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Background Though insomnia is associated with affected emotion regulation and dysfunctional ideas about sleep, little is known about the relation of these problems with objective sleep disruption. We aimed to explore this relationship in young adults with and without insomnia. Methods Twenty young adults with diagnosed insomnia disorder (aged 27.7 ± 8.6 years) and twenty age-matched individuals without insomnia (26.7 ± 7.0 years) completed questionnaires, measuring sleep-related thoughts and emotions and emotion regulation. Objective sleep measurements were collected through 10-days actigraphy as a representative sample of nights, and analyzed for sleep onset latency, sleep efficiency total sleep time. T-tests and multivariate analyses of variance (MANOVA) were conducted for sample characterization and analysis of the association of sleep-related thoughts and emotions and emotion regulation with objective sleep data. Results As expected, young people showed more dysfunctional sleep-related thoughts and emotions (all ps ≤ 0.025) and dysfunctional emotion regulation strategies (all ps ≤ 0.040). Surprisingly, MANOVA results showed that only emotion coping strategies after a stressful event (p = 0.017) and dysfunctional beliefs about sleep (p = 0.012), but not other factors of arousal or sleep reactivity, were associated with overall worse sleep, especially sleep onset latency (all ps ≤ 0.012) and sleep efficiency (all ps ≤ 0.010). Conclusions Maladaptive emotion coping strategies after a stressful event and dysfunctional sleep-related beliefs and attitudes affect objective sleep onset latency and sleep efficiency in young adults, highlighting the importance of targeting these features in the prevention and treatment of chronic insomnia and improving actual sleep quality.

Circadian system contributes to the regulation of inflammatory processes, but the role of circadian misalignment as a risk factor for contracting Covid-19 has up to now been poorly studied. The aim of this study was to explore the relationship between circadian misalignment (chronic disturbance of the circadian system) and the risk of Covid-19 infection in a population of subjects suspected of contact or infection with SARS-CoV-2.Cross-sectional single-center study conducted during a period without lockdown in winter 2021. Recruitment took place in a Covid-19 outpatient testing center. Subjects between 18 and 45 years old were included whether they were symptomatic or not, healthcare workers or not, in contact with a Covid-19 case or not. To determine social jetlag, a proxy of circadian misalignment, they were asked about their usual sleep-wake behaviors. Usual sleep duration and sleep-wake timing were explored on workdays and free days. Social jetlag was defined as at least 2 h shift of circadian alignment (defined as the difference between mid-sleep on workdays and mid-sleep on free days, mid-sleep as the median between bedtime and rise time).One thousand fourteen subjects were included (sampling rate: 10.8%, 39% men, mean age 28 ± 8) with 56 subjects positive for Covid-19 (positivity rate: 5.5%). Usual mean sleep duration was equivalent in both groups (7h47 versus 7h49, p = 0.733). Social jetlag greater than 2 h comprised 33.3% of subjects in the Covid-19 group versus 20.6% in the control group (p = 0.026). After adjustment on age, gender, BMI and work schedules, subjects presenting with social jetlag greater than 2 h had a 2.07-fold higher likelihood to test positive than subjects who had identical sleep-wake timing on workdays and free days (OR = 2.07, 95%CI = [1.12-3.80], p = 0.024).Circadian misalignment not only is present in subjects infected by Covid-19 but could also be responsible for a higher likelihood of being infected. The chronobiological impact on the immune system or a higher likelihood of being exposed to social contacts during nocturnal activities could explain our findings, which need to be confirmed in a future large cohort study. Regular sleep-wake timing could ultimately become a target for preventing Covid-19 infection.

Objective/background It has been shown that actigraphy may have a discriminant function (DS) for the diagnosis of narcolepsy type 1 patients (NT1), based on a combination of nighttime and daytime parameters. Here, we aimed to test those findings using another actigraph model with a different clinical sample as control (ie, primary insomniacs, PI), carrying out a secondary analysis of previously collected data. Patients/methods The study sample consisted of 13 NT1 (nine females; mean age 39.38 ± 11.48), 13 PI (nine females; mean age 38.69 ± 10.72) and 13 Healthy Controls (HC) (nine females; mean age 38 ± 10.77). Participants wore the Actiwatch AW64 (Cambridge Neurotechnology Ltd, Cambridge, UK) around the non-dominant wrist for seven consecutive days. Results Significant differences between groups were observed with a higher number of episodes of wakefulness (wake bouts, WB) in PI than HC, a higher fragmentation index (FI) in NT1 than HC and PI, a higher duration of the longest nap (LNAP) in NT1 than HC and PI and higher DS in PI and NT1 than HC. A new DS (NDS), with LNAP and FI as independent variables, was proposed; which was higher in NT1 than HC and PI. Conclusions The present study confirms that actigraphy discriminates NT1 from HC. However, considering PI, a new discriminant function NDS which takes into account LNAP and FI is better for this actigraph model.

Objective To assess the diagnostic accuracy of portable polygraphy (PG) for the detection of sleep apnea (SA) in multiple system atrophy (MSA). Methods Thirty consecutive patients with probable MSA underwent PG (overnight recording of nasal flow, thoracic/abdominal movements and pulse oximetry), followed 4 weeks later by full polysomnography (PSG) (reference standard). The accuracy of PG was first assessed using the same threshold as for PSG (apnea–hypopnea index [AHI] ⩾ 5), then for all possible AHI thresholds using the area under the receiver operating characteristics (AUROC) curve. Inter-rater reliability of PG was assessed using the kappa coefficient. Results Among 30 patients enrolled, seven were excluded for technical problems on PG or PSG and 23 were included in the main analysis. Eight out of 23 had an AHI ⩾ 5 on PSG. With the same threshold, sensitivity, specificity, positive and negative predictive values of PG for the diagnosis of SA were 87.5% (95% confidence interval: 47–99), 80% (52–96), 70% (35–93) and 92.3% (64–99), respectively. The kappa between PG raters was 0.75 (0.49–1.00) indicating good agreement. The AUROC was 0.93 (0.82–1.00). No association was found between sleep and excessive daytime sleepiness questionnaires and SA. Conclusion Portable PG seems to be valuable for ruling out SA in MSA.

Large prospective studies have established that sleep-disordered breathing (SDB) is associated with an increased incidence of cardiovascular and cerebrovascular diseases. Heterogeneous results have been published about SDB and ischaemic stroke mechanism. The aim of this study was to evaluate the relationship between poststroke apneic syndrome and stroke aetiologies according to the ASCO classification.A total of 134 patients with acute ischaemic cerebrovascular events were prospectively included. Patients with severe or infratentorial infarctions were excluded. Stroke risk factors and clinical characteristics were recorded in all patients. An overnight polygraphy was recorded (Embletta PDS). Apneic patients were defined if the polygraphy reported an apnea-hypopnea index ≥15. A standardized diagnosis workup, including serum biological investigation, evaluation of extra and intracranial arteries and heart morphology and function, was performed. Stroke mechanism was defined using ASCO and TOAST classifications.A proportion of 42% (56 of 134) of the patients were diagnosed as having sleep apneas. Apneic patients were older (p 0.001), had higher BMI (p = 0.02), and more were hypertensive (p 0.001). Using ASCO classification, a major cardioembolic source of stroke, mainly atrial fibrillation, was more frequently observed in apneic patients (41.1% vs. 20.5%, p 0.05), while no difference was observed when considering atherosclerosis or small-vessel disease mechanisms. Univariate analysis showed that cardioembolic stroke depends on sex, age, left atrial size and OSA; however, age remained the only significant factor in multivariate analysis.This study confirms the high prevalence of sleep apneas in stroke-affected patients and identifies atrial fibrillation as a major source of stroke in this population. The strong correlation between age and SDB seems to drive the increased frequency of stroke related to atrial fibrillation in this population.

Insomnia is common and associated with poor health status and quality of life. We designed a study to evaluate the impact of insomniac complaints with and without comorbidity on health status and absenteeism.This is a cross-sectional study performed within a 1-year follow up study on a prospective cohort of French employees. Insomniac subjects (n=986) were compared to control subjects (n=584). Insomniacs suffering from self-reported depressive feelings and behavioral and organic sleep complaints were excluded.Subjects with insomniac complaints (whether with mood or behavioral and organic sleep complaints or not) reported poorer quality of life and had a higher absenteeism rate than controls (9.6+/-31 versus 5.8+/-19 days, P0.01). A logistic regression model adjusting for depressive and behavioral and organic sleep complaints showed that insomniac complaints were no longer predictive of absenteeism.Insomniac complaints are strongly associated with deterioration in quality of life but not necessarily with higher absenteeism.

Objective : To evaluate of the effect of 7 days of sleep restriction – with sleep placed at the beginning of night or early morning hours – on sleep variables, maintenance of wakefulness test, and serum leptin. Methods : After screening young adults with questionnaires and actigraphy for 1 week, eight young adult males were recruited to participate in a sleep restriction study. The subjects were studied for baseline data for 2.5 days, with 8.5 h per night in bed, and then over 7 days of sleep restriction to 4 h per night with a 22:30 h bedtime for half the group and a 02:15 h bedtime for the other half. At the end of study, after one night of ad libitum sleep, subjects again had 2 days of 8.5 h in bed. Wakefulness was continuously verified and tests, including Maintenance of Wakefulness (MWT), were performed during the scheduled wake time. Blood was drawn six times throughout the 24 h of the 7th day of sleep restriction and after 2 days of the post-restriction schedule. Results : There was individual variability in response to sleep restriction, but independent of group distribution, MWT was significantly affected by sleep restriction, with the early morning sleep group having less decrease in MWT score. Sleep efficiency was also better in this group, which also had shorter sleep latency. Independent of group distribution there was a greater increase in the percentage of slow wave sleep than rapid eye movement sleep, despite a clear internal variability and variability between subjects. Peak serum leptin was significantly decreased with 7 days of sleep restriction for all subjects. Conclusion : Sleep restriction to 4 h affected all subjects, but there were individual and group differences in MWT and sleep data. In this group of young adult males (mean age 19 years), there was a better overall adaptation to the early morning sleep, perhaps related to the general tendency in most adolescents to present some phase-delay during late teen-aged years.

Objective We aimed to investigate sleepiness, sleep hygiene, sleep disorders, and driving risk among highway drivers. Methods We collected data using cross-sectional surveys, including the Epworth Sleepiness Scale (ESS) questionnaire, Basic Nordic Sleep Questionnaire (BNSQ), and a travel questionnaire; we also obtained sleep data from the past 24 h and information on usual sleep schedules. Police officers invited automobile drivers to participate. Results There were 3051 drivers (mean age, 46 ± 13 y; 75% men) who completed the survey (80% participation rate). Eighty-seven (2.9%) drivers reported near-miss sleepy accidents (NMSA) during the trip; 8.5% of NMSA occurred during the past year and 2.3% reported sleepiness-related accidents occurring in the past year. Mean driving time was 181 ± 109 min and mean sleep duration in the past 24 h was 480 ± 104 min; mean sleep duration during workweeks was 468 ± 74 min. Significant risk factors for NMSA during the trip were NMSA in the past year, nonrestorative sleep and snoring in the past 3 months, and sleepiness during the interview. Neither sleep time in the past 24 h nor acute sleep debt (sleep time difference between workweeks and the past 24 h) correlated with the occurrence of near misses. Conclusions Unlike previous studies, acute sleep loss no longer explains sleepiness at the wheel. Sleep-related breathing disorders or nonrestorative sleep help to explain NMSA more adequately than acute sleep loss.

Background: Respiratory events during sleep usually lead to micro arousals resulting in consecutive daytime sleepiness even in healthy snorers. The present study investigated the evolution of subjective and objective daytime sleepiness and reaction time in healthy snorers submitted to acute and chronic sleep deprivation. Methods: Objective sleepiness was measured by the MSLT, subjective sleepiness by the Karolinska Sleepiness Scale (KSS), and reaction time (RT) by the Psychomotor Vigilance Test. Mean sleep latencies, KSS scores and performance were analyzed through repeated measures ANOVAs with one between-factor (snorers and non-snorers) and two within-factors (sleep deprivation [baseline, acute, and chronic sleep deprivation] and time-of-day). Results: The findings reveal that sleep deprivation does not enhance snoring but that, during baseline, objective daytime sleepiness is higher in snorers than in non-snorers (shorter sleep latencies) with no difference in subjective assessments. The effects of acute and chronic sleep deprivation on sleep are similar in both groups, but, after acute sleep deprivation, RT and attentional lapses (RT >500 ms) are higher in snorers. Chronic sleep deprivation produces similar results in both groups. Conclusion: These results suggest that respiratory efforts may be involved in the increased vulnerability to sleep deprivation of healthy snorers when compared to non-snorers.

Introduction Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by a triad of symptoms involving hyperactivity, impulsivity and inattention. Several studies in children with ADHD showed a high prevalence of excessive daytime sleepiness. To our knowledge, no study has objectively assessed sleepiness in adults with ADHD. Moreover, it has been shown that adults with ADHD were at risk for driving accidents. The objectives of this study are to quantify objective sleepiness and its impact on driving performance in adult with ADHD. Materials and methods 36 subjects with ADHD (age (mean ± SE) = 36.3 ± 1.6) and 18 control subjects (age (mean ± SE) = 31.2 ± 1.2) were included. Nocturnal polysomnography was performed to identify potential sleep disorder. The next day patients were submitted to a Maintenance Wakefulness Test (MWT) at 10H, 12H, 14H, 16H to examine their level of daytime sleepiness. After a training of 15 min, a driving test of 1 h was carried out at 17H on a simulator (Oktal) to evaluate driving performance. Results ADHD subjects were divided into 2 groups according to their level of sleepiness at the MWT: the ”sleepy” group consisted of twenty subjects (mean sleep latency (SL) = 23.9 ± 1.3 min) and the “alert” group included sixteen subjects (LE = 37.3 ± 1 min)(p = 0.001). We observed that more than half of the ADHD subjects exhibit a sleep disorder: 31% among the alert ADHD subjects and 65% among sleepy ADHD subjects. But 35% of the sleepy ADHD subjects did not presented a sleep disorder. About driving performance, there were significant differences between driving performance (observed by the number of lines crossing) between the control group and the alert ADHD group (p = 0.05) and the control group and the sleepy ADHD group (p = 0.02). Conclusion This study supports the hypothesis that there is a sub group of ADHD patients that present pathological sleepiness. In our sample, half of the patients suffer of excessive daytime sleepiness. But it is appropriate to question the origin of the sleepiness found in the other patients and to wonder if they represent a particular phenotype. ADHD impacts on driving performances, but it is not possible today to clearly explain them: attention deficit and/or sleepiness? But it is important to focus on this question to provide therapeutic strategy modulated by the clinic. Acknowledgements JP reneric.

Objective While the Berlin Sleep Questionnaire (BSQ) was developed to identify patients at high risk of having sleep apnea, assessment can be difficult in patients suffering from impaired cognitive functions (i.e., stroke patients). We therefore created a modified version of the questionnaire to be used in patients’ bed partners to test whether it could give identical results to the original form of BSQ. Methods The BSQ was filled in by 90 patients hospitalized in our Sleep Clinic for polysomnographic recording and by 33 healthy control subjects recorded polysomnographically. An adapted version of the BSQ was completed by each bed partner. Results Sixty of the 123 subjects had a Respiratory Disturbance Index (RDI) > 5 and 49.6% of them were classified as being at high risk of having sleep apnea with both questionnaires. Being in the high-risk group with the self-reported Berlin questionnaire predicted an RDI > 15 with a sensitivity of 0.76 and a specificity of 0.61 versus a sensitivity of 0.82 and a specificity of 0.63 with the bed-partner Berlin questionnaire. Being in the high-risk group with the self-reported Berlin questionnaire predicted an RDI > 30 with a sensitivity of 0.71 and a specificity of 0.53 versus a sensitivity of 0.79 and a specificity of 0.54 with the bed-partner Berlin questionnaire. Conclusions The bed-partner Berlin questionnaire predicts an RDI > 15 with a better sensitivity and specificity than the original questionnaire. It could, therefore, be used in bed partners of patients suspected of obstructive sleep apnea syndrome who cannot fill in the self-reported Berlin questionnaire.

Background Patients with obstructive sleep apnea syndrome (OSAS) are known to have an increased risk for motor vehicle crashes. They suffer from sleep-related respiratory abnormality causing repetitive arousal leading to daytime sleepiness. In turn, it has been demonstrated that sleepiness can impair human psychomotor performance causing slowing of reaction times (RTs). Patients with OSAS present with RTs comparable to young adults under the influence of blood alcohol concentrations above the legally permitted level to drive a motor vehicle. Vigilance related risk levels in patients with upper airway resistance syndrome (UARS) and potential deficits in psychomotor performance are unknown. Methods We designed a study to compare psychomotor performance in UARS and compared it to patients with OSAS. Forty-seven UARS patients were matched by gender and age with 47 OSAS patients. All subjects completed a standardized vigilant attention task utilizing reaction time before undergoing polygraphic sleep studies. Results Patients with UARS presented worse psychomotor performance on most test metrics than patients with OSAS. Conclusions Our study results may suggest that patients with UARS may also present an increased risk for motor vehicle crashes as previously demonstrated in OSAS patients.

Objective To assess the efficacy and compliance of a traction-based mandibular repositioning device (MRD) for treatment of moderate to severe obstructive sleep apnea syndrome (OSAS) under a patient-driven protocol in a routine outpatient care setting. Methods Forty patients, 10 severe and 30 moderate OSAS sufferers (apnea–hypopnea index [AHI] >30 and between 15 and 30, respectively), were enrolled by four sleep centers. Nocturnal polygraphy, quality of life, and quality of sleep questionnaires were used to measure the effect of treatment after 45 days. Results Thirty-five patients completed the study. Frequency of respiratory events, daytime sleepiness, snoring, patient assessment of sleep quality, specific short-form multipurpose health survey (SF-36) and the Pittsburgh Sleep Quality Index (PSQI) improved significantly with the MRD. Sixty percent of patients were “responders” (>50% decrease in AHI); 46% of patients were “full responders” (>50% decrease and AHI Observance of treatment was high; 80% of patients wore the MRD every night. Side effects and patient complaints were minor and transitory. No serious side effects or cases of pathology aggravation were reported. Conclusion Efficacy on respiratory and somnolence parameters of this innovative traction-based MRD was validated under a simple protocol of care with response rates similar to those published in the literature. This study shows consistent significant improvement by the MRD in quality of life and quality of sleep parameters across several tests. Treatment with the MRD under a simple, patient-driven protocol of care with control of efficacy by nocturnal polygraphy is appropriate in routine outpatient practice for moderate OSAS patients.

To explore the association between sleep duration and daily caffeine intake in a working population. Caffeine acutely disrupts sleep in the laboratory, but the inter-relations between sleep and caffeine intake in daily life are ill-known.Questionnaire and diary based survey of 1498 persons from the GAZEL cohort of employees of the National Electricity and Gas Company (EDF-GDF) working in various locations in the Paris and South-West France areas. We analyzed total sleep time, our primary measure, and time in bed, both by sleep logs. We assessed daily intake of caffeine, consumption of alcohol and tobacco, use of hypnotics, and daytime somnolence, all by questionnaire.Multiple linear regression analysis did not find a significant relationship between total sleep time and daily caffeine intake less than 8 cups of coffee per day, after controlling for age, gender, alcohol intake, smoking status, and use of hypnotics. By contrast, time in bed was reduced as caffeine intake increased (beta=-0.125; P0.001). Higher caffeine intake was not related to a higher daytime somnolence.Despite the well-known acute effects of caffeine on sleep, habitual use of up to 7 cups of coffee (or 600 mg of caffeine equivalent) per day was not associated with decreased duration of sleep.

Objective : To investigate the sleep–wake behavior and performance of a random sample of European truck drivers. Methods : The drivers completed a questionnaire concerning sleep–wake habits and disorders experienced during the previous 3 months. In addition, they were asked to complete a sleep and travel log that included their usual work and rest periods during the previous two days. They answered questions concerning working conditions and reported their caffeine and nicotine intake during their trips. Results : A total of 227 drivers, mean age 37.7± 8.4 years (96.2% acceptance rate), participated in the study. The drivers were found to have a fairly consistent total nocturnal sleep time during their work week, but on the last night at home prior to the new work week there was an abrupt earlier wake-up time associated with a decrease in nocturnal sleep time. Of the drivers, 12.3% had slept less than 6 h in the 24 h previous to the interview and 17.1% had been awake more than 16 h. Conclusions : Shifting sleep schedules between work and rest periods can generate long episodes of wakefulness. This type of sleep deprivation is rarely investigated. Its is usually not taken into consideration when creating work schedules, but affects the performance of drivers. Unsuspected shifts occur at the onset of a new workweek. Sleep hygiene education for professional drivers is still far from perfect.

Objective : We investigated glucose metabolism and insulin resistance in non-obese and moderately overweight sleep apnea patients, as well as their response to nasal CPAP treatment. Methods : A group of subjects with glucose intolerance was screened for sleep disordered breathing by clinical interview and ambulatory recordings. Ten subjects were found to have untreated sleep apnea and were asked to participate in further investigation. This included nocturnal polysomnography, oral glucose tolerance test and indirect calorimetry. Subjects then had calibration of nasal CPAP with polysomnography. Two months after start of treatment, all subjects were restudied as at baseline. In parallel, six obstructive sleep apnea syndrome (OSAS) subjects, diagnosed through the sleep clinic, were matched for gender, age and oxygen desaturation index with the other group, and had a euglycemic hyperinsulinemic clamp at baseline and after 2 months of nasal CPAP. Results : The first ten patients showed no change in total glucose oxidation, glucose oxidation by weight or by fat free mass, or insulin energetic expenditure, despite nocturnal usage of nasal CPAP. Similarly, when comparing baseline to the treatment at 2 months, the six OSAS patients had no change in mean glycemia, insulin, C peptide and hemoglobin (Hgb) A1C measurements. No difference in the amount of glucose infused during the duration of the clamp was noted either. Conclusion : Our data do not support the existence of a significant relationship between glucose and insulin metabolism and obstructive sleep apnea. Obesity, when present, is the important variable.

Introduction To identify risk factors for sleep-related near miss accidents in highway drivers. Materials and methods Cross-sectional survey including the Epworth sleepiness questionnaire, Basic Nordic Sleep Questionnaire, a travel questionnaire, sleep data for the past 24 h, and usual sleep schedules. Highway-patrol officers in France invited a random sample of automobile drivers to participate. Results 3051 drivers (mean age, 46 ± 13 years; 75% males) completed the survey, yielding an 80% participation rate; 87 (2.9%) drivers reported sleepiness- related near-miss events during the trip and 8.5% during the past year and 2.3% reported sleepiness-related accidents in the past year. Mean driving time was 181 ± 109 min, mean sleep duration during workweeks was 468 ± 74 min, and mean sleep duration in the past 24 h was 480 ± 104 min. Significant risk factors for sleep-related near misses during the trip were near miss in the past year, non-restorative sleep and snoring in the past 3 months, and sleepiness during the interview. Neither sleep time in the past 24 h nor acute sleep debt (sleep time difference between workweeks and past 24 h) correlated with the occurrence of near misses. Conclusion Sleep-related near miss accidents remain unacceptably common during long drives on the highway, despite improvements in sleep time before the departure. The exact contribution of sleep-related breathing disorders to sleepiness at the wheel needs to be investigated. Acknowledgements The study was funded by a grant from the Fondation Vinci pour une conduit responsable.

out between them. Each patient used OA, placebo and nCPAP. At each phase the following procedures were followed: standard polysomnographic recordings, Epworth Sleepiness Scale (ESS), SF36 (quality of life inventory), PVT (attention test) and blood measures to evaluate oxidative stress (lipidic peroxidation-MDA, catalase, superoxide desmutase-SOD, vitamin C, E, B12, uric and folic acids). Results: (mean ± SD) Twelve men and 1 woman were evaluated (age = 44 ± 8y, BMI = 27.4 ± 5 Kg/m, ESS = 10.6 ± 4, AHI = 45.5 ± 28). For group 1 (n = 5) there was a reduction in AHI (baseline = 51.0, OA = 38.1, placebo = 56.0, nCPAP = 4.4) (p < 0.001). For group 2 (n = 8) similar results were observed (baseline = 42.1, placebo = 44.7, OA = 26.2, nCPAP = 4.6) (p < 0.001). ESS: reduction only for group 1 after nCPAP when compared to placebo (9.5 · 13.7; p = 0.02). SF36: for group 1: OA improved the physical aspects limitation (65% to 90%, p = 0.04) and vitality (50% to 63%) and nCPAP improved mental health (60% to 79%, p = 0.01). The results for PVT improved with nCPAP for both groups in relation to baseline data (group 1 = 0.910 · 0.854 ms, p = 0.02; group 2 = 0.927 · 0.853 ms, p = 0.01). MDA values did not differ between groups. SOD values decreased on group 1 with OA compared to baseline (10.4 · 5.7 mU/mg Hg, p = 0.03). Catalase reduced for both groups with OA and nCPAP, but for group 1 the reduction was more accentuated with OA treatment (148.8 ·111 mU/mg Hg, p = 0.001). Conclusion: Although the use of OA in moderate to severe OSA patients did not normalize AHI as was the case with nCPAP, it did however lead to a reduction in oxidative stress and improve the quality of life for patients.