Surgical treatment of obstructive sleep-apnoea syndrome

5 patients, 4 males aged 41, 32, 52 and 49 years and 1 female aged 57 years, suffered from socially unacceptable snoring and hypersomnolence in the daytime. They were evaluated for obstructive sleep-apnoea syndrome. After polysomnography and sleep endoscopy was performed to establish the severity of the sleep-apnoea syndrome and the level(s) of upper airway obstruction, a patient-specific treatment was performed. Conservative therapy with continuous positive airway pressure (CPAP) was refused by 4 patients, while 1 patient discontinued therapy after complaints of nose obstruction. This patient underwent radiofrequency thermotherapy (RFTT) of the inferior turbinates. The other patients underwent uvulopalatopharyngoplasty (UPPP), RFTT of the soft palate, hyoidthyroidpexia (HTP) and 'multilevel' surgery: UPPP, HTP and RFTT of the tongue base, respectively. All patients showed improvement after surgery. Although its longterm effects are not yet known, surgical treatment is an option for patients with obstructive sleep-apnoea syndrome who cannot or will not undergo CPAP.     

Objective and Subjective Health Parameters and Relation to CPAP Adherence in Pediatric Obstructive Sleep Apnea

Little is known regarding adherence-related factors for children prescribed continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). Parent and child health-related perceptions may contribute to adherence. This study investigated objective and subjective OSA-related health parameters for 51 youth ages 8–17 with OSA. More than half were non-adherent to CPAP, and three-fourths were overweight or obese. While objective disease severity did not differ between groups, youth who were non-adherent had more subjective symptoms (parent-reported daytime sleepiness and sleep duration problems; youth-reported daytime problem behaviors). Further research is needed to develop interventions to promote CPAP adherence for children with OSA.     

Unattended home diagnosis and treatment of obstructive sleep apnea without polysomnography

OBJECTIVE: To test the effectiveness of unattended home monitoring along with automatic titrating continuous positive airway pressure (auto-CPAP) as an acceptable method for diagnosing and prescribing proper CPAP pressure for treatment of patients presenting with classic symptoms of obstructive sleep apnea (OSA). DESIGN: Nonrandomized, prospective case study of 63 patients with a presumptive diagnosis of OSA. SETTING: University hospital and veterans affairs medical center ambulatory sleep disorders clinics. PARTICIPANTS: Fifty-eight men and 5 women were recruited for symptoms of excessive daytime sleepiness, heavy snoring, and witnessed apnea. INTERVENTION: Subjects with 10 or more respiratory events per hour were titrated by automatic, unattended home monitoring to an optimal CPAP pressure. MAIN OUTCOME MEASURES: Number of subjects able to be diagnosed by unattended home monitoring, titrated to optimal CPAP pressure, accepted an auto-CPAP machine for home use, and symptoms improved. RESULTS: Fifty-four (86%) of 63 patients completed sufficient diagnostic studies, and in 45 (83%) of these, a diagnosis of OSA was established. Nine subjects were unable to adjust to the nasal mask for an adequate diagnostic recording, and 9 had fewer than 10 respiratory events per hour. Ten subjects with OSA could not complete a titration study. Thirty-five of the subjects diagnosed with OSA accepted the auto-CPAP machine into their home, while 30 used it for therapy longer than 3 weeks. The estimated cost of performing in-home studies was less than one fourth of the estimated cost for in-laboratory polysomnographic examinations had they been performed. CONCLUSION: Unattended monitoring plus auto-CPAP allows cost-effective diagnosis and CPAP titration of most patients with OSA with straightforward symptoms.     

Sleep apnea-hypopnea syndrome. Concept, diagnosis and medical treatment

The sleep apnea-hypopnea syndrome (SAHS) is characterised by daytime sleepiness, cardiorespiratory and cognitive disorders, secondary to repeated episodes of obstruction of the upper airway during sleep. This disease is highly prevalent in the general population and has damaging effects on the cardiovascular system; it increases the incidence of traffic accidents due to excessive somnolence, reduces the quality of life and is associated with an excess of mortality. It usually affects obese patients and the most important symptoms are snoring and repeated respiratory pauses. With each apnea and/or hypopnea there is a fall in saturation that alters the nocturnal average and ends up causing serious cardiovascular problems in the medium to long term. The destructuring of the architecture of sleep leads to daytime sleepiness that can interfere in social and working life. Diagnosis is carried out by means of polysomnography or respiratory poligraphy, an abbreviated method that is valid for 75% of cases. The most efficient medical treatment is the application of positive pressure to the airway (Continuous positive airway pressure - CPAP) that has scarce and light secondary effects and is in general well-tolerated. Once adapted, the patient must carry out an adjustment of the pressure through polysomnography and with the autoCPAP, which can vary pressure until the respiratory events are corrected. Primary care has an essential role to play in suspicion of the clinical symptoms, the correct utilisation of the referral criteria and the control of patients receiving treatment once adapted.     

Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort

OBJECTIVE: To test the hypothesis that sleep disorders are relevant to the risk of ischaemic stroke and ischaemic heart disease events in older men. DESIGN: A cohort study. SETTING: The Caerphilly cohort, a representative population sample of older men in South Wales, UK. PARTICIPANTS: 1986 men aged 55-69 years completed a questionnaire on sleep patterns with help from their partners. This asked about symptoms of disturbed sleep: insomnia, snoring, restless legs, obstructive sleep apnoea, and about daytime sleepiness. During the following 10 years 107 men experienced an ischaemic stroke and 213 had an ischaemic heart disease event. MAIN RESULTS: Up to one third of the men reported at least one symptom suggestive of sleep disturbance, and one third reported daytime sleepiness. Compared with men who reported no such symptoms, the adjusted relative odds of an ischaemic stroke were significantly increased in men with any sleep disturbance, the strongest association being with sleep apnoea (relative odds 1.97; 1.26 to 3.09). The association with daytime sleepiness was not significant for stroke. Relations with ischaemic heart disease events were all raised in men with symptoms of sleep disturbance, but none was significant, other than daytime sleepiness (relative odds: 1.41; 1.04 to 1.92). There were no significant relations with blood pressure. CONCLUSION: The risk of an ischaemic stroke is increased in men whose sleep is frequently disturbed, and daytime sleepiness is associated with a significant increase in ischaemic heart disease events.     

Narcolepsy: update on etiology, clinical features and treatment

Narcolepsy is a disease that involves an alteration in the generation and organisation of sleep. The main symptoms are excessive daytime sleepiness and cataplexy, followed by hypnagogic hallucinations, sleep paralysis and disrupted nocturnal sleep. The prevalence of typical narcolepsy oscillates between 25-50: 100.000 in general. Recently there has been a peak incidence in patients born in the month of March. According to the new classification, the Multiple Sleep Latency Test (MSLT) is mandatory for diagnosing narcolepsy without cataplexy, and advisable for diagnosing narcolepsy with cataplexy. Until now, the attempt has been made to control each symptom by its own specific treatment. At present, new American and European treatment guidelines propose new drugs that act on all the symptoms. The application of new criteria of diagnosis and treatment has improved the diagnosis, giving better options of treatment.     

Somnolence diurne excessive. Étude épidémiologique basée sur un questionnaire « sommeil/respiration »

BackgroundA field survey used a “sleep-breathing” questionnaire to estimate the prevalence of the excessive daytime sleepiness in a sample of middle-aged males.MethodsEight hundred and fifty men aged 22 to 66 years agreed to answer a questionnaire and have anthropometric measurements. To the question on excessive daytime sleepiness, 90 subjects (10.8%) responded “often” or “almost always”; 740 gave a negative answer.ResultsThe sleepy subjects were older and had a higher “central” weight. All the sleep-disturbed breathing symptoms and those suggesting sleep disturbances were more frequent in sleepy subjects. Sleepiness was significantly associated with sleep apnea and chronic bronchitis. Logistic regression identified six items independently associated with daytime sleepiness; there were three indirect indicators of sleepiness, age, a history of chronic bronchitis and disruptive movements during sleep.ConclusionsThis epidemiologic study in a sample of active middle-aged males confirms the association of daytime sleepiness with a series of respiratory and non-respiratory sleep disturbances. The original findings are the role of a “central” obesity, the association with nightmares, and the role of chronic bronchitis as a determinant of daytime sleepiness.     

Excessive daytime sleepiness among the Japanese general population

BACKGROUND: Excessive daytime sleepiness is one of the principal symptoms of sleep disturbances, and is often associated with serious consequences including traffic and industrial accidents, decreased productivity, and interpersonal problems. However, there are few epidemiologic studies on excessive daytime sleepiness in a large scale sample targeting Japanese general population. METHODS: The survey was performed using a self-administered questionnaire in June 2000, targeting a population randomly selected from among 300 communities throughout Japan. This questionnaire included information about sleep habits and sleep problems. Excessive daytime sleepiness measured according to a question "Do you fall asleep when you must not sleep (for example when you are driving a car)?" RESULTS: A total of 28,714 subjects completed the questionnaire. The prevalence of excessive daytime sleepiness was 2.5% (male=2.8% and female=2.2%). Backward elimination analysis showed that the following were associated with excessive daytime sleepiness: male sex, young age, short sleep duration, subjective insufficient sleep, loss of deep sleep, disagreeable sensations in the legs, interruption of sleep by snoring or dyspnea, and feeling psychological stress. Interruption of sleep by snoring or dyspnea was the strongest associated factor (adjusted odds ratio=2.46, 95% confidence interval=1.76-3.43) of excessive daytime sleepiness. CONCLUSIONS: These results suggest that excessive daytime sleepiness in Japanese is associated with several sleep problems. These findings may be useful in attempts to prevent excessive daytime sleepiness in the general population of Japan.     

Daytime sleepiness: an epidemiological study of young adults.

OBJECTIVES: Although excessive daytime sleepiness is associated with increased risks for accidents, decreased productivity, and interpersonal difficulties, information on its epidemiology is scarce. This paper examines correlates of and suspected risk factors for daytime sleepiness from a longitudinal epidemiological study of young adults. METHODS: The sample consisted of 1007 randomly selected young adults from a large health maintenance organization in southeast Michigan. Data were gathered in personal interviews conducted with 97% of the sample 5.5 years after baseline. Information on sleep characteristics in the last 2 weeks, including daytime sleepiness, nocturnal sleep onset, snoring, and hours of sleep, was collected on a self-administered instrument. Psychiatric disorders were measured by the National Institute of Mental Health's Diagnostic Interview Schedule. RESULTS: The average length of nocturnal sleep on weekdays was 6.7 hours. Daytime sleepiness was inversely related to hours of sleep and positively related to the ease of falling asleep at night; it varied significantly by employment and marital status. Snoring was associated with increased daytime sleepiness, as was recent major depression. CONCLUSIONS: Factors that might increase daytime sleepiness among young adults include social factors (being single and being employed full time) and pathological conditions (frequent snoring and major depression).     

Shift work sleep disorder and job stress in shift nurses: implications for preventive interventions

Background:A growing literature has revealed a relationship between shift-work, including night-shift, and the disturbance of sleep-wake cycle, leading to insomnia and/or increased daytime sleepiness in shift nurses; recent findings showed an association between shift work sleep disorders and distress, work accidents, decreased job performance and, consequently, lower quality of health service provision and lower standards of care.Objectives:To analyze across the gender how shift nurses experience shift work sleep disorders and job stress.Methods:A cross-sectional study was performed following the STROBE Statement. The Italian version of the Job Content Questionnaire, the Bergen Insomnia Scale and the Epworth Sleepiness Scale were administered to the registered nurses employed in three Departments of General Practice and Elderly Care Medicine.Results:No significant association was found between high job strain and insomnia and daytime sleepiness. Significantly more women than men experienced high job strain, insomnia and daytime sleepiness; among women the level of social support was significantly and negatively associated with insomnia and daytime sleepiness.Conclusions:The findings of this study suggest that interventions aimed to prevent shift work sleep disorder and job stress in shift-nurses should incorporate the assessment of social support across the gender. Moreover, longitudinal studies are required to evaluate the effectiveness of interventions targeted on social support to minimize the occurrence of insomnia and daytime sleepiness in shift nurses.Key words: Shift work, work related stress, insomnia, sleepiness, interventions     

Arm pain and daytime sleepiness among nursing home employees

We investigated the relationship between musculoskeletal disorders and sleep problems among 98 employees (79 women) at three nursing homes. Self-reported data were collected regarding pain in the neck, shoulders, arms, legs, and low back, sleep disturbances, daytime sleepiness (Epworth Sleepiness Scale), and the level of workload on the hands, legs, and low back by type of care. Pain in the arms was significantly associated with less difficulty initiating sleep, fewer symptoms of insomnia, and a higher level of daytime sleepiness. After adjusting for age and gender, only the association between arm pain and daytime sleepiness remained significant (Odds Ratio 6.70, 95% Confidence Interval 1.40-31.97). Participants with both arm pain and daytime sleepiness showed significantly greater levels of workload in some kinds of care in a systemic manner than counterparts without either complaint. These findings suggest that arm pain is associated with elevated sleep propensity/fatigue in nursing home work.     

Relation of smoking and drinking to sleep disturbance among Japanese pregnant women

BACKGROUND: Pregnant women suffer from sleep disturbance, which may be aggravated by smoking and/or drinking. We investigate here the joint effect of smoking and drinking with respect to sleep disturbance during pregnancy. METHODS: Survey of about 16,000 pregnant women in Japan, conducted in 2002 using a self-administered questionnaire. RESULTS: Both smoking and drinking increased the odds of sleep disturbances, such as subjective insufficient sleep, difficulty in initiating or maintaining sleep, early-morning awakening, short sleep duration, excessive daytime sleepiness and restless legs syndrome. The joint odds ratios for smoking and drinking corresponded more or less to the products of the odds ratio for smoking or drinking. CONCLUSION: Smoking and drinking are independently associated with increased sleep disturbance during pregnancy, in addition to their other well-known side-effects.     

Management of Narcolepsy

Narcolepsy is a chronic sleep disorder characterised by excessive daytime sleepiness, with or without cataplexy, sleep paralysis and hypnagogic hallucinations, with an estimated prevalence of 0.02 to 0.05% worldwide.The goal of managing narcolepsy is to keep patients as alert as possible during daytime hours and to minimise the incidence of cataplexy. A combination of nonpharmacological (lifestyle and behavioural modifications) and pharmacological treatments may be used to alleviate excessive daytime sleepiness. Stimulants such as amphetamines and methylphenidate have been the mainstay of pharmacological treatment, although a range of different agents have been used over several decades.Modafinil, a benzohydrylsulfinyl-acetamide derivative, has demonstrated good efficacy in the treatment of excessive daytime sleepiness, but has limited anticataplectic effects. In clinical studies modafinil 200 to 400 mg/day significantly improved subjective and objective measures of sleepiness and alertness compared with placebo. A long term study of up to 10 years’ duration showed modafinil to have good to excellent efficacy in 64% of patients. Use of modafinil does not appear to be associated with the development of tolerance or dependence, and it is considered to have limited potential for abuse. Modafinil is generally well tolerated with few adverse effects, the most common being headache, nausea, nervousness and anxiety. It may be coadministered with drugs for treating cataplexy. The efficacy and the cost effectiveness of modafinil in the treatment of narcolepsy have not been compared with other available agents. Conclusions: Modafinil provides a useful alternative to traditional stimulants for the treatment of excessive daytime sleepiness associated with narcolepsy. It is well tolerated, may be taken in combination with medications for cataplexy, and shows long term efficacy without development of tolerance.     

A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers

In this study the authors estimated the prevalence of elevated daytime sleepiness, depressive symptoms, and musculoskeletal pain among Latino migrant farmworkers, and examined the relationship among these symptoms. Data are from a cross-sectional survey of migrant farmworkers (N?=?300) conducted in eastern North Carolina in 2009. Eleven percent of Latino farmworkers reported elevated levels of daytime sleepiness, 28% reported elevated levels of depressive symptoms, and 5% reported moderate to severe musculoskeletal pain on a daily or weekly basis. Depressive symptoms and daytime sleepiness were positively associated. Depression and daytime sleepiness may increase risk of injury; further research regarding sleep issues is warranted.     

Social Media Use,Social Media Stress,and Sleep: Examining Cross-Sectional and Longitudinal Relationships in Adolescents

ABSTRACT

There are concerns that social media (SM) use and SM stress may disrupt sleep. However, evidence on both the cross-sectional and longitudinal relationships is limited. Therefore, the main aim of this study is to address this gap in the literature by examining the cross-sectional and longitudinal relationships between SM use, SM stress, and sleep (i.e., sleep latency and daytime sleepiness) in adolescents. In total, 1,441 adolescents 11–15 years, 51% boys) filled out a survey in at least one of three waves that were three to four months apart (N_Wave1 = 1,241; N_Wave2 = 1,216; N_Wave3 = 1,103). Cross-sectionally, we found that SM use and SM stress were positively related to sleep latency and daytime sleepiness. However, when examined together, SM use was not a significant predictor of sleep latency and daytime sleepiness above the effects of SM stress. The longitudinal findings showed that SM stress was positively related to subsequent sleep latency and daytime sleepiness, but only among girls. Our findings stress that it is important to focus on how adolescents perceive and cope with their SM use, instead of focusing on the mere frequency of SM use.     

Identification of quality of life concerns of patients with obstructive sleep apnoea at the time of initiation of continuous positive airway pressure: A discourse analysis

Background: Obstructive sleep apnoea syndrome (OSAS) is a common condition with multiple symptoms dominated by daytime somnolence. Thus many worries and concerns of patients remain hidden. Treatment by nasal continuous positive airway pressure (CPAP) can be imposing for the individual. An analysis of the freely expressed concerns of such patients is required. Objective: To seek an in-depth analysis of how patients live with sleep apnoea by allowing them an open discourse and analysing the text of their statements. Design: A trained psychologist conducted semi-directive interviews with patients attending a pulmonary rehabilitation and convalescent unit around the themes of sleep, health and treatment. An analysis of content and of discourse was carried out by textual analysis and by propositional analysis of discourse (PAD) with the aid of dedicated computer programs (Tropes, Sphinx Lexica). Results: Thirty patients with severe sleep apnoea were interviewed of whom 15 were initiating treatment with CPAP. Patients spoke of abnormal fatigue (22 mentions) and somnolence (21 times). Many have problems with obesity (25 instances), snoring related problems (12). There were 30 mentions of depression with a relationship to alcohol and anti-depressives. Twenty six times the theme of nocturnal waking was raised. There were many instances of problems with CPAP (nasal mask and noise problems raised 21 times). Patients have problems with relationships and sex because of OSAS. Other concerns were loss of memory and fear of dying. Conclusion: In a non-directed conversation OSAS patients express concerns not revealed in the standard medical paradigm and such concerns should be addressed in assessing treatment or evaluating quality of life (QOL).     

An occupational health physician's report on the improvement in the sleeping conditions of night shift workers

This paper reviews briefly our research findings on sleep and health for shift workers at a bakery and a dish factory and aims to give some information on health protection with improved sleep. Our medical examinations revealed that rises in blood pressure (BP) were frequently observed in male bakery workers on the fixed night shift. They took a two-hour nap from 1:00 to 3:00 during the night shifts according to our advice. As a result, their diastolic BP significantly decreased in subsequent years. Women working shifts before 3:00 at a dish factory seemed to show more sleep disturbance, higher daytime sleepiness, and more fatigue than those working shits from 3:00. Total sleep hours taken during the daytime was similar between two groups. Among the dish, factory workers who switched to midnight or night shifts, 70% reported slow recovery from fatigue and 30% felt deteriorated health. These women also reported increased efforts to obtain a deep sleep, probably making up for shortened sleep. Occupational physicians can act to improve shift work conditions through monitoring the health of workers, applying naps, and designing possible schedules to secure deep, sufficient sleep.     

Hypersomnia: diagnosis, classification and treatment

Hypersomnia or excessive daytime sleepiness is common in neurological practice and may have different etiologies. Hypersomnia may be defined as sleepiness at an inappropriate time or in an inappropriate situation. It is important to consider that hypersomnia is at times referred to as tiredness or fatigue. A detailed clinical history is essential to reach an accurate diagnosis. A correct diagnosis is necessary to initiate the appropriate treatment considering the negative social and occupational consequences of hypersomnia. Excessive daytime sleepiness syndromes include primary sleep disorders like narcolepsy and hypersomnia secondary to several neurological and psychiatric disorders and also as an adverse effect of numerous drugs.