.7 ± 5.6, 14.9% showing EDS with an increasing trend according to OSA severity (p <0.001). Sleepy subjects were more frequently men, having a greater body mass index (BMI), alcohol intake, depression score, and indices of OSA severity (23% of severe OSA cases being sleepy). No differences were present between sleepy and non-sleepy subjects in regard to other clinical, metabolic, and autonomic nervous system measurements. Regression analyses adjusted for age, gender, BMI, hypertension, depression score, autonomic sleep fragmentation, and AHI and/or oxygen desaturation index revealed that gender (p <0.0001), depression score (p <0.0001), and BMI (p = 0.01) were the only significant factors affecting the presence of sleepiness in this population.ConclusionsIn healthy elderly with OSA, the prevalence of EDS was low, and it affected only severe cases. Despite a weak association between the ESS score and the AHI index, male gender and depression score were the most significant predictors for the occurrence of sleepiness.     

Sleepiness and activity in heart failure patients with reduced ejection fraction and central sleep-disordered breathing

ObjectivePatients with heart failure (HF) and sleep disordered breathing (SDB) are typically not sleepy, unlike patients without heart failure. Previous work in HF patients with obstructive SDB suggested that sleepiness was associated with a reduction in daytime activity. The consequences of predominately central SDB on sleepiness in HF are less well understood. The aim of this study was to test the hypothesis that subjective sleepiness is associated with reduced daytime activity in HF patients with central SDB, compared to those without SDB.MethodsThe Epworth Sleepiness Scale (ESS), nocturnal polysomnography, and 14 days of wrist watch actigraphy were used to assess subjective daytime sleepiness, nocturnal sleep and breathing, and 24-h activity levels, respectively.ResultsA total of 54 patients with HF were studied, nine had obstructive SDB and were removed from further analysis. Of the patients, 23 had HF with predominantly central SDB (HF-CSA; apnea–hypopnea index (AHI) median 20.6 (IQR 12.9–40.2)/h), and 22 had noSDB (HF-noSDB; AHI 3.7 (2.5–5.9)/h). The median patient age was 68 years (range 59–73 years). There were no significant differences either in ESS score (HF-CSA; 8 [4–10] vs. HF-noSDB; 8 (6–12); p = 0.49) or in duration of daytime activity (HF-CSA 14.5 (14.1–15.2) and HF-noSDB 15.1 (14.4–15.3) hours; p = 0.10) between the groups.ConclusionHF patients with predominately central SDB are not subjectively sleepy compared to those without SDB, despite reduced sleep quality. We speculate that the lack of sleepiness (based on ESS score) may be due to increased sympathetic nerve activity, although further studies are needed due to the small number (n = 5) of sleepy HF-CSA patients. Daytime activity was not different between HF-noSDB and HF-CSA patients.     

Clinical significance and correlates of behaviorally induced insufficient sleep syndrome

Background and purposeThe aim of this study was to investigate the demographic variables and clinical characteristics of behaviorally induced insufficient sleep syndrome (BIISS) and to compare it with the other major hypersomnia disorders.Patients and methodsOne-thousand two-hundred forty-three consecutive patients referred to the outpatient clinic for complaint of excessive daytime sleepiness (EDS) were retrospectively investigated.ResultsThe rate of BIISS in patients with EDS was 7.1%, predominant in males. The mean age of initial visit was younger than that for obstructive sleep apnea syndrome (OSAS), while the mean age of onset of symptoms was older than that for idiopathic hypersomnia, narcolepsy, and circadian rhythm sleep disorders. The mean Epworth sleepiness scale (ESS) score before treatment was lower than that for narcolepsy but higher than that for both OSAS and circadian rhythm sleep disorders. Twenty-two percent of BIISS cases reported having accidents or near-miss accidents during the five-year period preceding the investigation, and this group showed higher ESS scores than the group without accidents.ConclusionsOur findings showed that an unignorably large number of people suffer from BIISS, and that people with severe cases of the disorder are at high risk for getting into an accident. Characteristics and demographic information could be helpful for making a differential diagnosis of BIISS.     

Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea

BACKGROUND: Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of a complete or partial collapse of the upper airway during sleep. Traditionally, the disease is diagnosed by overnight polysomnography. Studies have shown correlation between parameters of cephalometry and severity of sleep apnea. We wish to determine the variable of craniofacial dimensions in the upper airway that contribute to OSA, and to investigate the significance of craniofacial measurements in positional and non-positional sleep apnea patients. METHODS: From July 2002 to June 2006, we studied 84 males and 15 females who came to the sleep center because of daytime sleepiness. All the participants underwent overnight polysomnography and lateral cephalograms, performed by an experienced technician. RESULTS: Craniofacial measurements of gnathion-gonion, anterior superior hyoid to mandibular plane (MP-H), posterior nasal spine (PNS) to the velum tip (SPL), widest point of the soft palate (SPW), and the product of PNS to the velum tip and widest point of the soft palate (product of soft palate (SPP)=SPL x SPW) were positively related to the apnea/hypopnea index (AHI). The velum tip to the pharyngeal wall parallel to the Frankfurt horizontal (PAS) was negatively related to the AHI. We further divided the study subjects into 4 groups according to AHI value (group 1, AHI<5; group 2, 5 or=30). Age, body mass index (BMI), neck circumference (NC), distances of PAS, SPL, SPW, SPP and angle of sella-nasion-infradentale (SNB) were significantly different depending on the degree of severity of sleep-disordered breathing (SDB). Patients who were older, with a high BMI and longer MP-H distance, had more daytime sleepiness (Epworth sleepiness scale, ESS). Furthermore, lower AHI values and longer PAS measurements were found in the positional sleep apnea group when compared to the non-positional sleep apnea group. After adjusting for confounding factors of age, BMI and NC, we found that BMI, MP-H distance and PAS measurement were correlated with severity of OSA. CONCLUSIONS: Cephalometry could be a useful and inexpensive clinical tool to evaluate Chinese patients with OSA. MP-H and PAS should be measured in Chinese patients with OSA. MP-H was correlated with ESS. The PAS measurement was narrower in non-positional OSA patients compared to positional OSA patients.     

Association of daytime sleepiness with nigrostriatal dopaminergic degeneration in early Parkinson's disease

Abstract Introduction Many patients with Parkinson's disease (PD) report daytime sleepiness. Its etiology, however, is still not fully understood. The aim of this study was to examine if the amount of nigrostriatal dopaminergic degeneration is associated with subjective daytime sleepiness in patients with PD. Patients and methods We investigated 21 patients with PD clinically and by means of [¹²³I] FP-CIT-SPECT (DaTSCAN^R). Each patient filled in the Epworth sleepiness scale (ESS), the Parkinson's Disease Sleep Scale (PDSS), and the self-rating depression scale according to Zung (SDS) to assess sleepiness, sleep quality, and depressive symptoms. Results The mean specific dopamine transporter binding in the 21 PD patients (60.8 ± 10.4 years, nine females, median Hoehn and Yahr stage 2.0) was decreased. Nine patients were in Hoehn and Yahr stage 1 (58.7 ± 6.6 years, four females; ESS score 7.4 ± 4.5; PDSS score 105.1 ± 30.9), the other 12 patients were in Hoehn and Yahr stage 2 (62.4 ± 12.6 years, five females; ESS score 6.7 ± 4.7, PDSS score 97.1 ± 25.6). Age, gender, ESS, and PDSS scores were not significantly different in both groups. However, ESS scores showed an inverse correlation with mean DAT binding in the striatum (r = -0.627, p = 0.03), the caudate nucleus (r = -0.708, p = 0.01), and the putamen (r = -0.599, p = 0.04) in patients with Hoehn and Yahr stage 2. There was no correlation of the ESS score with age, disease duration, UPDRS motor score, PDSS score, or depression score. Conclusion Subjective daytime sleepiness seems to be associated with dopaminergic nigrostriatal degeneration in early PD.     

阻塞性睡眠呼吸暂停低通气综合征患者的睡眠障碍

目的 探讨不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠障碍和夜间缺氧的发生特点和影响因素.方法 对425例打鼾患者应用Epworth嗜睡量表进行问卷调查,计算嗜睡评分;用多导睡眠监测仪(PSG)进行整夜睡眠监测,分析患者睡眠结构和夜间反复低氧的特点与嗜睡评分及临床症状之间的相关性.结果 按呼吸暂停低通气指数(AHI)将425例患者分为单纯鼾症组65例(15.3%);OSAHS患者360例(84.7%),其中轻度OSAHS组96例(22.6%),中度OSAHS组77例(18.1%),重度OSAHS组187例(44.O%).OSAHS患者随着病情加重,嗜睡评分明显升高,组间比较差异均有统计学意义.OSAHS患者与单纯鼾症组比较,睡眠效率、非快速眼球运动1和2期(NREMl+2)睡眠时间增长,3和4期(NREM3+4)睡眠时间缩短;氧减指数(ODI)、脉搏氧饱和度低于90%的时间[T(SpO2<90%)]增高,最低脉搏氧饱和度(LSpO2)降低.随着OSAHS病情加重,各指标变化越大.相关分析提示,嗜睡评分与AHI呈正相关(r=0.474,P<0.01),两者与ODI、T(SpO2<90%)及NREMl+2睡眠时间呈正相关(嗜睡评分r=0.392、0.356、0.194,AHI r=0.714、0.682、0.365;均P<0.01),与LSpO2和NREM3+4睡眠时间呈负相关(嗜睡评分r=-0.414、-0.196,AHI r=-0.740、-0.385;均P<0.01),其中LSp02、ODI、T(SpO2<90%)为主要影响因素.临床上患者出现白天嗜睡、记忆力下降、疲乏、口于、夜间憋醒、晨起头痛等主要症状,重度患者白天嗜睡症状的发生率达73.3%(137/187).结论 不同程度OSAHS患者均存在睡眠障碍,患者嗜睡的严重程度与睡眠结构的改变部分相关,而与缺氧情况呈明显相关.随着疾病严重程度的加重,睡眠障碍和缺氧越明显,嗜睡评分越高.     

The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patients with partial epilepsy

This study investigated the effect of the novel antiepileptic drug levetiracetam (LEV) on sleep in eleven patients with partial epilepsy. At baseline and one week after therapy with LEV (1000 mg/day), patients underwent polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). Patients also rated their own degree of sleep disturbance and daytime sleepiness with the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS). A group of 10 age- and gender-matched control participants were also included in the study. Patients had decreased total sleep time and increased daytime sleepiness compared to baseline, as evaluated by AIS subscales. Furthermore, LEV therapy significantly decreased the rapid eye movement sleep time and percentage as measured by PSG. Patients reported a significant increase in ESS score but did not exhibit changes in MSLT performance after LEV treatment. The study demonstrated that short-course LEV treatment can affect subjective sleep time and objective sleep architecture. Furthermore, LEV treatment affected subjective daytime sleepiness but did not influence objective mean daytime sleep latencies in patients with partial epilepsy.     

Falling asleep while driving and automobile accidents among patients with obstructive sleep apnea-hypopnea syndrome

Among 448 patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), 40 patients (8.9%) had been involved in one or more automobile accidents during the preceding 5 years. The main cause of these accidents was falling asleep while driving. Excessive sleepiness during driving was associated with an Epworth sleepiness scale (ESS) score of > 11 and/or an apnea-hypopnea index (AHI) of > 15. The automobile accident rate among 182 patients with severe OSAHS (AHI > 30) was significantly higher than the rate among 106 simple snorers (AHI < 5). Although four of the simple snorers were involved in automobile accidents, their ESS scores were all very high (15 or more).     

Subjective nocturnal symptoms have different associations with depressive symptoms and anxiety than with daytime sleepiness in patients with obstructive sleep apnea

BackgroundWe determined the relationships among the subjective symptoms of sleep apnea and daytime sleepiness, depressive symptoms, and anxiety in adults with obstructive sleep apnea (OSA).MethodsWe developed the Subjective Apnea Severity Questionnaire (SASQ) to measure subjective OSA symptoms during the night and on waking in the morning. Construct validity and reliability were assessed. The Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and State Scale of State Trait Anxiety Inventory (STAI-S) were applied. Multiple linear regression analyses were performed, and the results were adjusted for several confounders.ResultsA total of 337 OSA patients were included. The SASQ consists of eight items with three domains. Cronbach's α for the SASQ was 0.657. The mean SASQ score was 1.35 ± 0.59. Symptoms related to nocturnal breathing difficulties were associated with polysomnographic (PSG) respiratory parameters. In the adjusted models, total SASQ scores were associated with ESS scores but not with BDI or STAI-S scores. Unlike other symptom groups, nocturnal breathing difficulties tended toward a positive relationship with ESS scores (p = 0.076), but were negatively related to BDI scores (p = 0.003) and STAI-S scores (p = 0.012). Symptoms related to nocturnal awakening or morning waking were either positively related or unrelated to ESS, BDI, and STAI-S scores.ConclusionsThe subjective OSA symptoms measured via the SASQ were associated with daytime sleepiness in adults with OSA, but not with depressive symptoms or anxiety. Nocturnal breathing difficulties were positively related to daytime sleepiness, but negatively related to depressive symptoms and anxiety.     

A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia

OBJECTIVE: To prospectively evaluate the relationship between obstructive sleep apnea syndrome (OSAS), nocturia and quality of life in elderly patients free of the urologic and medical conditions that lead to increased nocturia. METHODS: Prospective study of nocturia in men 65 years and older with isolated OSAS or sleep onset insomnia. After a 7-day nocturia evaluation and nocturnal polysomnography, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Quality of Life (SF-36) were administered. RESULTS: OSAS patients with frequent nocturia had significantly greater body mass index (BMI), greater apnea-hypopnea index (AHI), lower lowest oxygen saturation and lower SF-36 subscale scores. Treatment with nasal continuous positive airway pressure (CPAP) for OSAS and behavioral techniques for insomnia improved ESS and BDI scores for all three groups. SF-36 subscale scores improved more in subjects with multiple nocturia. AHI and BMI explain 38% of the variance for nocturia. CONCLUSION: Nasal CPAP reduces OSA and nocturia and improves quality of life of elderly patients.     

Findings of the Maintenance of Wakefulness Test and its relationship with response to modafinil therapy for residual excessive daytime sleepiness in obstructive sleep apnea patients adequately treated with nasal continuous positive airway pressure

ObjectiveWe aimed to examine the relationship between subjective and objective sleepiness in obstructive sleep apnea syndrome (OSAS) patients with residual sleepiness, and to determine whether baseline objective sleepiness severity predicts the response to modafinil therapy.MethodsData were obtained from a randomized, placebo-controlled modafinil (200 mg/day) study in Japanese OSAS patients with residual sleepiness receiving nasal continuous positive pressure (n-CPAP) treatment. We analyzed 50 participants whose subjective (Epworth Sleepiness Scale [ESS] total score) and objective (Maintenance of Wakefulness Test [MWT] sleep latency) sleepiness were evaluated before and after treatment. Subjects were dichotomized into two subgroups according to the mean baseline MWT sleep latency. ESS total score and MWT sleep latency changes after treatment were compared between the placebo and modafinil groups in both subgroups.ResultsThe mean baseline ESS total score and MWT sleep latency were 14.1 ± 2.8 and 14.2 ± 4.9 min, respectively; there was no significant correlation between these two variables. Patient characteristics were similar between the two subgroups (MWT sleep latency: <14 min, n = 23; ≥14 min, n = 27). In the <14-min subgroup, changes in ESS total score and MWT sleep latency after treatment were significantly greater in the modafinil group than in the placebo group (p = 0.005). In the ≥14-min subgroup, changes in these parameters did not differ between the treatment groups.ConclusionIn OSAS patients with residual sleepiness, the objective sleepiness level was not as high as expected, despite increased subjective sleepiness. Improvements in subjective and objective sleepiness seemed difficult to achieve with modafinil treatment among subjects with less objective sleepiness.     

Job stress,burnout, and job satisfaction in sleep apnea patients

ObjectiveTo assess job stress, burnout, and job satisfaction in patients with obstructive sleep apnea syndrome (OSAS).MethodsA total of 182 patients with OSAS and 71 healthy individuals completed the Job Content Questionnaire, the Maslach Burnout Inventory – General Survey, the Index of Job Satisfaction, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index. All participants were assessed with full-night polysomnography.ResultsSurvey scores of patients diagnosed with OSAS only differed from those of the control group in the emotional exhaustion dimension (P = 0.015). According to a multivariate analysis, the apnea–hypopnea index (AHI) was only correlated with perceived support at work (β coefficient = 0.142; P = 0.048). Associations were found between subjective sleep quality, perceived support from coworkers, and supervisors (β = 0.157; P = 0.025), psychological demands (β = 0.226; P = 0.001), emotional exhaustion (β = 0,405; P = 0.000), and cynicism (β = 0.224; P = 0.002). The study also revealed associations between excessive daytime sleepiness and the burnout dimensions emotional exhaustion (β = 0.232; P = 0.000) and cynicism (β = 0.139; P = 0.048).ConclusionObjective parameters of OSAS such as the AHI seem to have limited influence on the psychosocial aspects of the occupational life of patients with OSAS. There is evidence of significant associations between the subjective symptoms of the disease, such as daytime sleepiness, subjective sleep quality, job stress, and burnout.     

老年帕金森病患者日间过度思睡的临床调查及相关因素分析

目的了解老年帕金病(PD)患者日间过度思睡(EDS)的临床情况及相关因素。方法收集北京医院老年PD患者80例和年龄、性别相匹配的健康对照者50名,采用爱泼沃斯思睡量表(ESS)评定EDS,简易精神状态量表(MMSE)评定智能状况,比较PD患者和健康对照的EDS情况,同时对PD患者进行改良Webster评分、Hoehn-Yahr(H-Y)分期、Hamilton抑郁和焦虑量表调查,并询问是否具有夜间易醒、疲倦、不宁腿综合征、日间睡眠发作、夜间入睡困难、是否应用多巴受体激动剂及多巴胺药物的用量。根据ESS评分情况将PD患者分为EDS组(ESS≥10)和非EDS组(ESS<10分),并对两组间的上述调查项目进行比较。同时以ESS总分为因变量,以计量资料年龄、Hoehn-Yahr分级、左旋多巴用量、Webster评分、病程、Hamilton抑郁和焦虑评分及睡眠时间为自变量进行多元逐步回归分析,分析ESS评分与以上各因素的相关性。结果 80例PD患者中23例(28.8%)ESS≥10分,健康对照组5名(10.0%)ESS≥10分,两组有差异有统计学意义(χ2=6.40,P=0.01)。EDS组23例(男10例、女13例),年龄(72.26±5.94)岁,日间疲倦18例(78.26%),Hamilton抑郁量表评分(13.57±3.31)分,Hamilton焦虑量表评分(19.13±5.38)分,病程(7.65±4.12)年,非EDS组57例(男40例、女17例),年龄(68.58±5.27)岁,日间疲倦18例(31.58%),Hamilton抑郁量表评分(7.32±2.71)分,Hamilton焦虑量表评分(13.25±5.12)分,病程(5.55±3.40)年,两组间比较有统计学差异(均P<0.05);两组患者Hoe-hn-Yahr分级、改良Webster评分、应用左旋多巴剂量、是否应用多巴受体激动剂、夜间睡眠时间、入睡困难、不宁腿综合征、夜间易醒均无统计学差异(均P>0.05)。多元逐步回归分析结果显示,PD患者年龄和抑郁程度与ESS评分相关(分别回归系数=0.10,标准偏回归系数=0.16,P=0.04;回归系数=0.59,标准偏回归系数=0.66,P=0.00),抑郁程度相关性更强。结论老年PD患者EDS较为常见,可能受年龄和抑郁情绪的影响,但与疾病严重程度可能不存在相关性。