Search

Objectives: Dyslipidemia, sleep-disordered breathing (SDB) and hypertension are comorbid factors evidenced in adults, but poorly studied in old people. This study aimed to examine the long-term evolution of the serum lipid profile, and its relationships with SDB and blood pressure (BP) in the elderly., Methods: A ten-year follow-up of the prospective Prognostic Indicator of Cardiovascular and Cerebrovascular Events (PROOF) and the Autonomic Nervous System Activity, Aging and Sleep Apnea/Hypopnea (SYNAPSE) cohort, which initially included 1011 elderly subjects from the general population, and who were untreated by continuous positive airway pressure (CPAP). Serum lipid profile, respiratory polygraphy for SDB and ambulatory blood pressure monitoring were performed., Results: A total of 266 subjects (male/female 150/116; age 66.2 ± 0.8 years) were reassessed after 9.6 ± 0.7 years (age 75.8 ± 1.2 years). The prevalence of high-risk dyslipidemia decreased from 61.3 to 44.4%, and hypertension from 57.9 to 27.4%. The nocturnal oxygen desaturation index increased (mean + 2.3 ± 6.7 events/hour; p < 0.001), while the mean SaO 2 and minimal SaO 2 decreased. These variations (Δ) of oxygen desaturation worsened whether or not elderly subjects took anti-hypertensive and lipid-lowering treatments, and were not associated with serum lipid variations. The decrease in diurnal diastolic BP was independently associated with aging, and with the lowering of the waist/hip ratio (ΔW/H) and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, while the decrease in diurnal systolic BP only depended on aging and ΔW/H., Conclusions: The results suggested that the observed worsening of nocturnal oxygen desaturation after 10 years in the elderly was independent of the change in circulating lipids, and not influenced by lipid-lowering treatments. However, the variation in blood pressure remained associated with aging, waist/hip and LDL-C/HDL-C ratios., Trial Registry: NCT00759304 and NCT00766584 at clinicaltrials.gov., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: Autonomic nervous system dysfunction has been described in narcolepsy with cataplexy affecting sympathetic functions. In this study we analyzed whether altered diurnal and nocturnal cardiovascular control is present in idiopathic hypersomnia (IH)., Methods: Fourteen drug-free patients aged 26.2 ± 7 years and 14 age-matched controls were examined. Clinical data, 24-h polysomnography, heart rate (HR) variability, and the HR response to spontaneous arousal were available., Results: Sleep macrostructure was comparable between controls and patients, with the latter having significantly longer sleep time, a higher number of sleep cycles (p < 0.0001), and low sleep efficiency (p < 0.01). The HR variability indices did not differ between groups, except for the rise of high frequency (HF) and HFnu in patients (p < 0.05) associated with blunted sympathetic indices (p < 0.01). These parasympathetic alterations were present for light, slow wave, and rapid eye-movement sleep and persisted for all sleep cycles. Compared to controls, the HR arousal response was significantly higher (p < 0.01) in patients starting before the arousal onset and persisting into the post-arousal period., Conclusions: In IH patients a dysfunction of the parasympathetic activity during awake and sleep and an altered autonomic response to arousals are present. These findings suggest an impaired parasympathetic function that may explain some vegetative symptoms present in this type of central hypersomnia., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: Several studies suggest a relationship between bone mineral density (BMD) anthropometric and metabolic variables, and obstructive sleep apnea (OSA); all of these factors have an effect on osteoporosis (OS) risk. This cross-sectional study explores these associations in a large sample of older subjects with and without OSA., Methods: Volunteers were recruited from the PROgnostic indicator OF cardiovascular and cerebrovascular events survey. A total of 461 subjects, aged 68.7 ± 0.8 years, were examined, blood samples were taken, and they were subjected to home polygraphy, assessment of daily energy expenditure (DEE), and dual-energy X-ray absorptiometry., Results: Osteopenia (OP) was detected in 44% of subjects at the femoral and 39% at the vertebral level, while the prevalence of OS was lower at the femoral (4%) and vertebral (12%) levels. As expected, women had a higher prevalence of OP and OS. Subjects with OP and OS had a tendency to have lower DEE and values of obesity, apnea-hypopnea index (AHI), and indices of hypoxemia (ODI). At the correlation analyses, anthropometric factors and DEE were significantly related to BMD with a slight effect of indices of OSA severity. After adjustment for confounding variables, univariate and multivariate regression analyses showed a strong significant association between femoral and lumbar BMD and T-score and DEE without contribution of metabolic data and with a slight negative effect of respiratory factors., Conclusions: In this sample of the elderly, physical activity was the best predictor of OS with a slight effect of body mass index. The indices of OSA confirm their protective effect on bone mineral density., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: Previous studies have suggested an association between obstructive sleep apnea (OSA) and anxiety and depression, but it remains unclear as to whether this is due to OSA or other factors. The aim of this study was to evaluate this association in a large sample of healthy elderly with unrecognized OSA., Methods: 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory home polygraphic study and completion of questionnaires related to depression, anxiety and sleepiness were examined. According to the apnea-hypopnea index (AHI), the subjects were stratified into no-OSA, mild-moderate and severe OSA cases., Results: Anxiety was present in 38% of the sample and depression in 8%. Anxiolytic treatment was reported by 9% of the population and antidepressant treatment in 5%. Women had high scores for anxiety and depression and they were more frequently taking anxiolytic and antidepressant medications. No differences were found for anxiety and depression scores and medication intake in the three groups of subjects stratified according to the AHI. Regression analyses adjusted for age, gender, body mass index, hypertension (HT), AHI, and indices of hypoxemia revealed that females were 5.44 times more likely to have depression with a low contribution of the time with SaO2 < 90%., Conclusions: In a large sample of healthy elderly with OSA, neither the existence nor the severity of the OSA was associated with anxiety and depression score, with women having higher anxiety and depression scores. This finding supports the hypothesis that depressive symptoms originate from factors other than measures of OSA severity., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: Obstructive sleep apnea (OSA) is associated with behavioral consequences such as excessive daytime sleepiness (EDS). The aim of this study was to establish the presence of sleepiness in elderly with unrecognized OSA and the factors explaining its occurrence., Methodology: A total of 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory polygraphy, and heart-rate variability analysis were studied. According to the apnea-hypopnea index (AHI), the subjects were stratified in four categories: no-OSA (AHI <5), mild (5 > AHI <15), moderate (15 ≥ AHI <30), and severe OSA (AHI ≥30). Participants with EDS were defined on the basis of the Epworth Sleepiness Scale (ESS) score ≥10., Results: Overall, the mean ESS score was 5.7 ± 5.6, 14.9% showing EDS with an increasing trend according to OSA severity (p <0.001). Sleepy subjects were more frequently men, having a greater body mass index (BMI), alcohol intake, depression score, and indices of OSA severity (23% of severe OSA cases being sleepy). No differences were present between sleepy and non-sleepy subjects in regard to other clinical, metabolic, and autonomic nervous system measurements. Regression analyses adjusted for age, gender, BMI, hypertension, depression score, autonomic sleep fragmentation, and AHI and/or oxygen desaturation index revealed that gender (p <0.0001), depression score (p <0.0001), and BMI (p = 0.01) were the only significant factors affecting the presence of sleepiness in this population., Conclusions: In healthy elderly with OSA, the prevalence of EDS was low, and it affected only severe cases. Despite a weak association between the ESS score and the AHI index, male gender and depression score were the most significant predictors for the occurrence of sleepiness., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objectives: The impact of sleep-related breathing disorders on the incidence of arterial hypertension (AHT) in the older adults is not well-established. The aim of our study was to test the link between severe obstructive sleep apnea (OSA) and the occurrence of hypertension in older subjects after 3 years., Methods: 372 normotensive subjects with a mean age of 68.2 years were included in our longitudinal study. All participants had a ventilatory polygraphic recording and an ambulatory blood pressure (BP) monitoring at baseline and after 3 years. Severe OSA was defined by an apnea-hypopnea index (AHI) of ≥ P30 per hour. A new onset of hypertension was defined according to a mean 24-hour value >140mmHg for systolic BP and >85mmHg for diastolic BP or the use of antihypertensive medication., Results: The baseline factors significantly associated with an increased risk for new-onset hypertension were male gender, obesity, diabetes mellitus (DM), dyslipidemia, and OSA. Multiple logistic regression analyses showed that an AHI ≥30 per hour was independently associated with incident hypertension after 3 years (P=.02; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8)., Conclusions: The presence of severe OSA is associated with new-onset AHT in normotensive elderly (mean age, 68.2 y) subjects., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Sleep-disordered breathing (SDB) has emerged as an independent risk factor for carotid atherosclerosis (CA) and cerebrovascular disease in middle-aged subjects. Currently, there is no study providing a causal relationship between SDB and cerebrovascular lesions in elderly., Objective: To assess the impact of SDB on CA in a cohort of healthy elderly subjects., Methods: Seven hundred and fifty-five participants of a cross-sectional study on the association between SDB and cardiovascular morbidity, aged 68yr at study entry, were examined. All subjects underwent carotid ultrasonography and risk factors for atherosclerosis including smoking, metabolic syndrome and hypertension were examined. An apnea + hypopnea index (AHI)>15 was considered indicative of SDB., Results: Presence of carotid lesion was found in 35% of the sample, predominantly in men and in overweight subjects. The most frequent alteration was arteriosclerosis present in 74% of cases, with stenosis >50% found in only 9% of subjects. No significant difference in the prevalence of carotid lesion was found between subjects with and without SDB, subjects with an AHI>30, even though, having a slight increase in CA. At the logistic regression analysis, male gender (p<0.001), systolic and diastolic blood pressure (p<0.001), dyslipidemia (p=0.003) and hypertension (p=0.009) were the variables independently associated with carotid lesions even in severe cases., Conclusion: The incidence of CA in healthy elderly subjects is mediated more by gender, metabolic factors and hypertension than by presence of SDB. Further clinical studies including extensive evaluation of all atherosclerotic factors are needed to elucidate the predisposing role of SDB for cerebrovascular risk., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: Some epidemiological data are available on the association between sleep duration and sleep quality, sleep complaints, and the aging related cognitive impairment in the elderly. In this study we examined a large sample of healthy elderly subjects to assess the relationship between sleep quality, subjective cognitive complaints, and neuropsychological performance., Methods: A total of 272 elderly subjects (mean age 74.8 ± 1.1 years) were recruited from a population-based cross-sectional study on aging and cardiovascular morbidity. All subjects filled in self-assessment questionnaires evaluating cognitive function, anxiety, depression, sleep-related parameters, and the Pittsburgh Sleep Quality Index (PSQI). Ambulatory polygraphy and extensive neuropsychological tests were also performed. Based on the total PSQI score, subjects were classified as good sleepers (GS, PSQI<5, n=116) and poor sleepers (PS, PSQI≥5, n=156)., Results: Poor sleep did not affect the subjective cognitive function score, subjective cognitive impairment being mainly related to anxiety, depression, and sleep medication intake. No significant differences were seen between GS and PS in any of the objective cognitive function tests except for the Trail Making Test A (TMA-A), processing speed being longer in the PS group (p<0.001). Neither the presence of sleep-related breathing disorders nor gender affected cognitive performance., Conclusions: Our results suggest that in healthy elderly subjects, subjective sleep quality and duration did not significantly affect subjective and objective cognitive performances, except the attention level, for that the interference of sleep medication should be considered., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: To evaluate the ability of the heart rate power spectral density of the very low frequency component expressed as a percentage of the total power spectral band (%VLFI) to diagnose obstructive sleep apnoea (OSA) in the elderly., Patients and Methods: Eight hundred and thirty-two subjects aged 68.5±0.8 years were selected from the participants of a 7-year cross-sectional study on the association between OSA and vascular morbidity-mortality. All subjects underwent electrocardiogram Holter monitoring and an at-home polysomnogram to measure the apnoea/hypopnoea index (AHI). OSA was assessed as an AHI>15., Results: The very low, the low frequency powers, and the %VLFI increased in subjects with OSA and were correlated with the autonomic arousal index and AHI (p<0.0001). A %VLFI of 2.4% and 4% demonstrated a sensitivity of 62% and 69% and a specificity of 45% and 44% to predict OSA in the population., Conclusion: The %VLFI did not provide a high level of diagnostic sensitivity and specificity at different degrees of OSA severity in an elderly healthy population. The ability for prediction was lower in mild cases and in women. These findings suggest that the ageing-related changes in the autonomic nervous system reduce the applicability of HRV to diagnose OSA in older populations., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: In the elderly, obstructive sleep apnea (OSA) is frequently under diagnosed. This study was undertaken to assess the accuracy of the Berlin questionnaire to diagnose OSA in a large healthy elderly population., Patients and Methods: Six hundred forty-three participants aged 65.6 years were examined. All subjects completed the Berlin questionnaire and underwent at-home respiratory recording. Presence of OSA was defined by an AHI>15., Results: Of the respondents, 202 subjects (31.4%) were in an OSA high-risk group according to the Berlin questionnaire. The high-risk subjects were significantly heavier, had greater waist and hip circumferences, higher AHI, and reported more frequently hypertension and diabetes. Habitual snoring was present in 54% of the sample, sleepiness in 12% of participants, and a BMI>30 and a history of hypertension in 42.1%. Being in the high-risk group predicted an AHI>15 with a sensitivity of 77%, a specificity of 39%, a positive predictive value of 63% and a negative predictive value of 55%. Among Berlin questionnaire categories, snoring correctly classified 61% of the sample and explained the 5% variance of AHI., Conclusions: The Berlin questionnaire did not provide a high level of diagnostic specificity to discriminate OSA in an elderly population. Although not sufficiently accurate, this questionnaire can be used to identify subjects for sleep study assessment., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background and Purpose: An association between obstructive sleep apnoea/hypopnea (OSAH) and cardiovascular risk factors such as dyslipidemia has been described in adults and high-risk populations., Patients and Methods: We examined this association in a prospective cohort (SYNAPSE study) of 846 elderly (68.5+/-1.1 years) volunteers (41.6% of men). No subject presented with recognized OSAH syndrome, heart disease, or any neurological disorder. Unattended at-home polygraphy was done by all subjects. OSAH severity was defined as moderate (apnoea/hypopnea index: AHI>15/h) or severe (AHI>30/h). High-density lipoprotein cholesterol (HDL-c) was measured by immuno-separation-based homogenous assay., Results: The prevalence of severe cases reached 21.5% (AHI mean+/-SD: 43.5+/-11.9). Using univariate linear regression analysis, AHI (R=-0.172; p<0.0001), oxyhemoglobin desaturation index (ODI) (R=-0.108; p<0.002), mean SaO(2) (R=0.125; p<0.0003) and Nadir SaO(2) (R=0.094; p<0.007) were significantly associated with HDL-c. Multiple regression analysis demonstrated that male gender, BMI, waist to hip ratio, ODI, and AHI represent independent predictors of HDL-c. Logistic regression analysis showed a significant association between severe OSAH and low HDL-c serum levels (p<0.03) after adjustment for gender, BMI, hypertension, glycaemia, waist to hip ratio, alcohol intake and treated dyslipidemia. The association appears more evident in subjects free of lipid-lowering medications and beta-blockers (p<0.007). There was no independent association of OSAH syndrome with low-density lipoprotein (LDL) cholesterol., Conclusion: Unrecognized moderate to severe apnoea/hypopnea syndrome was independently associated with low HDL-c serum levels in the present cross-sectional based elderly population. This could explain the deleterious effect of OSAH syndrome on cardiovascular risk.

Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region., Methods: We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK)., Results: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome., Conclusion: Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.

Background and Purpose: To evaluate the test-to-test variability of the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS)., Patients and Methods: Twenty patients with primary RLS (12 men and eight women; age: 53.3+/-11.3 years) were selected for the study. We compared the results of two SITs performed on two consecutive evenings prior to polysomnographic recordings., Results: Overall, the periodic leg movement index during the SIT (SIT PLM) and the SIT PLM index associated with sensory manifestations (SIT PLM+) were not significantly different between tests. The number of PLM sequences per SIT, the mean PLM duration and the PLM interval did not significantly change between the two consecutive tests. The pattern of temporal evolution of motor activity across the SIT was very reproducible, SIT PLM showing a clear tendency to a progressive increase across the test, with the SIT PLM+ index decreasing in the second half of the test. Despite good reproducibility, there were marked intra-individual differences. Considering the proposed cut-off value of 12 for the SIT PLM index to confirm RLS, 11 patients were positive at the first test and four additional patients became positive at the second test. SIT PLM index changes did not correlate with age, severity of disease and polysomnographic measures., Conclusions: Quantitative analysis of motor activity during two consecutive SITs in RLS patients showed a significant inter-test intra-individual variability unrelated to demographic, clinical or polysomnographic parameters. SIT PLM index variability suggests that a single test would not be sensitive enough for diagnostic purposes in unclear cases and that new criteria need to be applied to increase its specificity and sensitivity.

Background and Purpose: Restless legs syndrome (RLS) is usually associated with periodic leg movements (PLM) occurring during wakefulness and sleep. The PLM index obtained by the polysomnographic method reflects the degree of motor symptoms and their consequences on sleep structure. Automated analysis of PLM using actigraphy can assess this condition and can therefore be used to assess therapeutic effects in clinical trials. In the current study we assessed the reliability of the PAM-RL, an ambulatory device measuring limb movements and PLM with a high-time resolution., Patients and Methods: Forty-three patients consecutively referred to the sleep laboratory for insomnia and/or excessive daytime sleepiness underwent one or two nights of polysomnography (PSG) with simultaneous bilateral recording of limb activity by the PAM-RL device. The PSG recordings were blinded and manually analyzed for PLM, while limb actimetry was scored automatically based on the manufacturer's algorithm., Results: There was a significant correlation between PLM derived from PSG and actimetry (r=0.87, P<0.0001) with good agreement across a wide range of values. The sensitivity and specificity of the PAM-RL device in detecting patients having a polysomnographic PLM index >10 were, respectively, 0.88 and 0.76 with a receiving operating curve having an area under the curve (AUC) of 0.86 for the entire group of patients. All patients with clinically definitive RLS and primary PLM disorder (PLMD) had a PLM index >10 on PSG, but among patients with sleep-related breathing disorders (SRBD) 60% reached this cut-off value. Conversely, only 50% of those patients with an actigraphically assessed PLM index >10 had clinically definitive RLS or PLMD, and 40% had SRBD., Conclusions: We demonstrate that automatic detection of PLM derived from the PAM-RL device is highly reliable when compared to the 'gold standard' of polysomnography in patients with RLS and PLMD. Therefore, limb actigraphy can be used routinely to assess motor restlessness in patients with RLS and PLMD. The higher discrepancy in patients with SRBD and insomnia may preclude the use of the device in these patients.

Background and Purpose: Although a night-to-night variability in periodic leg movements (PLM) occurrence has been described in patients with primary PLM disorder and sleep apnea syndrome, no study has apparently considered the inter-night effect on PLM index during wakefulness and sleep in patients with Restless Legs Syndrome (RLS). Moreover, no study has examined the night-to-night variability in PLM index according to sleep stage and time of night. We therefore examined changes in PLM index during wakefulness and sleep during two consecutive nights in a group of untreated RLS patients., Patients and Methods: Twenty-eight drug-free RLS patients, aged 53.4+/-2.3 yr, with a mean International Restless Legs Syndrome Study Group (IRLSSG) severity score of 20.2+/-1.6, were studied during two consecutive nights. PLM duration and interval, PLM index during wakefulness (PLMWI), during total sleep time (PLMSI), as well as during each sleep stage were measured. Analysis was also extended to examine PLM occurrence during sleep cycles., Results: In the group of patients as a whole, the PLMW and PLMS index, duration and interval did not show significant difference between nights, these measures being consistently similar for both nights. Comparison of PLMS index between different sleep stages did not reveal inter-night differences. Nocturnal variation in PLM number, duration and interval for total recording time and sleep period revealed a progressive decline across the night for PLM index (P

Background and Purpose: Micro-arousals (MA) are commonly considered as sleep components reflecting sleep fragmentation. However, their elucidation is time-consuming, with considerable inter-observer variability. The aim of our study was to investigate the usefulness of a sleep fragmentation index (SFI) to detect sleep disruption in a large sample of patients., Patients and Methods: Five-hundred ninety-eight polysomnographic studies made in controls and patients were examined. The SFI was calculated as the total number of awakenings and sleep stage shifts divided by total sleep time., Results: In the whole group a significant correlation was found between the SFI and the MA index (MAI) (P<0.001) with good agreement across a wide range of values. When patients were stratified according to final diagnosis a significant relation was noted for patients with insomnia (P<0.001), parasomnia (P<0.001), circadian schedule disorders (P<0.001) and sleep related breathing disorders (P< 0.001). Lower values were found in controls (P<0.01) and in patients with periodic limb movement disorder and/or restless legs syndrome (P<0.05). In 111 patients having two consecutive recording nights, a good reproducibility was present with no differences between nights (P=ns) and with significant correlation (P<0.001)., Conclusions: The SFI seems to be an accurate, reproducible and easy method to detect sleep fragmentation in patients with sleep disorders. Further studies are needed to validate the usefulness of this tool in clinical practice.

Objective: The etiology of depression and personality disorders in patients with sleep-disordered breathing (SDB) is not well defined and it is still unclear if they are directly related to the severity of the disease. In this study we test the hypothesis as to whether daytime sleepiness largely contributes to appearance of mood disorders., Methods: Sixty patients diagnosed as having snoring (n=16) or OSA (n=44) were examined. Daytime sleepiness was assessed by the administration of the Epworth Sleepiness Scale (ESS) and by the Maintenance Wakefulness Test (MWT). The Hospital Anxiety (HAD-A) and Depression (HAD-D) Scale and the Temperament and Character Inventory (TCI) questionnaires were used for psychopathological evaluation., Results: The mean HAD-A score was 6.9+/-0.45 and the average HAD-D score was 4.6+/-0.48, with no significant difference between snorers and OSA patients. Anxiety was present in 16% of cases and depression in 7%. The HAD-D score was related to the ESS score (R=0.37, P=0.003), the mean sleep latency at the MWT (R=-0.34, P=0.04), and the mean low SaO(2), ESS score alone explaining the 17% of variance in the HAD-D score. Compared to controls, there were no differences in almost all TCI scores, with novelty-seeking temperament score higher in patients. No relationships were found between HAD or TCI scores and apnea density., Conclusions: We conclude that among patients evaluated for SDB, higher depression scores show an association with reduced daytime alertness, which therefore may have important effects on mood.