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Background: One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it. Methods: Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self‐report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information. Results: Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre‐indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post‐indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression. Conclusion: This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences. [ABSTRACT FROM AUTHOR]

This study aimed to progress the understanding of idiopathic hypersomnia (IH) by assessing the moderating influence of individual characteristics, such as age, sex, and body mass index (BMI) on sleep architecture. In this retrospective study, 76 IH participants (38.1 ± 11.3 years; 40 women) underwent a clinical interview, an in-laboratory polysomnography with a maximal 9-h time in bed and a multiple sleep latency test (MSLT). They were compared to 106 healthy controls (38.1 ± 14.1 years; 60 women). Multiple regressions were used to assess moderating influence of age, sex, and BMI on sleep variables. We used correlations to assess whether sleep variables were associated with Epworth Sleepiness Scale scores and mean sleep onset latency on the MSLT in IH participants. Compared to controls, IH participants had shorter sleep latency (p = 0.002), longer total sleep time (p < 0.001), more time spent in N2 sleep (p = 0.008), and showed trends for a higher sleep efficiency (p = 0.023) and more time spent in rapid eye movement (REM) sleep (p = 0.022). No significant moderating influence of age, sex, or BMI was found. More severe self-reported sleepiness in IH patients was correlated with shorter REM sleep latency and less N1 sleep in terms of proportion and duration (ps < 0.01). This study shows that, when compared to healthy controls, patients with IH had no anomalies in their sleep architecture that can explain their excessive daytime sleepiness. Moreover, there is no moderating influence of age, sex, and BMI, suggesting that the absence of major group differences is relatively robust. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Turkish Sleep Medicine is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The purpose of this study was to develop a screening tool that is simple and easy to use for assessing sleep problems, including hypersomnolence, restless legs syndrome, and insomnia. We also examined the reliability and validity of this tool. Methods: We developed the Sleep Problem Screening Questionnaire (SPSQ), which consists of three sub-sections: insomnia (SPSQi), hypersomnolence (SPSQh), and restless legs syndrome (SPSQr). Subsequently, the participants, consisting of 222 patients with insomnia disorder and 78 healthy individuals, completed both the SPSQ and the comparative scale (Korean version of the Insomnia Severity Index). The analysis was then conducted using this data. Results: The SPSQ demonstrated good convergent and discriminant validity, as well as satisfactory internal consistency. A cutoff score of 6 on the SPSQi was found to be optimal for distinguishing individuals with insomnia. Conclusion: The results of this study suggest that the SPSQ is a reliable and valid tool for screening sleep problems among general adult population. However, there is a limitation as a comparison and validation with scales related to restless legs syndrome and hypersomnolence were not conducted. [ABSTRACT FROM AUTHOR]

Summary: Little attention has been paid to the long‐term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow‐up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence. [ABSTRACT FROM AUTHOR]

Abstract:Introduction: Sleep is crucial for athletes' recovery and performance while overtraining can negatively affect sleep quantity and sleep quality. We present a case of a 16-year-old female athlete exploring the reciprocal negative effects of overtraining and sleep problems on each other. Methods: A flyer of a high school cheerleading team with a history of injuries, irregular menses, chronic fatigue, and various sleep-related complaints presented with declining athletic performance. Results: After medical causes were ruled out, sleep disorders such as insomnia, restless legs syndrome and delayed sleep phase were identified and treated. Despite treatment, her daytime sleepiness and sleep attacks persisted and thus necessitated further investigation. Comprehensive sleep studies, including actigraphy, polysomnography, and multiple sleep latency testing, ultimately revealed insufficient sleep syndrome as the underlying cause. Notably, periods of reduced training intensity coincided with significant improvements in her daytime sleepiness. Conclusion: This case highlights the importance of comprehensive sleep-wake assessments for adolescent athletes to accurately diagnose sleep disorders in the context of overtraining. Prioritizing sleep is crucial for optimizing athletic performance in young athletes by preventing and managing overtraining-related sleep disorders. [ABSTRACT FROM AUTHOR]

Background and purpose: Despite their detrimental impact on the quality of life in autoimmune encephalitis, sleep disorders have not been investigated in anti‐glutamic acid decarboxylase (GAD65) associated neurological syndromes. Methods: Six consecutive adult patients diagnosed with anti‐GAD65‐associated neurological syndromes (four with limbic encephalitis and two with stiff‐person syndrome) and 12 healthy controls were enrolled. Participants underwent sleep interviews and sleep studies including night‐time video‐polysomnography, followed by five daytime multiple sleep latency tests (MSLTs, to assess propensity to fall asleep) and an 18 h bed rest polysomnography (to assess excessive sleep need). Results: Patients reported the need for daily naps and that their cognition and quality of life were altered by sleepiness, but they had normal scores on the Epworth sleepiness scale. Compared with controls, sleep latencies during the MSLT were shorter in the patient group (median 5.8 min, interquartile range [IQR] 4.5, 6.0 vs. 17.7 min, IQR 16.3, 19.7, p = 0.001), and the arousal index was reduced (2.5/h, IQR 2.3, 3.0 vs. 22.3/h, IQR 13.8, 30.0, p = 0.002), although total sleep time was similar between groups (621 min, IQR 464, 651 vs. 542.5 min, IQR 499, 582, p = 0.51). Remarkably, all six patients had MSLT latencies ≤8 min, indicating severe sleepiness. No parasomnia or sleep‐disordered breathing was detected. Conclusion: Central hypersomnia is a relevant characteristic of anti‐GAD65‐associated neurological syndromes. [ABSTRACT FROM AUTHOR]

Biological, environmental, behavioral, and social factors can influence sleep and lead to sleep disorders or diseases. Sleep disorders are common, numerous, and heterogeneous in terms of their etiology, pathogenesis, and symptomatology. The management of sleep–wake circadian disorders (SWCDs) includes education on sleep hygiene, behavioral strategies, psychotherapy (cognitive behavioral therapy (CBT), particularly), instrument-based treatments (i.e., positive airway pressure therapy, hypoglossal nerve stimulation), and pharmacotherapy. Depending on the disease, therapy varies and is executed sequentially or can be a combination of several forms of therapy. Drugs used for SWCDs include traditional sleep- or wake-promoting agents and chronotherapeutic agents. Recently, novel medications, which more precisely act on specific neurochemical systems (i.e., the orexin system) important for sleep and waking, are also increasingly being used. In this review, the pharmacotherapy of common sleep disorders (insomnia, sleep-related breathing disorder, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders) embedded in the overall therapeutic concept of each disorder is presented. There is also an outlook on possible future pharmacotherapies. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Obstructive sleep apnea (OSA) is underdiagnosed, partially from variable clinical presentations. Emphasis is often placed on Epworth Sleepiness Scale (ESS), a subjective measure of sleepiness, but variable in OSA. We hypothesized that daytime complaints measured with Language of Sleepiness Questionnaire (LOS) in OSA are not being captured by ESS. Methods: Adults referred to a tertiary sleep clinic undergoing sleep studies completed ESS and LOS questionnaires (20 items with various patient-reported descriptors). LOS was examined in patients who had or did not have OSA without sleepiness based on ESS < 10. Cluster analysis was performed to assess whether or not groups of individuals differed based on classification with or without OSA and with or without ESS-based sleepiness. Results: Approximately half the study population (n = 185 completed) had OSA. ESS score (mean ± SD) was 9.0 ± 5.4. There was no significant difference in ESS between patients with and without OSA (9.0 ± 5.1 vs 9.1 ± 5.7, p = 0.969). In patients with OSA, females, older patients and white patients were significantly less likely to have an ESS ≥ 10 when compared to patients with an ESS < 10. In patients with an ESS < 10, there were no significant differences in descriptors of sleepiness between patients with and without OSA with the most common descriptors selected being "I lack energy," "I wake up sleepy," "I keep waking up," and "I don't sleep enough." Conclusions: The ESS failed to discriminate patients with OSA from those without OSA. Despite an ESS < 10, both daytime and sleep complaints using the LOS questionnaire were present in patients with OSA. Asymptomatic OSA may be less common than previously reported. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to develop a screening tool that is simple and easy to use for assessing sleep problems, including hypersomnolence, restless legs syndrome, and insomnia. We also examined the reliability and validity of this tool. Methods: We developed the Sleep Problem Screening Questionnaire (SPSQ), which consists of three sub-sections: insomnia (SPSQi), hypersomnolence (SPSQh), and restless legs syndrome (SPSQr). Subsequently, the participants, consisting of 222 patients with insomnia disorder and 78 healthy individuals, completed both the SPSQ and the comparative scale (Korean version of the Insomnia Severity Index). The analysis was then conducted using this data. Results: The SPSQ demonstrated good convergent and discriminant validity, as well as satisfactory internal consistency. A cutoff score of 6 on the SPSQi was found to be optimal for distinguishing individuals with insomnia. Conclusion: The results of this study suggest that the SPSQ is a reliable and valid tool for screening sleep problems among general adult population. However, there is a limitation as a comparison and validation with scales related to restless legs syndrome and hypersomnolence were not conducted. [ABSTRACT FROM AUTHOR]

Background: Hypersomnolence has been considered a prominent feature of seasonal affective disorder (SAD) despite mixed research findings. In the largest multi-season study conducted to date, we aimed to clarify the nature and extent of hypersomnolence in SAD using multiple measurements during winter depressive episodes and summer remission. Methods: Sleep measurements assessed in individuals with SAD and nonseasonal, never-depressed controls included actigraphy, daily sleep diaries, retrospective self-report questionnaires, and self-reported hypersomnia assessed via clinical interviews. To characterize hypersomnolence in SAD we (1) compared sleep between diagnostic groups and seasons, (2) examined correlates of self-reported hypersomnia in SAD, and (3) assessed agreement between commonly used measurement modalities. Results: In winter compared to summer, individuals with SAD (n = 64) reported sleeping 72 min longer based on clinical interviews (p < 0.001) and 23 min longer based on actigraphy (p = 0.011). Controls (n = 80) did not differ across seasons. There were no seasonal or group differences on total sleep time when assessed by sleep diaries or retrospective self-reports (p 's > 0.05). Endorsement of winter hypersomnia in SAD participants was predicted by greater fatigue, total sleep time, time in bed, naps, and later sleep midpoints (p 's < 0.05). Conclusion: Despite a winter increase in total sleep time and year-round elevated daytime sleepiness, the average total sleep time (7 h) suggest hypersomnolence is a poor characterization of SAD. Importantly, self-reported hypersomnia captures multiple sleep disruptions, not solely lengthened sleep duration. We recommend using a multimodal assessment of hypersomnolence in mood disorders prior to sleep intervention. [ABSTRACT FROM AUTHOR]

Objective Adult attention-deficit/hyperactivity disorder (ADHD) is characterized by a dysexecutive syndrome reflected in cognitive, emotional, and behavioral areas. Independently of a formal diagnosis of ADHD, higher ADHD symptoms are associated with higher levels of insomnia and sleepiness symptoms in adult population-based samples. Insomnia and sleepiness are sleep disorders that are both associated with deficits in several aspects of executive functions which in turn are likely to mimic a range of ADHD symptoms. Our objective was to explore the interrelationships between ADHD, insomnia, and sleepiness symptoms and executive functioning in community-dwelling adults. Method A total of 442 participants (18–89 years, 56% females) underwent a semistructured clinical interview and completed questionnaires for insomnia, sleepiness, and everyday behaviors in which executive functions are implicated. Mediation Models were applied. Results Insomnia and sleepiness symptoms did not play a mediating role between ADHD symptoms and executive functioning. Conversely, our results highlighted a mediating effect of daytime insomnia consequences and sleepiness on ADHD symptoms via behavioral regulation executive symptoms (respectively, β  = −0.32, p  < .001, 95% CI [−0.46, −0.20]; β  = 0.09, p  < .05, 95% CI [0.02, 0.16]) and metacognitive executive symptoms (respectively, β  = −0.30, p  < .001, 95% CI [−0.44, −0.18]; β  = 0.12, p  < .01, 95% CI [0.04, 0.22]). Conclusions Daytime insomnia consequences and sleepiness symptoms could lead to ADHD-like symptoms through their associated executive symptoms expressed in daily life. When faced with symptoms suggestive of ADHD in adults, insomnia and sleepiness should be systematically screened with standardized instruments. [ABSTRACT FROM AUTHOR]

Summary: Patients with narcolepsy or idiopathic hypersomnia (IH) are at increased risk of driving accidents. Both excessive daytime sleepiness, i.e. unwanted sleep episodes during the day, and disturbed vigilance are core features of these disorders. We tested on‐the‐road driving performance of patients with narcolepsy or IH coming in for a routine driving fitness evaluation and examined: (1) correlations between driving performance and the Maintenance of Wakefulness Test (MWT), Sustained Attention to Response Task (SART) and Psychomotor Vigilance Test (PVT) as objective tests; (2) the predictive power of the MWT and SART for increased risk of impaired driving; (3) the best set of objective predictors for increased risk of impaired driving. Participants were 44 patients (aged 18–75 years) with narcolepsy type 1 (NT1), type 2 (NT2) or IH. They completed the MWT, SART, PVT, a subjective sleepiness questionnaire, and a standardised on‐the‐road driving test. The standard deviation of the lateral position (SDLP) was used as outcome measure of driving performance. The MWT had low correlation with the SDLP (ρ = −0.41 to −0.49, p < 0.01). The SART and PVT had low correlations with SDLP (ρ = 0.30 and ρ = 0.39, respectively, both p < 0.05). The predictive power of MWT for an increased risk of impaired driving was significant, but low (area under the curve = 0.273, p = 0.012), and non‐significant for SART. We conclude that in our present group, none of the tests had adequate ability to predict impaired driving, questioning their use for clinical driving fitness evaluation in narcolepsy and IH. Real‐time monitoring of sleepiness while driving seems more promising in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Psychiatry & Clinical Psychology / Psychiatria i Psychologia Kliniczna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Narcolepsy is a chronic neurologic disorder associated with the dysregulation of the sleep–wake cycle that often leads to a decreased quality of life and results in a considerable health burden. There is often a delay to diagnosis of narcolepsy, mainly due to the lack of recognition of this disorder. One of the main factors hindering the diagnosis of narcolepsy is the association of comorbidities, which include other sleep disorders, psychiatric disorders, cardiovascular disorders, and metabolic disorders. The signs and symptoms of these comorbidities often overlap with those of narcolepsy, and some of the medications used for their treatment may obscure the symptoms of narcolepsy, leading to a delay in diagnosis. This review is targeted to clinicians unaccustomed to working with sleep disorders and aims to increase recognition and improve the management of narcolepsy. [ABSTRACT FROM AUTHOR]

Craniopharyngiomas are rare solid or mixed solid and cystic tumors that arise from Rathke's pouch remnants along the pituitary-hypothalamic axis, from the sella turcica to the brain third ventricle. Both the tumor and its treatment can lead to significant neurological and endocrinological complications. Due to the essential role of the hypothalamus in the complex neurophysiologic process of sleep, tumors involving the hypothalamic area may be responsible for disturbances in sleep–wake regulation with alterations in the circadian rhythm, sleep fragmentation, and increased daytime sleepiness. We report two cases of patients with craniopharyngioma, who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes. A comprehensive clinical data collection and a targeted diagnostic work-up led to a diagnosis of severe sleep disorder characterized by hypersomnia, altered sleep–wake rhythm, and sleep-related breathing disorder. In addition, the polysomnography revealed peculiar alterations in the sleep structure. The diagnostic work-up lead to an accurate differential diagnosis between epileptic seizures and episodes expressions of sleep disturbances. These clinical features can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment. Diagnosis of sleep disorders is crucial, considering the impact of sleep on general health, cognition, and neuropsychological functioning. These findings support the need to incorporate a comprehensive sleep evaluation in childhood brain tumor involving the suprasellar/hypothalamic region. [ABSTRACT FROM AUTHOR]

Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults, and is primarily characterized by muscle weakness and myotonia, yet some of the most disabling symptoms of the disease are cognitive and behavioral. Here we evaluated several of these non-motor symptoms from a cross-sectional time-point in one of the largest longitudinal studies to date, including full-scale intelligence quotient, depression, anxiety, apathy, sleep, and cerebral white matter fractional anisotropy in a group of 39 adult-onset myotonic dystrophy type 1 participants (27 female) compared to 79 unaffected control participants (46 female). We show that intelligence quotient was significantly associated with depression (P < 0.0001) and anxiety (P = 0.018), but not apathy (P < 0.058) or hypersomnolence (P = 0.266) in the DM1 group. When controlling for intelligence quotient, cerebral white matter fractional anisotropy was significantly associated with apathy (P = 0.042) and hypersomnolence (P = 0.034), but not depression (P = 0.679) or anxiety (P = 0.731) in the myotonic dystrophy type 1 group. Finally, we found that disease duration was significantly associated with apathy (P < 0.0001), hypersomnolence (P < 0.001), IQ (P = 0.038), and cerebral white matter fractional anisotropy (P < 0.001), but not depression (P = 0.271) or anxiety (P = 0.508). Our results support the hypothesis that cognitive deficits, hypersomnolence, and apathy, are due to the underlying neuropathology of myotonic dystrophy type 1, as measured by cerebral white matter fractional anisotropy and disease duration. Whereas elevated symptoms of depression and anxiety in myotonic dystrophy type 1 are secondary to the physical symptoms and the emotional stress of coping with a chronic and debilitating disease. Results from this work contribute to a better understanding of disease neuropathology and represent important therapeutic targets for clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: The effects of caffeine on drowsiness and reaction time in patients with narcolepsy are unclear. We aimed to assess the effects of caffeine as add-on therapy in narcolepsy patients. Methods: A randomized, double-blind, placebo-control clinical pilot trial was conducted with a parallel, two-arm trial allocation ratio of 1:1. Participants attended two study visits 7 days apart. The drug was administered orally in a single opaque capsule containing 200 mg caffeine/placebo daily in the morning for 1 week. Sleepiness was assessed objectively using infrared reflectance oculography to measure the percentage of long eye closure (LEC%) and subjectively using two sleepiness scales, the Stanford Sleepiness Scale (SSS) and Karolinska Sleepiness Scale (KSS). Parameters were measured at baseline (BL) prior to taking the drug, after taking the first dose (FD), and after 1 week (WD) of daily caffeine. Results: Sixteen participants with narcolepsy were included. No significant differences between groups in baseline measurements were observed. LEC% was significantly decreased after the FD and WD compared with baseline levels (BL 1.4 ± 2.1 vs. FD 0.06 ± 0.0.6 and WD 0.03 ± 0.04). Significant improvements in alertness were observed using the KSS when comparing BL with FD and WD (6.3 ± 1.6, 4.9 ± 1.7, and 4.7 ± 1.7, respectively; p = 0.01). No changes in reaction time or SSS scores were noted. Conclusion: Our findings suggest that a small dose of caffeine has positive effects on alertness in patients with narcolepsy. However, larger trials are required to confirm these findings. Trial registration no.: ClinicalTrial.gov NCT02832336 [ABSTRACT FROM AUTHOR]

The thalamus and the mesencephalon have a complex blood supply. The artery of Percheron (AOP) is a rare anatomical variant. Occlusion of this artery may lead to bithalamic stroke with or without midbrain involvement. Given its broad spectrum of clinical features, AOP stroke is often misdiagnosed. Usually, it manifests with the triad of vertical gaze palsy, memory impairment, and coma. In this article, we report three cases of bilateral thalamic strokes whose clinical presentations were dominated by a sudden onset of hypersomnia. We also reviewed last 5 years' publications related to the AOP strokes in males presenting sleepiness or equivalent terms as a delayed complication. The AOP stroke may present a diagnostic challenge for clinicians which should be considered in the differential diagnosis of hypersomnia. [ABSTRACT FROM AUTHOR]

Purpose: This case-control study assessed the prevalence of psychiatric disorders in Arab (Saudi) patients with narcolepsy using a structured clinical interview. Methods: The study included 74 adult patients with narcolepsy and 265 controls matched for age and sex. Narcolepsy diagnosis was made according to the International Classification of Sleep Disorders-Third Edition. Psychiatric disorders were diagnosed via using a validated Arabic version of the Mini International Neuropsychiatric Interview DSM-IV (MINI version 6). A multivariate logistic regression model was used to assess the potential influence of narcolepsy on the comorbidity of psychiatric disorders. Results: The mean age of the patients was 29.4 ± 10.2 years, and males accounted for 81% of the study sample. Forty-four patients (60%) were diagnosed with narcolepsy type-1 (NT1) and 30 (40%) with narcolepsy type-2 (NT2). Psychiatric disorders were diagnosed in 45% of patients with narcolepsy compared with 15% of the controls (p < 0.001). The multivariate logistic regression models demonstrated that compared with the controls, patients with narcolepsy were more likely to have major depressive disorders (OR, 4.3 [CI, 2.2–8.2]), and generalized anxiety disorders (OR, 9.5 [CI, 1.8–50.2]). No difference was detected between the prevalence of various psychiatric disorders in patients with NT1 and NT2. Conclusion: Comorbid psychiatric disorders are common among Arab (Saudi) patients with narcolepsy compared with the general population. Therefore, clinicians should be aware of the comorbidity of narcolepsy and psychiatric disorders, particularly depression. [ABSTRACT FROM AUTHOR]

We describe an 11-year-old female who presented with severe hypersomnolence after receiving 1 week of modest doses of clobazam (CLB). In reviewing the above case, we considered that the hypersomnolence could be related to a pharmacodynamic, pharmacokinetic, or pharmacogenomic issue associated with CLB or to a combination of these factors. Although serum concentrations of CLB and its active metabolite are sensitive to factors that affect cytochrome-dependent metabolism, drug-drug interactions were omitted as a cause of the hypersomnolence. Subsequent DNA analysis of the cytochrome P450 2C19 gene revealed the patient as *2/*2 genotype with poor metabolizer enzyme activity. Because genetic testing of all patients treated with CLB is currently not practical, CLB dose/concentration ratios and pharmacokinetic drug-drug interaction impact models may be indicated. Genetic testing should be considered when an adverse effect suggests the possibility of a polymorphism important to drug metabolism. [ABSTRACT FROM AUTHOR]

Purpose: Patients with obstructive sleep apnea (OSA) commonly report residual excessive daytime sleepiness (EDS) despite treatment with positive airway pressure (PAP). The present study aimed to determine whether patients presenting with subjective sleepiness after treatment with PAP therapy had objective evidence of residual sleepiness. Methods: We conducted a retrospective analysis of 29 adults with OSA on PAP therapy who underwent a standardized evaluation for EDS. Patients were evaluated with the Epworth Sleepiness Scale (ESS) and attend an in-lab polysomnogram (PSG) with PAP followed by a multiple sleep latency test (MSLT). Results: Our cohort consisted of 23 men (79%) and 6 women (21%) with a mean age of 40.7 years. All patients were subjectively sleepy with an ESS score of > 10 and met minimal PAP usage of 4 h a night for at least 70% of nights with a residual apnea-hypopnea index (AHI) ≤ 10. On MSLT, 31% of patients had an average sleep onset latency (SOL) < 8 min, 35% had a SOL between 8 and 11 min, and 35% had SOL > 11 min. Conclusion: After optimizing PAP therapy and sleep in patients with OSA and residual EDS, the majority were found to have objective findings of an abnormally short SOL on MSLT. This is further evidence that there is a distinct OSA phenotype that will have persistent EDS despite appropriate treatment of their sleep-disordered breathing. Objective testing to quantify the degree of sleepiness is recommended for OSA patients with residual EDS. [ABSTRACT FROM AUTHOR]

Objective: Poor sleep may increase obesity and type 2 diabetes (T2D) risk in youth. We explored whether subjective sleep duration, sleep quality, or risk for obstructive sleep apnea (OSA) are associated with glycemia, body mass index (BMI), or blood pressure (BP) in overweight/obese youth. Methods: Two‐hundred and fourteen overweight/obese youth of 10 to 19 years of age at risk for or recently diagnosed with T2D who were screened for the Restoring Insulin Secretion (RISE) Study had a 2‐hour oral glucose tolerance test (OGTT) and completed a Cleveland Adolescent Sleepiness questionnaire and a Sleep Disturbances Scale questionnaire. Independent associations between sleep variables and measures of glycemia, BMI, and BP were evaluated with regression models. Results: The multiethnic cohort was 67% female, 14.1 ± 2.1 years, and BMI 35.9 ± 6.5 kg/m2. Habitual sleep duration <8 hours was reported in 74%. Daytime sleepiness was reported in 51%, poor sleep quality in 26%, and 30% had high obstructive sleep apnea (OSA) risk. Daytime sleepiness was associated with higher HbA1c (0.2%, P =.02) and 2‐hour glucose (13.6 mg/dL, P < .05). Sleep duration, sleep quality, and OSA risk were not associated with the evaluated outcomes. Poor sleep quality and OSA risk were associated with higher BMI (2.9 kg/m2, P =.004 and 2.83 kg/m2, P < .003, respectively). Conclusions: In overweight/obese youth with or at risk for T2D, daytime sleepiness was associated with higher HbA1c. In addition, poor sleep quality and OSA risk were associated with higher BMI. These findings support intervention studies aimed at improving sleep quality in obese youth. [ABSTRACT FROM AUTHOR]

Background Sarcopenia is emerging as an important public health problem, and evidences have determined that poor sleep is associated with muscle strength, but the potential effects of excessive daytime sleepiness (EDS), snoring and witnessed apnea on handgrip strength have not been evaluated. Aim We aimed to examine the association between EDS, snoring, witnessed apnea and muscle strength in an adult population. Design Cross-sectional study. Methods This cross-sectional study comprised 19 434 adults. Handgrip strength was measured using a handheld digital dynamometer. EDS was assessed by Epworth Sleepiness Scale, snoring and witnessed apnea during sleep were reported through simple yes/no questions. Analysis of covariance was carried out to determine the association between EDS with snoring or witnessed apnea and muscle strength. Results The means (95% confidence interval) for average handgrip strength/body weight (kg/kg) across symptoms categories were 0.396 (0.333–0.472), 0.393 (0.330–0.467), 0.396 (0.333–0.471) and 0.386 (0.325–0.460) (P  <   0.0001), respectively. Similar results were observed with maximal handgrip strength/body weight (kg/kg). Conclusions Self-reported EDS accompanied with snoring or apnea is associated with lowest handgrip strength, independently of confounding factors. Whether improvement of EDS, snoring and apnea, can ameliorate age-associated decline in muscle strength warrants further studies. [ABSTRACT FROM AUTHOR]

Purpose of review: The aim of this review is to discuss and summarize the main therapeutic strategies for the management of excessive daytime sleepiness (EDS) in patients with narcolepsy. An overview of novel therapies and potential future options are covered as well. Recent findings: First line treatments for EDS in narcolepsy patients include modafinil/armodafinil and sodium oxybate. Other options with a stimulant effect, such as methylphenidate and amphetamines are considered if the former do not control the symptoms. More recently, pitolisant (H3 receptor inverse agonist) was approved by the European Medicines Agency, and solriamfetol (dopamine and norepinephrine reuptake inhibitor) by the Food and Drug Administration, for the treatment of EDS in adult narcolepsy patients. Sodium oxybate was recently approved for EDS management in paediatric patients from the age of seven. Further studies involving the paediatric population are warranted to have solid evidence in the management of children with narcolepsy. Ongoing research of new molecules is based on several mechanisms of action (histamine antagonists/inverse agonists, GABA receptor modulators), and potential future strategies involve immunologic treatment and hypocretin-based therapies. Summary: Additionally to the wakefulness-promoting agents and stimulants classically used, other pharmacologic options have been recently approved for the treatment of EDS in Europe (pitolisant) and the US (solriamfetol). Emerging treatments are under development; newly developed wakefulness-promoting agents act via different mechanisms of action, whereas other forms of therapy are focused in the underlying hypocretin deficiency that characterizes narcolepsy type 1. [ABSTRACT FROM AUTHOR]

Previous studies reported high sensitivity and specificity of the Swiss Narcolepsy Scale (SNS) for the diagnosis of narcolepsy type 1. We used data from the Bern Sleep–Wake Database to investigate the discriminating capacity of both the SNS and the Epworth Sleepiness Scale (ESS) to identify narcolepsy type 1 and type 2 in patients with central disorders of hypersomnolence (CDH) or sleepy patients with obstructive sleep apnea (OSA). In addition, we aimed to develop a simplified version of the SNS. We created the two-item short-form SNS (sSNS), based on the discriminative capability of the models including all possible combinations of the five questions of the SNS. Using the previously published co-efficiencies, we confirmed the high capacity of the SNS in identifying narcolepsy type 1. The updated SNS (based on new co-efficiencies and cutoff) and the sSNS showed high capacity and were both superior to ESS in identifying narcolepsy type 1. The sSNS correlated significantly with the SNS (r = − 0.897, p < 0.001). No scale showed sufficient discrimination for narcolepsy type 2. This is the largest cohort study that confirms the discriminating power of SNS for narcolepsy type 1 in patients with hypersomnolence and the first study to assess its discriminative power for narcolepsy type 2. The easy-to-use and easy-to-calculate short-form scale has a high discriminating power for narcolepsy type 1 and may be used as screening tool, especially among general practitioners, to identify patients and accelerate their referral to a center of expertise. [ABSTRACT FROM AUTHOR]

Background and Objectives: We aimed to evaluate effects of endonasal dilators (END) on sleep quality in patients with obstructive sleep apnea (OSA) by improving nasal airflow. Materials and Method: In 13 patients with OSA, changes of total nasal volume (TNV) and minimal cross-sectional area (MCA) before and after END use were evaluated. The change in peak nasal inspiratory flow (PNIF) was also measured. Subjects completed Epworth Sleepiness Scale questionnaire before and 2 weeks after END use. Finally, changes in apnea-hypopnea index (AHI), respiratory distress index (RDI), oxygen desaturation index (ODI), sleep time, sleep position and loudness of snoring (in decibels) were obtained by repetitive portable polysomnography. Results: After END use, TNV (11.4±3.1 cm³ to 19.4±5.7 cm3) and MCA (0.7±0.2 cm2 to 0.9±0.1 cm2) increased significantly (p=0.001). PNIF also increased significantly after END (147.3±39.5 to 194.6±57.6 liter/min, p=0.001). Among 11 patients undergoing 2-week follow-up, 7 reported improvement in daytime sleepiness. Although AHI, RDI and ODI showed no statistically significant change before and after END (p＞0.05), the proportion of subjects sleeping in the supine position increased from 38.0 to 44.5%. Conclusion: END may be an effective adjunctive tool for patients with OSA with the potential to improve nasal airflow and daytime sleepiness. [ABSTRACT FROM AUTHOR]

Purpose: Symptomatic narcolepsy is characterized as low orexin (hypocretin) levels (≤ 110 pg/ml) due to neurological diseases. However, we have experienced the cases that show symptoms similar to narcolepsy, complaining of pathological sleepiness even in cases with intermediate orexin levels (110-200 pg/ml). Therefore, we reevaluated the previously reported cases to make the concept of disease to the group in which the orexin concentration is intermediate.Methods: Although orexin-deficient symptomatic narcolepsy has been reported worldwide, facilities that are capable of measuring orexin are still limited. Currently, our laboratory handles with almost all the CSF samples from Asian countries for determining orexin levels. We measured over 2500 cases including 182 cases suspected of symptomatic narcolepsy/hypersomnolence. Therefore, we subdivided these cases into three groups according to CSF orexin levels, low orexin group (≤ 110 pg/ml), intermediate orexin group (110-200 pg/ml), and normal orexin group (> 200 pg/ml). We defined "symptomatic hypersomnia" for hypersomnolence cases with intermediate CSF orexin levels. MSLT was recommended but not necessary. Short sleep latency (< 8 min) without SOREMPs should be observed on MSLT when performed. We compared symptoms (excessive daytime sleepiness and cataplexy) and objective measures (mean sleep latency and number of SOREMPs in MSLT) among the three groups, attempting to characterize the "symptomatic hypersomnia" group.Result: Among the 182 cases with clinical hypersomnolence, there were 32 cases of symptomatic narcolepsy (16%) and 14 cases of symptomatic hypersomnia (8%). Causative diseases of symptomatic narcolepsy cases consist of immune-mediated demyelinating disorders (34%) and neurodegenerations (19%), whereas those of symptomatic hypersomnia are immune-mediated demyelinating disorders (43%) and encephalopathies (14%). Significant differences were not found between orexin levels and the existence of cataplexy, SOREMPs, and short sleep latency among three hypersomnolence groups. From these results, we found that it is difficult to estimate orexin concentration from subjective symptoms and PSG/MSLT findings.Conclusion: We identified that 32 symptomatic narcolepsy and 14 cases of symptomatic hypersomnolence with intermediate CSF orexin levels. We proposed these latter cases as a novel category of "symptomatic hypersomnia". Currently, symptomatic hypersomnia cases with intermediate orexin levels or short sleep latency (< 8 min) without SOREMPs were not classified as a specific entity. However, symptomatic hypersomnia had similar severity of hypersomnolence symptoms to symptomatic narcolepsy. Therefore, these cases including equivalent pathophysiology are enough to make a comparable category as "symptomatic hypersomnia". Since it is difficult to estimate the orexin concentration from subjective symptoms and physiological findings (PSG/MSLT), further studies for the characterization of "symptomatic hypersomnia" and understanding its pathophysiology are necessary. [ABSTRACT FROM AUTHOR]

Objective: Prevalence rates of sleep difficulties in advanced cancer patients have varied widely across studies (12 to 96%), and none of these employed a diagnostic interview to distinguish different types of sleep-wake disorders. Moreover, very limited information is available on subjective and objective sleep parameters in this population. Our study was conducted in palliative cancer patients and aimed to assess rates of sleep-wake disorders and subsyndromal symptoms and to document subjective and objective sleep-wake parameters across various types of sleep-wake difficulties.Method: The sample was composed of 51 community-dwelling cancer patients receiving palliative care and having an Eastern Cooperative Oncology Group score of 2 or 3. Relevant sections of the Duke Interview for Sleep Disorders were administered over the phone. An actigraphic recording and a daily sleep diary were completed for 7 consecutive days.Results: Overall, 68.6% of the sample had at least one type of sleep-wake difficulty (disorder or symptoms): 31.4% had insomnia and 29.4% had hypersomnolence as their main sleep-wake problem. Participants with insomnia as their main sleep difficulty had greater disruptions of subjective sleep parameters, while objectively-assessed sleep was more disrupted in patients with hypersomnolence comorbid with another sleep-wake difficulty.Significance of the Results:The high rates of sleep-wake difficulties found in this study indicate a need to screen more systematically for sleep-wake disorders, including insomnia and hypersomnolence, in both palliative care research and clinical practice, and to develop effective nonpharmacological interventions specifically adapted to this population. [ABSTRACT FROM AUTHOR]

Purpose: Kleine-Levin syndrome (KLS) is a rare, relapsing-remitting, debilitating sleep disorder. Examining KLS characteristics in different ethnic populations may help elucidate the genetic basis of the disorder. No studies have examined KLS in Arabs. Therefore, we compared the clinical characteristics of Saudi Arabian KLS patients to those in other published cohorts to determine whether Arab patients have a distinct phenotype. Methods: This study included all patients who were diagnosed with KLS at our center between June 2003 and July 2016 (P = 12; Six familial cases). All participants completed the Stanford KLS questionnaire. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale; eating attitudes were assessed with the Eating Attitudes Test-26. We compared the clinical characteristics of our patients to those in other published cohorts. Results: Saudi Arabian patients with KLS had similar features to those in patients from different countries and ethnic backgrounds, with only minor differences in sleep duration during disease episodes (2-3 h shorter). However, between episodes, Saudi Arabian KLS patients reported worse sleep, greater daytime sleepiness and higher levels of baseline depression, which may be related to KLS or to local cultural practices. Ankylosing spondylitis was present in five of the six familial patients. Conclusion: Saudi Arabian patients with KLS exhibited similar clinical characteristics during episodes compared to patients with KLS of different ethnicities. However, a new and interesting finding is that KLS patients may have inter-episode behavioral and pathophysiological changes, which may suggest that KLS is not necessarily a static disorder. [ABSTRACT FROM AUTHOR]

Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis and cause significant impairments in social and occupational functions. Although currently approved medications are efficacious, they are far from satisfactory. Benzodiazepines, antidepressants, antihistamines and anxiolytics have the potential for dependence and addiction. Moreover, some of these medications can gradually impair cognition. Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous hormone produced by the pineal gland and released exclusively at night. Exogenous melatonin supplementation is well tolerated and has no obvious short- or long-term adverse effects. Melatonin has been shown to synchronize the circadian rhythms, and improve the onset, duration and quality of sleep. It is centrally involved in anti-oxidation, circadian rhythmicity maintenance, sleep regulation and neuronal survival. This narrative review aims to provide a comprehensive overview of various therapeutic functions of melatonin in insomnia, sleep-related breathing disorders, hypersomnolence, circadian rhythm sleep–wake disorders and parasomnias. Melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects. [ABSTRACT FROM PUBLISHER]

Hypersomnolence plays an important role in the presentation, treatment and course of mood disorders. However, there has been relatively little research that examines objective measures of sleep duration and continuity in patients with depression and hypersomnolence, despite the use of these factors in sleep medicine nosological systems. This study compared total sleep time and efficiency measured by naturalistic actigraphic recordings followed by ad libitum polysomnography ( PSG; without prescribed wake time) in 22 patients with major depressive disorder and co-occurring hypersomnolence against age- and sex-matched healthy sleeper controls. The major depressive disorder and co-occurring hypersomnolence group demonstrated significantly longer sleep duration compared with healthy sleeper controls quantified by sleep diaries, actigraphy and ad libitum PSG. No between-group differences in sleep efficiency ( SE), latency to sleep or wake after sleep onset were observed when assessed using objective measures. To further contextualize these findings within the broader scientific literature, a systematic review was performed to identify other comparable investigations. A meta-analysis of pooled data demonstrated patients with mood disorders and co-occurring hypersomnolence have significantly greater sleep duration and similar SE compared with healthy controls when assessed using ad libitum PSG. These results suggest current sleep medicine nosology that distinguishes hypersomnia associated with psychiatric disorders primarily as a construct characterized by low SE and increased time in bed may not be accurate. Future studies that establish the biological bases hypersomnolence in mood disorders, as well as clarify the accuracy of nosological thresholds to define excessive sleep duration, are needed to refine the diagnosis and treatment of these disorders. [ABSTRACT FROM AUTHOR]

Relationships between symptoms of hypersomnolence, psychiatric disorders, and hypersomnia disorders (i.e., narcolepsy and idiopathic hypersomnia) are complex and multidirectional. Hypersomnolence is a common complaint across mood disorders; however, patients suffering from mood disorders and hypersomnolence rarely have objective daytime sleepiness, as assessed by the current gold standard test, the Multiple Sleep Latency Test. An iatrogenic origin of symptoms of hypersomnolence, and sleep apnea syndrome must be considered in a population of psychiatric patients, often overweight and treated with sedative drugs. On the other hand, psychiatric comorbidities, especially depression symptoms, are often reported in patients with hypersomnia disorders, and an endogenous origin cannot be ruled out. A great challenge for sleep specialists and psychiatrists is to differentiate psychiatric hypersomnolence and a central hypersomnia disorder with comorbid psychiatric symptoms. The current diagnostic tools seem to be limited in that condition, and further research in that field is warranted. [ABSTRACT FROM AUTHOR]

Public concern has been growing over severe adverse events caused by human papillomavirus (HPV) vaccination. Some patients also exhibited sleep disorders. We investigated their symptoms, clinical examinations and cerebrospinal fluid orexin (hypocretin) levels. The subjects were 6 patients with hypersomnolence after HPV vaccination. Since all of them had normal orexin levels, hypersomnolence was not caused by orexin deficiency. Although each case did not meet the diagnostic criteria of narcolepsy type 2 and idiopathic hypersomnia adequately, one case had frequent multiple SOREMPs and the other had shortened sleep latency. They might be affected with symptoms of hypersomnolence disorders after their vaccination. [ABSTRACT FROM AUTHOR]

Purpose: Excessive daytime sleepiness (EDS) is a key symptom of various sleep disorders such as narcolepsy, obstructive sleep apnea, and insomnia. In addition, EDS can negatively impact a broad range of activities in children. Therefore the aim of this study is to evaluate clinical features and diagnosis of disorders that cause EDS in children. Methods: We retrospectively analyzed medical records of children and adolescents who were presented with excessive daytime sleepiness at two institutions from March 2011 to October 2015. To check the sleep habits, sleep problems and the degree of subjective daytime sleepiness, parents and patients filled out the sleep questionnaires. Subjects had polysomnography (PSG), multiple sleep latency test (MSLT) or actigraphy to get objective measures of sleep disorders. Results: Subjects included 10 boys and 6 girls, with a mean age of 12.3 years. In addition to EDS, abnormal limb movement, snoring, sleep apnea, cataplexy were reported. Five patients showed decreased mean sleep latency and two or more sleep onset Rapid Eye Movement period (SOREMP), which was compatible with narcolepsy. Apnea-hyponea index was increased in 3 subjects and periodic limb movement index was increased in 2 children, they were diagnosed with obstructive sleep apnea and periodic limb movement disease respectively. One subject who had actigraphy showed delayed sleep phase disorder. Conclusion: It appears that the presence of EDS is associated with various sleep disorders, so children with EDS should be assessed and evaluations are needed. Sleep questionnaire is important screening tool. In addition, objective tests are also needed to confirm the diseases. [ABSTRACT FROM AUTHOR]

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Background: Sleep disturbances and disruption of the neural regulation of the sleep-wake rhythm appear to be involved in the cellular and molecular mechanisms of cognitive decline. Although sleep problems are highly prevalent in mild cognitive impairment (MCI) and many types of dementia, they have not been systematically investigated in the clinical setting and are often only investigated by sleep specialists upon individual request. Summary: This review discusses sleep disorders in the context of cognitive decline and provides an overview of the clinical diagnosis and management of these disorders in patients with dementia and MCI. Key Messages: Sleep disorders are largely underestimated and do not receive sufficient attention in the global management of dementia patients. Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression. They are positively associated with the severity of behavioral problems and cognitive impairment. Clinical Implications: The recent recommendations by the Sleep Study Group of the Italian Dementia Research Association can be used as a guideline for the clinical assessment and management of sleep disorders in MCI and dementia patients. Sleep disorders should be carefully investigated using an in-depth sleep history, physical examination, questionnaires and clinical scales and should be validated with the support of a direct caregiver. The recommendations for older adults can be used as a framework to guide the diagnosis and treatment of sleep disorders in individuals with dementia and MCI. The management strategy should be based on the choice of different treatments for each sleep problem present in the same patient, while avoiding adverse interactions between treatments. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We studied the relationship of orexin (hypocretin) system and astrocyte activation in hypersomnolence symptom ( HS) in Parkinson's disease ( PD). In a total of 30 subjects, including five PD patients with HS, eight PD patients without HS, eight patients with narcolepsy, and nine control subjects, orexin and glial fibrillary acidic protein ( GFAP) as well as S100B levels in cerebrospinal fluid ( CSF), which are markers of astrocyte activation, were measured and compared. In the comparison of orexin levels among the four groups of subjects, only the narcolepsy group showed significantly lower levels. The levels of CSF orexin in the PD patients with HS tended to be lower compared with those in the control group, although the difference was not statistically significant. The majority of reports have indicated that CSF orexin levels are in the normal range in most PD patients, some PD patients with severe HS showed low orexin levels. Compared with those of the control group, GFAP levels were significantly higher in the group of PD with HS and narcolepsy, but not PD without HS. No groups showed a significant difference in S100B levels. In the whole subjects with PD, narcolepsy, and controls, orexin levels were inversely correlated with GFAP. Therefore, increased GFAP may indicate orexin deficiency both in narcolepsy and PD with HS. [ABSTRACT FROM AUTHOR]

Purpose: Although excessive daytime sleepiness (EDS) is one of the key symptoms of obstructive sleep apnea (OSA), associations between OSA and EDS have been inconsistent, even in patients with severe OSA. To that end, our goal was to investigate factors associated with EDS based on the Epworth Sleepiness Scale (ESS) score in a large clinical population with severe OSA (apnea-hypopnea index ≥30). Methods: This cross-sectional study included 1,126 consecutive adult patients referred for their first in-laboratory polysomnogram for suspicion of OSA. All patients completed a routine questionnaire including demographics, race, co-morbidities, sleep history, ESS, short-form quality of life questionnaire-12 (SF-12), the Center for Epidemiologic Studies Depression scale, and medications used. Severe OSA was diagnosed in 498 patients. After excluding patients taking narcotics, hypnotics, benzodiazepines, antidepressants, or those with diagnosis of depression, 355 patients remained in the final analytic cohort. Patients were divided into quartiles based on the ESS and comparisons were made between the lowest quartile (ESS ≤ 6; n = 105) and highest quartile (ESS ≥ 13; n = 97). Results: Compared to the ESS ≤ 6 group, patients in the ESS ≥ 13 group had a significantly higher 3 % oxygen desaturation index and a significantly lower oxygen saturation nadir during sleep ( p < 0.05). Moreover, patients with severe OSA in the highest quartile of ESS had higher depressive symptomatology. Conclusions: In patients with severe OSA, intermittent hypoxemia and depressive symptoms are important contributing factors to EDS. [ABSTRACT FROM AUTHOR]

Significant advancements have been made over the past three decades to better understand the disease entity of obstructive sleep apnea and the mechanisms by which this prevalent disorder imparts injury. Once considered a disorder of reversible sleepiness and insignificant arterial oxygen desaturations because of their intermittency, obstructive sleep apnea is now considered an independent risk factor for cardiovascular morbidity and mortality and an important contributor to neurocognitive impairment and neural injury as well as metabolic dysfunction. The rapidly fluctuating oxygen patterns are now believed to be central to oxidative injury in the brain and peripheral organs. Recent studies in both humans with sleep apnea and animal models of the disorder have increased our understanding of the molecular mechanisms underlying both the disorder and its sequelae, providing great insight into the significance of the disorder and bringing us closer to finding therapies to prevent or reduce both obstructive sleep apnea and it morbidities. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to verify whether it is clinically useful to repeat the Epworth Sleepiness Scale (ESS) in individuals with suspected sleep-disordered breathing (SDB). Methods: In this cross-sectional, prospective study, results of the repeated administration of the ESS were analyzed. In 929 consecutive patients, ESS was obtained as usual in the laboratory routine, immediately before the sleep study (ESS1) and was repeated in the morning, after the polysomnography (ESS2). ROC curve, classical psychometry, and item response theory (IRT) Rasch analysis were used to assess measurement properties of ESS. Results: The ESS1 score was (mean ± SD), 11 ± 5.1, and the ESS2, 13 ± 4.7 ( p < 0.001). Change in ESS score is explained in multivariate analysis by age, but not by gender, educational level, change in Stanford Sleepiness Scale, symptoms of sleep disorder, or polysomnography results. Accuracy of an ESS score >10 to predict apnea-hypopnea index ≥5 increased from 56% (ESS1) to 72% (ESS2). IRT psychometric properties (unidimensionality, invariance, local independence) were maintained in ESS2. Conclusions: Repeating the administration of the Epworth Sleepiness Scale in a clinical setting increases its score and diagnostic accuracy and correlation with SDB variables, without changing the psychometric properties of the scale. This experiment indicates the clinical usefulness of repeating the ESS. The scale can be repeated at a negligible cost, before dismissing individual patients on the basis of a low ESS score, discontinuing a potentially lifesaving diagnostic and therapeutic process. [ABSTRACT FROM AUTHOR]

Kleine-Levin syndrome (KLS) and idiopathic hypersomnia (IH) are primary sleep disorders of unknown etiologies, which often run a chronic course. The common core symptoms of these syndromes are hypersomnolence and sleep drunkenness, with periodic hypersomnolence and hyperphagia being the prominent symptoms of KLS. Psychiatric manifestations are common to both and include irritability, depression, apathy, inattention and poor concentration. Both disorders are diagnosed clinically and no specific laboratory investigation is available to confirm the diagnosis. We present a case highlighting the overlapping of the symptoms of KLS and IH, producing a complex clinical picture. [ABSTRACT FROM AUTHOR]

Artery of Percheron (AOP) occlusion is a rare cause of ischemic stroke characterized by bilateral paramedian thalamic infarcts, with or without mesencephalic infarction. Clinically it presents with mental state disturbances, hypersomnolence, aphasia/dysarthria, amnesia and ocular movement disorders, including vertical gaze palsy. Here, we report a case of cardioembolic AOP infarction in a 37-year-old woman with rheumatic mitral valvular stenosis. This case is being reported to highlight the interesting clinical and neuroimaging features of this rare condition, and the differential diagnosis of AOP infarction on imaging have been discussed. [ABSTRACT FROM AUTHOR]

The article discusses the result of high rate of comorbidity between sleep disorders and psychiatric illnesses including mood and anxiety disorders. The data shows that disturbance of sleep quality associated with sleep disorders predispose to the development or exacerbation of psychological distress and mental illness. It explores also the psychiatric conditions, psychiatric comorbidity in sleep disorders and reciprocal psychopathology in sleep disorders.

To determine one-year clinical outcome of patients with first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries (PMAS), we conducted a prospective study evaluating the cognitive functions of 28 patients with PMAS. Neuropsychological tests were performed during the first month of stroke onset and at the 12th month of follow-up. There were 12 women and 16 men. Mean age of onset for women and men was 70 years and 65 years, respectively. Progressing strokes occurred in 62% of patients and 96% developed a full-blown picture of the clinical triad of akinetic mutism, hypersomnolence, and bilateral blepharoptosis and ophthalmoparesis. Involuntary movements occurred in 6, and focal myoclonus in 4 patients. The top four associated risk factors were hypertension (68%), hyperlipidemia (57%), diabetes mellitus (46%), and atrial fibrillation (36%). Unilateral midbrain infarctions occurred in 12 patients and bilateral lesions in 16. Thalamic infarctions were unilateral in 10 and bilateral in 13 cases. Three of the 28 (11%) patients died of recurrent cerebral infarctions within 1 year of the onset of PMAS. The recurrent infarctions involved the basilar artery territory in two cases and the carotid system in another. One patient died of acute myocardial infarction. Of the 24 patients who had survived the stroke by 1 year, 20 (71%) developed dementia. We conclude that first-ever ischemic stroke with PMAS is not a benign syndrome. Most patients developed dementia by 1 year after the stroke. [ABSTRACT FROM AUTHOR]

Truck drivers are more likely to suffer severe injury and death due to certain truck driving characteristics. Identifying and preventing factors associated with accidents in this population is important to minimize damage and improve road safety. Excessive daytime sleepiness is a major public health problem, leading to impaired cognitive function, reduced alertness, and increased risk of motor vehicle crashes. The aim of this cross‐sectional study was to determine the prevalence and predictors of hypersomnolence (defined as an Epworth Sleepiness Scale score greater than 10) among truck drivers. Three hundred male truck drivers were studied. Quality of sleep was assessed by the Pittsburgh Sleep Quality Index, and the association between demographic, clinical, and occupational data with excessive sleepiness was analyzed. The mean daily sleep duration was 5.6±1.3 h, and poor quality of sleep was found in 46.3% of the individuals. Hypersomnolence was found in 46% of the drivers and was associated with younger age, snoring, and working >10 h without rest. A positive correlation between hypersomnolence and previous accidents was detected (p=0.005). These results show that sleep deprivation and hypersomnolence are frequent among truck drivers. The treatment of sleep‐disordered breathing and the implementation of educational programs, particularly targeting younger drivers and promoting increased awareness of the deleterious effects of sleep loss and work overload, may help to reduce hypersomnolence and accidents among truck drivers. [ABSTRACT FROM AUTHOR]

Study objectives: The upper airway resistance syndrome (UARS) is a recently described form of sleep-disordered breathing in which transient increases in upper airway resistance result in repetitive EEG arousals. UARS is not associated with apnea or diminished airflow, although snoring and excessive daytime somnolence (EDS) are common. This report describes a subset of patients with UARS diagnosed by polysomnography who do not manifest snoring, which we define as silent upper airway resistance syndrome (SUARS). Design: A retrospective review of all polysomnographies performed at our sleep disorders center during 2000. Setting: Sleep disorders center of a large, academic, military hospital. Patients: Our center serves military personnel, military retirees, and their dependent families. Interventions: Esophageal manometry during polysomnography was routinely performed on patients with hypersomnolence (Epworth sleepiness scale> 10) who demonstrated a total arousal index ≥ 10/h and a respiratory disturbance index of < 5/h on prior polysomnography. UARS was definitely diagnosed in patients who demonstrated repetitive increased upper airway resistance (IUAR) associated with brief EEG arousals followed by normalization of esophageal pressure (Pes). IUAR was defined by a pattern of crescendo negative inspiratory Pes of ≤ - 12 cm 1120. Results: During calendar year 2000, we performed 724 polysomnographies in 527 patients. Obstructive sleep apnea was diagnosed in 383 patients (72.6%), and 44 patients (8.4%) were found to have UARS. In four patients with UARS (0.8% of total and 9.1% of UARS), snoring was not reported by history or observed during polysomnography, and SUARS was ultimately diagnosed. Conclusions: UARS may occur in the absence of clinically significant snoring and may be an occult cause of EDS. We report a prevalence of SUARS of 9% among UARS patients and nearly 1% of all patients studied for hypersomnolence by polysomnography.

Multiple sclerosis (MS) patients occasionally present with homeostatic disturbances suggestive of hypothalamic dysfunction; however, the hypothalamus often appears normal on imaging, apart from confirmation in a few necropsy studies. In this article we describe a Chinese woman with atypical clinical presentation. She presented with relapsing symptoms and signs consistent with hypothalamic dysfunction including hyperprolactinema, syndrome of inappropriate secretion of anti-diuretic hormone (SIADH), hypersomnolence and temperature dysregulation. Serial MRI depicted the atypical reversible changes in the hypothalamus, correlating with the observed homeostatic abnormalities. [ABSTRACT FROM AUTHOR]