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Polysomnographic Findings in Patients With Obstructive Sleep Apnea With and Without Excessive Daytime Sleepiness
Kh Sadeghniiat-Haghighi,Z Yazdi,MA Zohal
Journal of Shahid Sadoughi University of Medical Sciences , 2011,
Abstract: Introduction: Obstructive sleep apnea syndrome(OSAS) is a common disorder in the general population. Excessive daytime sleepiness (EDS) is a frequent symptom in patients with OSA. Obstructive sleep apnea and its resultant EDS lead to an increased risk of deadly motor vehicle accidents. In this study the relationship between EDS and different polysomnographic variables in patients sufferinf from OSAS is evaluated. Methods: This is a retrospective study of 126 consecutive patients with OSA who underwent sleep polysomnography. Subjective sleepiness was assessed by Epworth Sleepiness Scale. Absence of EDS was defined as ESS score of<10. Polysomnographic recordings were compared in patients with and without excessive daytime sleepiness. Results: 71 patients with EDS and 55 patients without EDS were studied. Patients with EDS had lower oxygen saturation, longer total sleep time , shorter sleep latency, more total Respiratory Disturbance Index, and more total limb movement than patients without EDS(P<0.05). EDS and non-EDS patients did not differ in the sleep efficiency, sleep stage distribution and number of awakenings(P>0.05). Conclusion: Our results suggest that there is a relationship between excessive daytime sleepiness and respiratory sleep variables in polysomnography and oxygen desaturation at night. Patients with more severe daytime sleepiness are characterized by more severe nocturnal hypoxemia. Nocturnal hypoxemia may be a major determinant of EDS in OSA patients
Impact Of Nasal Continuous Positive Airway Pressure On Excessive Daytime Sleepiness In Obstructive Sleep Apnea Patients  [PDF]
Geetha Kandasamy,Abhay Dharamsi
International Journal of Pharma Sciences and Research , 2013,
Abstract: Purpose: To study the impact of nasal continuous positive airway pressure (nCPAP) on excessive daytime sleepiness in obstructive sleep apnea patients (OSA). Method: Patient’s data were collected through direct patient interview and polysomnographic reports. Excessive daytime sleepiness (EDS) was assessed by using Epworth Sleepiness Scale (ESS) at baseline and after six months of nCPAP treatment. Results: This prospective study was conducted from August 2008 to June 2012. A total of 141patients were diagnosed as OSA based on Apnea Hypopnea Index. The study group (n=141) was further categorized based on AHI as Mild, Moderate and Severe. AHI 17.71% (31) had mild OSA (AHI 5-14.9), 33.14% (24) had moderate (AHI 15-29.9 Events/hour)and 49.14% (86) were found to have severe OSA (AHI≥30). Evaluation of demographic data revealed that among the 141 patients, 121 were male (85.81%) and 20 were female (14.48%) and the mean age was 51.82±11.77 years. The mean ESS Score for mild OSA, moderate OSA, and severe obstructive sleep apnea groups were 8.13±1.78, 13.45±3.14, 15.48±5.22 respectively. The ESS score was significantly higher in severe obstructive sleep apnea patients as compared to mild and moderate OSA. ESS scores at baseline were 12.48±3.12 and after nCPAP treatment were 6.42±2.92. Significantly improved after 6 months of nCPAP treatment. Conclusion: Nasal CPAP reduces daytime sleepiness, resulting in an increased daytime activity. Subjective sleepiness was also (Excessive daytime sleepiness) significantly improved after 6 months of nCPAP treatment.
Obstructive Sleep Apnea, Excessive Daytime Sleepiness, and Road Traffic Accidents among Interstate Commercial Vehicle Drivers in Nigeria  [PDF]
Daniel O. Obaseki,Gregory E. Erhabor,Josephine E. Obaseki,Ibukun Abidoye,Akinjide Adebisi,Babatunde Olaiya
Journal of Respiratory Medicine , 2014, DOI: 10.1155/2014/580264
Abstract: Introduction. Obstructive sleep apnea (OSA) is a growing public health problem in developing countries. However the burden among commercial drivers is not well described. Methods. The Epworth Sleepiness Scale (ESS) and Berlin questionnaire were administered to interstate commercial road transport drivers to assess the tendency to sleep in daytime and the risk of OSA, respectively. Body mass index (BMI), neck, and waist-hip circumferences were measured. Results. Out of 138 commercial drivers, 124 (90%) responded and provided complete data. The mean (SD) age, BMI, neck, and waist circumferences were 40.4 (9.3) years, 28.0 (4.6)?kg/m2, 40.0 (3.0)?cm, and 92.8 (11.1)?cm, respectively. Twenty-two percent had ESS score above 11 and 36% of the respondents had a high risk for obstructive sleep apnea. Adjusting for age, BMI, and waist and neck circumferences, the key predictors of road accidents were ESS score above 11 (OR 3.77, 95% CI 1.18–12.06), self-reported diagnosis of hypertension (OR 4.63, 95% CI 1.46–14.69), and increasing hip circumference (OR 1.12, 95% CI 1.01–1.23). Conclusion. Obstructive sleep apnea is common among commercial interstate road drivers in Nigeria and ESS may be a simple tool for assessing accident risk. 1. Introduction Obstructive sleep apnea (OSA) is a growing public health challenge [1]. It is characterized by recurring episodes of partial or absolute airway obstruction during sleep resulting in repeated sleep interruptions. When accompanied by daytime somnolence, it is often referred to as obstructive sleep apnea syndrome (OSAS). OSAS is associated with excessive daytime somnolence, cardiovascular morbidity, underperformance in workplace, domestic injuries, and road traffic accidents [2]. There is a large body of evidence that shows that these events may be explained by sleep fragmentation, work patterns, circadian rhythm, and sleep habits like snoring [3, 4]. About 15–25% of the general population in high-income countries is reported to experience excessive daytime sleepiness (EDS) [5] and this may partly be due to obstructive sleep apnea. Though there is a paucity of data on the burden of OSA in many low-income countries, it is generally presumed that OSA is uncommon in these populations. This position has mainly been supported with the argument that the prevalence of obesity is low in low-income economies where low energy diets are staple. However, obesity alone does not explain the variance in the prevalence of OSA across countries. Recent studies in Nigeria have suggested that OSA may be largely underrecognized as high
Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment  [PDF]
Wataru Yamadera, Shintaro Chiba, Masayuki Iwashita, Ryo Aoki, Daisuke Harada, Miki Sato, Hiroto Moriwaki, Keita Obuchi, Motohiro Ozone, Seiji Nishino, Hiroshi Itoh, Kazuhiko Nakayama
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.33039
Abstract: The purpose of this study was to assess factors associated with subjective sleep evaluation, chiefly excessive daytime sleepiness (EDS) in obstructive sleep apnea syndrome (OSAS) adult outpatients under continuous positive airway pressure (CPAP) treatment. One thousand and forty-eight OSAS outpatients (mean age: 51.4% male: 90.5%) who were treated by CPAP were consecutively collected. Age, sex, CPAP compliance (CPAP usage as their device of nights with application-time of at least 4 hours per night objectively; %usage ≥ 4 h/d), and Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) of the patients showing EDS (Japanese version of the Epworth Sleepiness Scale; JESS ≥ 11) were compared cross-sectionally with those of the patients who did not show EDS (JESS < 11). Nineteen point two % of all patients showed EDS subjectively. Two hundred one patients were classified to an EDS(+) group and an 847 patients were classified to EDS(–) group. Age and global PSQI-J scores were significantly different between the two groups. Logistic regression showed that EDS was significantly associated with global PSQI-J scores, but not with age. Among PSQI-J components, overall sleep quality, duration of sleep, sleep disturbance, and day dysfunction due to sleepiness were significantly higher in the EDS(+) group. Especially, 19.4% of patient in the EDS(+) group reported actual sleep time during the past month to be less than 5 hours/day. Although functional relationship should be further evaluated, insufficient sleep is the main factor associated with EDS in the OSAS patients under CPAP treatment.
Risk of Obstructive Sleep Apnea with Daytime Sleepiness Is Associated with Liver Damage in Non-Morbidly Obese Patients with Nonalcoholic Fatty Liver Disease  [PDF]
Edoardo Alessandro Pulixi, Eleonora Tobaldini, Pier Maria Battezzati, Paola D'Ingianna, Vittorio Borroni, Anna Ludovica Fracanzani, Marco Maggioni, Serena Pelusi, Mara Bulgheroni, Massimo Zuin, Silvia Fargion, Nicola Montano, Luca Valenti
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0096349
Abstract: Background A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. Aims To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. Methods We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) <35 Kg/m2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score. Results In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7–51, p = 0.005 and OR 14.0, 95% c.i. 3.5–70, p = 0.0002, respectively). Conclusions A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.
Obstructive sleep apnea syndrome: The case of residual sleepiness  [PDF]
Kathy Sexton-Radek
Health (Health) , 2013, DOI: 10.4236/health.2013.511252
Abstract: The case of a 62-year-old male illustrated the medical emergent need for treatment. Severe excessive daytime sleepiness, neurocognitive functioning symptoms were evident from his chronic untreated sleepiness. An all-night polysomnogram confirmed the diagnosis of Obstructive Sleep Apnea (OSA). The implication of this case’s chronic untreated experience of OSA is discussed in terms of neurocognitive/brain structure laboratory findings. Results at intake, one and three months of this case’s sleep and cognitive functioning are reported.
Excessive daytime sleepiness of the Brazilian emperor Dom Pedro II probably due to sleep apnea syndrome
Reim?o, Rubens;Gomes, Marleide da Mota;Maranh?o-Filho, Péricles;
Arquivos de Neuro-Psiquiatria , 2008, DOI: 10.1590/S0004-282X2008000500036
Abstract: objective: to show that the obstructive sleep apnea syndrome (osas) was the probable cause of d. pedro ii's excessive daytime sleepiness. method: research of historical documents and bibliographical. results: the excessive daytime sleepiness of d. pedro ii (1825-1891) was well known and bitterly criticized behavior by oppositionist magazines; it was also recognized by his peers. he would fall asleep in public places such as the theater and while attending lectures. as a youth, he was of normal complexion, putting on weight (obesity) at middle years. conclusion: the possibility of this diagnosis is particularly relevant in this case because it points to an organic cause for d. pedro ii daytime naps and excessive daytime sleepiness. it could be the result of osas and not "disinterest" as erroneously assumed at that time.
Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP
Rodrigues, Raimundo Nonato Delgado;Rodrigues, Aída Alexandra Alvim de Abreu e Silva;Pratesi, Riccardo;Gomes, Marília Miranda Fortes;Vasconcelos, Ana Maria Nogales;Erhardt, Christine;Krieger, Jean;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000100012
Abstract: background & purpose: the association of obstructive sleep apnea syndrome (osas) and restless legs syndrome (rls) has been reported in the literature for many years. both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. the primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (cpap) treatment in osas patients with and without rls. method: a prospective and comparative study between a group of 13 patients with osas and a group of 17 patients with osas+rls. laboratory blood tests and polysomnography were performed at baseline. the epworth sleepiness scale (ess) and the pichot?s questionnaire of fatigue/depression (pic) were applied before and after 3 months of cpap treatment. results were compared. results: no significant differences were found on psg and laboratory results at baseline. both groups had similar ess and pic scores at baseline (p=0.73 and 0.08, respectively). after n-cpap, osas+rls patients showed higher ess and pic scores (p=0.017 and 0.03, respectively). conclusions: despite a favorable general response, n-cpap seemed less effective in treating fatigue and sleepiness in the osas+rls group.
Obstructive Sleep Apnea Syndrome  [cached]
Ahmet Turan Evlice
Arsiv Kaynak Tarama Dergisi , 2012,
Abstract: Obstructive sleep apnea syndrome is characterized by repeated airway collapse during sleep. The syndrome affects adult men more common than women. The most frequent and characteristic nocturnal symptom is snoring, the most important daytime symptom is sleepiness. The social, neuropsychological and cardiovascular consequences of obstructive sleep apnea syndrome cause severe morbidity and mortality. Early diagnosis and treatment of this disease may reduce mortality and morbidity due to cardiovascular causes. [Archives Medical Review Journal 2012; 21(2.000): 134-150]
Obstructive Sleep Apnea Syndrome in Two Subjects with Down Syndrome: Continuous Positive Airway Pressure Contribution on Exercise Tolerance  [PDF]
Thomas Leti, Michel Guinot, Anne Favre-Juvin, Jean-Louis Pepin, Patrick Levy, Veronique A. Bricout
Neuroscience & Medicine (NM) , 2012, DOI: 10.4236/nm.2012.32024
Abstract: In subjects with Down syndrome the obstructive sleep apnea is the cause of many disorders (cognitive and cardiovascular disorders, premature exhaustion, increase of daytime sleepiness). The standard treatment in the obstructive sleep apnea is continuous positive airway pressure, which eliminates the respiratory events, allows recovery of a satisfactory quality of sleep, and suppresses daytime sleepiness and cognitive dysfunction. The aim of this study was to verify the effects of continuous positive airway pressure on aerobic performance, as well as on hormonal and metabolic parameters during exercise, in two young adults with Down syndrome and with obstructive sleep apnea, treated or not, after an interval of 5 years. The main result observed is the beneficial effect on the ability to achieve a longer submaximal exercise with higher intensity in subject receiving the treatment. Obstructive sleep apnea syndrome treatment in people with Down syndrome could improve aerobic capacity and reduce daytime sleepiness.
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