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Dimensions of sleepiness and their correlations with sleep-disordered breathing in mild sleep apnea
Martinez, Denis;Lumertz, Magali Santos;Lenz, Maria do Carmo Sfreddo;
Jornal Brasileiro de Pneumologia , 2009, DOI: 10.1590/S1806-37132009000600003
Abstract: objective: there are many ways of assessing sleepiness, which has many dimensions. in patients presenting a borderline apnea-hypopnea index (ahi, expressed as events/hour of sleep), the mechanisms of excessive daytime sleepiness (eds) remain only partially understood. in the initial stages of sleep-disordered breathing, the ahi might be related to as-yet-unexplored eds dimensions. methods: we reviewed the polysomnography results of 331 patients (52% males). the mean age was 40 ± 13 years, and the mean ahi was 4 ± 2 (range, 0-9). we assessed ten potential dimensions of sleepiness based on polysomnography results and medical histories. results: the ahi in non-rapid eye movement (nrem) stage 1 sleep (ahi-n1), in nrem stage 2 sleep (ahi-n2), and in rem sleep (ahi-rem) were, respectively, 6 ± 7, 3 ± 3 and 10 ± 4. the ahi-n2 correlated significantly with the greatest number of eds dimensions (5/10), including the epworth sleepiness scale score (r = 0.216, p < 0.001). factor analysis, using cronbach's alpha, reduced the variables to three relevant factors: questionnaire (α = 0.7); polysomnography (α = 0.68); and complaints (α = 0.55). we used these factors as dependent variables in a stepwise multiple regression analysis, adjusting for age, gender, and body mass index. the ahi-n1 correlated significantly with polysomnography (β = -0.173, p = 0.003), and the ahi-n2 correlated significantly with complaints (β = -0.152, p = 0.017). the ahi-rem did not correlate with any factor. conclusions: our results underscore the multidimensionality of eds in mild sleep apnea.
Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia
Fumiharu Togo, Benjamin H Natelson, Neil S Cherniack, Jennifer FitzGibbons, Carmen Garcon, David M Rapoport
Arthritis Research & Therapy , 2008, DOI: 10.1186/ar2425
Abstract: We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase.CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group.CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.Chronic fatigue syndrome (CFS) is a medically unexplained condition occurring mostly in women and is characterized by persistent or relapsing fatigue that lasts a
The Role of Daytime Sleepiness in Psychosocial Outcomes after Treatment for Obstructive Sleep Apnea  [PDF]
Esther Yuet Ying Lau,Gail A. Eskes,Debra L. Morrison,Malgorzata Rajda,Kathleen F. Spurr
Sleep Disorders , 2013, DOI: 10.1155/2013/140725
Abstract: We investigated the role of daytime sleepiness and sleep quality in psychosocial outcomes of patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Thirty-seven individuals with moderate to severe OSA and compliant with CPAP treatment for at least 3 months were compared to 27 age- and education-matched healthy controls. The OSA group and the control group were studied with overnight polysomnography (PSG) and compared on measures of daytime sleepiness (Epworth Sleepiness Scale), sleep quality (Pittsburg Sleep Quality Index), mood (Beck Depression Inventory, Profile of Mood States), and functional outcomes (Functional Outcomes of Sleep Questionnaire). After CPAP treatment, the OSA group improved on sleep quality and sleepiness. As a group, they did not differ from controls on sleep architecture after CPAP. The OSA group also showed significant improvements in functional outcomes and was comparable to controls on mood and functional outcomes. Persistent difficulties included lowered activity level and residual sleepiness in some individuals. Sleepiness was found to be a significant predictor of mood and affective states, while both sleepiness and sleep quality predicted functional outcomes. These results highlight the importance of assessment and intervention targeting psychosocial functioning and sleepiness in individuals with OSA after treatment. 1. Introduction Individuals with obstructive sleep apnea-hypopnea syndrome (OSA) experience excessive daytime sleepiness and fatigue, decreased cognitive function and mood changes, resulting in significant, negative consequences in work and driving performance, and lowered quality of life (see review by [1]). Therefore, the evaluation of OSA treatment on both nighttime and daytime consequences of OSA is critical. The most obvious consequence and manifestation of untreated OSA are probably subjective sleepiness and high propensity to fall asleep during the daytime. Engleman and Douglas [2] reviewed 29 studies that measured sleepiness and concluded that at least moderate impairments in terms of excessive daytime sleepiness are indicated in patients with OSA. Accumulating evidence suggests that the main causes of daytime sleepiness in patients with OSA are sleep fragmentation and sleep architecture disruptions [3]. Some propose that sleepiness of patients with more severe OSA may be more related to the breathing disruptions and the associated nocturnal hypoxemia (e.g., [4]). An association between OSA and mood disorders is revealed by studies reporting their comorbidity
OBSTRUCTIVE SLEEP APNOEA HYPOPNEA SYNDROME – AN OVERVIEW
MOHAMAD WHW,ISMAIL T
Malaysian Family Physician , 2011,
Abstract: Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a common cause of breathing-related sleep disorder, causing excessive daytime sleepiness. Common clinical features of OSAHS include snoring, fragmented sleep, daytime somnolence and fatigue. This article aims to provide a comprehensive review of the condition, including its management.
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.
Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan
Jiunn-Horng Kang, Shih-Ching Chen
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-248
Abstract: A total of 160 students underwent a semi-structured interview and completed a survey comprising 4 parts: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and a rating of irregular bedtime frequency. Participants were grouped into 3 groups in terms of irregular bedtime frequency: low, intermediate, or high according to their 2-week sleep log. To screen for psychological disorders or distress that may have affected responses on the sleep assessment measures, the Chinese health questionnaire-12 (CHQ-12) was also administered.We found an increase in bedtime schedule irregularity to be significantly associated with a decrease in average sleep time per day (Spearman r = -0.22, p = 0.05). Multivariate regression analysis revealed that irregular bedtime frequency and average sleep time per day were correlated with PSQI scores, but not with ESS or FSS scores. A significant positive correlation between irregular bedtime frequency and PSQI scores was evident in the intermediate (partial r = 0.18, p = 0.02) and high (partial r = 0.15, p = 0.05) frequency groups as compared to low frequency group.The results of our study suggest a high prevalence of both an irregular bedtime schedule and insufficient sleep among university students in Taiwan. Students with an irregular bedtime schedule may experience poor sleep quality. We suggest further research that explores the mechanisms involved in an irregular bedtime schedule and the effectiveness of interventions for improving this condition.Some behaviours or activities are detrimental to normal sleep have been suggested. These "inadequate sleep hygiene" behaviours include irregular sleep schedules, frequent or prolonged daytime naps, excessive alcohol consumption before bedtime, and staying on one's bed for non-sleep-related activities [1-3]. Accordingly, adequate sleep hygiene is considered to be an important adjuvant for treating patients with insomnia or other sleep disturbances [
Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?  [PDF]
Ulf Kallweit,Christian R. Baumann,Michael Harzheim,Hildegard Hidalgo,Dieter P?hlau,Claudio L. Bassetti,Michael Linnebank,Philipp O. Valko
Multiple Sclerosis International , 2013, DOI: 10.1155/2013/286581
Abstract: Background. Fatigue in patients with multiple sclerosis (MS) is highly prevalent and severely impacts quality of life. Recent studies suggested that sleep-disordered breathing (SDB) significantly contributes to fatigue in MS. Study Objective. To evaluate the importance of routine respirography in MS patients with severe fatigue and to explore the effects of treatment with continuous positive airway pressure (CPAP). Patients and Methods. We prospectively assessed the presence of severe fatigue, as defined by a score of ≥5.0 on the Fatigue Severity Scale (FSS), in 258 consecutive MS patients. Ninety-seven patients (38%) suffered from severe fatigue, whereof 69 underwent overnight respirography. Results. We diagnosed SDB in 28 patients (41%). Male sex was the only independent associate of SDB severity ( ). CPAP therapy in 6 patients was associated with a significant reduction of FSS scores ( versus , ), but the scores remained pathological (≥4.0) in all patients. Conclusion. Respirography in MS patients with severe fatigue should be considered in daily medical practice, because SDB frequency is high and CPAP therapy reduces fatigue severity. However, future work is needed to understand the real impact of CPAP therapy on quality of life in this patient group. 1. Introduction Although fatigue has been increasingly recognized over the past two decades as one of the most frequent and most debilitating symptoms in patients with MS, there are still no insights into its neurobiological mechanisms, and current treatment options are highly frustrating [1–4]. In clinical practice, MS patients complaining about fatigue are usually first scrutinized for additional and potentially treatable comorbidities, such as depression, pain, anemia, or sleep-wake disturbances [5]. If there is no such cause of fatigue, the patient is considered to suffer from “MS-related fatigue,” that is, a disease-inherent symptom related to the underlying neuroimmunological and neurodegenerative processes, and off-label symptomatic treatment with stimulants of the central nervous system may be recommended [3]. Recently, the need to search for sleep-wake disorders in MS patients has been reemphasized, as several groups observed a significant correlation with fatigue [6–10]. Specifically, sleep-disordered breathing (SDB) has been proposed as a potential risk factor for fatigue in MS. In the last year, a cross-sectional study in 48 MS patients suggested a predisposition for SDB [11], and two studies found that severe fatigue in MS was significantly associated with SDB and respiratory-related
Sleep disordered breathing in community psychiatric patients
Anderson,Kirstie N.; Waton,Tony; Armstrong,Daniel; Watkinson,Helen M.; Mackin,Paul;
The European Journal of Psychiatry , 2012, DOI: 10.4321/S0213-61632012000200002
Abstract: background and objectives: sleep disturbance is prominent in many neuropsychiatric disorders and may precipitate or exacerbate a range of psychiatric conditions. few studies have investigated sleep disordered breathing and in particular obstructive sleep apnoea in community psychiatric patients and the commonly used screening instruments have not been evaluated in patients with psychiatric disorders. the objective is to evaluate the prevalence of sleep disordered breathing in a community cohort with chronic mental illness on long term psychotropic medication, and to assess the effectiveness of commonly used screening instruments to detect abnormal sleep. methods: 52 patients completed sleep questionnaires and 50 undertook overnight oximetry. results: 52% (n = 26) had sleep-disordered breathing; 20% (n = 10) had moderate/severe sleep apnoea. the epworth sleepiness score and the pittsburgh sleep quality inventory did not predict sleep disordered breathing. conclusions: patients with psychiatric disorders in the community have a high rate of undiagnosed sleep disordered breathing, which is not reliably detected by established sleep disorder screening questionnaires.
Sleep disordered breathing in community psychiatric patients  [cached]
Kirstie N. Anderson,Tony Waton,Daniel Armstrong,Helen M. Watkinson
The European Journal of Psychiatry , 2012,
Abstract: Background and Objectives: Sleep disturbance is prominent in many neuropsychiatric disorders and may precipitate or exacerbate a range of psychiatric conditions. Few studies have investigated sleep disordered breathing and in particular obstructive sleep apnoea in community psychiatric patients and the commonly used screening instruments have not been evaluated in patients with psychiatric disorders. The objective is to evaluate the prevalence of sleep disordered breathing in a community cohort with chronic mental illness on long term psychotropic medication, and to assess the effectiveness of commonly used screening instruments to detect abnormal sleep. Methods: 52 patients completed sleep questionnaires and 50 undertook overnight oximetry. Results: 52% (n = 26) had sleep-disordered breathing; 20% (n = 10) had moderate/severe sleep apnoea. The Epworth Sleepiness Score and the Pittsburgh Sleep Quality Inventory did not predict sleep disordered breathing. Conclusions: Patients with psychiatric disorders in the community have a high rate of undiagnosed sleep disordered breathing, which is not reliably detected by established sleep disorder screening questionnaires.
Fatigue, Tiredness, Lack of Energy, and Sleepiness in Multiple Sclerosis Patients Referred for Clinical Polysomnography  [PDF]
Tiffany J. Braley,Ronald D. Chervin,Benjamin M. Segal
Multiple Sclerosis International , 2012, DOI: 10.1155/2012/673936
Abstract: Objectives. To assess the relationship between nocturnal polysomnographic (PSG) findings and a group of key self-reported symptoms—fatigue, tiredness, lack of energy, and sleepiness—among sleep-laboratory referred patients with and without multiple sclerosis (MS). Methods. PSG and questionnaire data from MS patients and matched controls were analyzed retrospectively. Associations between symptoms of fatigue, tiredness, lack of energy, sleepiness, and PSG variables of interest were examined among MS patients and controls. Results. More MS patients than controls reported fatigue, tiredness, and lack of energy to occur often or almost always (Chi-square for each), but sleepiness was reported similarly by both groups ( ). Among MS patients, tiredness correlated with sleepiness (Spearman correlation ), and a trend emerged toward correlation between fatigue and sleepiness (Spearman correlation ). Decreased sleep efficiency on PSGs correlated with fatigue, tiredness, and lack of energy in MS patients (Spearman correlation , 0.029, and 0.048, resp.), but not sleepiness or any symptom among controls. Conclusion. In comparison to controls, MS patients report more fatigue, tiredness, and lack energy, but not sleepiness. Fatigue and related symptoms may arise from MS itself or in relation to reduced sleep efficiency. 1. Introduction Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes myelin destruction and axonal damage in the brain and spinal cord. It is the leading cause of nontraumatic neurological disability among young adults and is associated with a variety of debilitating symptoms, including fatigue. Fatigue is the most common symptom experienced by persons with MS, affecting up to 90% of patients at some point in their disease course [1–3]. Fatigue imposes significant socioeconomic consequences, including loss of work hours and employment [4], and is a prominent cause of diminished quality of life among individuals with MS [3]. Despite its prevalence in MS as well as other medical conditions, there is no unified definition for fatigue. Consequently, there is potential for considerable overlap between fatigue and other subjective terms commonly used by MS patients to describe lack of energy or alertness, including sleepiness. Sleep disorders are traditionally recognized for their contributions to excessive daytime sleepiness. However, many subjects in the general population who have sleep disorders such as obstructive sleep apnea report that problems with fatigue, tiredness, or lack of energy supersede problems with
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