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Purpose: The aim of this study is to investigate the effect of comprehensive rehabilitation on apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). Methods: Patients diagnosed with OSA and meeting the eligibility criteria will be randomly allocated in the groups. The experimental group will receive comprehensive rehabilitation, and the control group will receive myofunctional therapy. CPAP will be continued by all the participants. Both the groups will receive the interventions for 12 weeks. The primary outcome measures are AHI and Epworth Sleepiness Scale (ESS), and secondary outcomes are Pittsburg Sleep Quality Index (PSQI), Oxygen Desaturation Index (ODI), Snoring Index (SI), Manual Assessment of Respiratory Motion (MARM), Breath Hold Test (BHT), and Self Evaluation of Breathing Questionnaire (SEBQ). The outcomes will be assessed at baseline and at the end of 12 weeks. A follow-up will be taken at the end of 24 weeks. Power analysis suggests that enrollment of 118 patients will required. Repeated measures ANOVA will be used to analyze the effect of the intervention. Conclusion: By performing this research, we may develop insights on a novel comprehensive approach for treatment of patients with OSA. Trial registration: CTRI/2023/10/058486. [ABSTRACT FROM AUTHOR]

Background/Aim: Restless legs syndrome (RLS) is a chronic neurological disease that impairs sleep quality, causes emotional stress and affects daily activities. While the association between disease severity and low iron and ferritin levels is known, the magnesium (Mg) results are contradictory. This study aimed to investigate the influence of low Mg and ferritin levels on the severity of the disease and sleep quality. Methods: A case-control study included 50 RLS patients aged 18-78 years and 50 healthy control patients. Mg and ferritin levels were measured, considering values below <1.8 mg/dL and 75 ng/mL as low. Both groups completed the International Restless Legs Syndrome Study Group score (IRLSSG score) to assess the severity of RLS, as well as the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) to evaluate subjective sleep quality. Results: The mean age of RLS patients and the control group was 47.06 (13.35) years and 43.30 (15.43) years, respectively (P=0.196). The RLS patients had an IRLSSG score of 25.16 (6.85). The PSQI total scores, subscale scores, and ESS scores of RLS patients were significantly higher than those of the control group. However, no significant difference was observed in the IRLSSG score, PSQI, and ESS scores based on Mg and ferritin levels. Sleep latency was found to be shorter in individuals with Mg deficiency. Conclusion: Sleep disorders are prevalent among RLS patients. No correlation was found between Mg and ferritin levels and disease severity or sleep disorders. Furthermore, Mg deficiency did not appear to exacerbate the IRLSSG score or sleep disorder scores. [ABSTRACT FROM AUTHOR]

In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under‐diagnosed and under‐treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions. [ABSTRACT FROM AUTHOR]

Glucose transporter type-1 deficiency syndrome, familial Glut1 DS, sleep disorder, seizure, daytime somnolence, paroxysmal exercise-induced dyskinesia Keywords: glucose transporter type-1 deficiency syndrome; familial Glut1 DS; sleep disorder; daytime somnolence; seizure; paroxysmal exercise-induced dyskinesia EN glucose transporter type-1 deficiency syndrome familial Glut1 DS sleep disorder daytime somnolence seizure paroxysmal exercise-induced dyskinesia 129 132 4 04/21/22 20220301 NES 220301 Conflict of Interest The authors declare no competing interests. Glut1 deficiency syndrome (Glut1DS): State of the art in 2020 and recommendations of the international Glut1DS study group. Introduction Glucose transporter type-1 deficiency syndrome (Glut1 DS) is a rare genetic-metabolic disorder caused by mutations in the I SLC2A1 i gene on chromosome 1p34.2. [Extracted from the article]

Background: Earlier detection of parkinsonism, specifically during its prodromal stage, may be key to preventing its progression. Previous studies have produced contradictory results on the association between sleep symptoms and prodromal parkinsonism. Objective: We conducted a prospective study within the Canadian Longitudinal Study on Aging (CLSA) to determine whether self-reported symptoms of insomnia, somnolence, apnea, and restless legs syndrome predate the diagnosis of parkinsonism after three years of follow-up. Methods: At baseline, amongst other information, participants completed a questionnaire for difficulty initiating or maintaining sleep, daytime somnolence, snoring or stopping breathing during sleep, and symptoms of restless legs syndrome. After 3 years of follow-up, baseline responses from participants who self-reported a new diagnosis of parkinsonism (cases) were compared to those who did not (controls). For each case, 10 controls were individually matched by age, sex, education, BMI, caffeine, smoking, and alcohol. Binary unconditional logistic regression models were used to estimate the association between sleep symptoms and new-onset parkinsonism, adjusting for age, sex, education, BMI, smoking, alcohol, and caffeine. Results: We identified 58 incident-parkinsonism cases and 580 matched controls (65.5%male, mean age = 69.60, SD = 8.0). Baseline symptoms of sleep-onset insomnia (12.1%vs. 13.0%, Adjusted OR[95%CI] = 0.87[0.32,2.33]), sleep-maintenance insomnia (24.1%vs. 20.2%, AOR = 1.01[0.46,2.20]), daytime somnolence (8.6%vs. 7.4%, AOR = 1.11[0.37,3.39]), obstructive sleep apnea (27.3%vs. 26.2%, AOR = 0.84[0.40,1.79]), and restless leg syndrome (20.6%vs. 9.9%, AOR = 1.34[0.42,4.25]) were similar among those who developed parkinsonism and those who did not. Conclusion: Symptoms of insomnia, somnolence, apnea, and restless legs did not predate a new diagnosis of parkinsonism over 3 years. [ABSTRACT FROM AUTHOR]

Introduction: The diagnostic process for idiopathic hypersomnia (IH) is complex due to the diverse aetiologies of daytime somnolence, ambiguous pathophysiological understanding, and symptom variability. Current diagnostic instruments, such as the multiple sleep latency test (MSLT), are limited in their ability to fully represent IH's diverse nature. This study endeavours to delineate subgroups among IH patients via cluster analysis of polysomnographic data and to examine the temporal evolution of their symptomatology, aiming to enhance the granularity of understanding and individualized treatment approaches for IH., Methods: This study included individuals referred to the Uppsala Centre for Sleep Disorders from 2010 to 2019, who were diagnosed with IH based on the International Classification of Sleep Disorders-3 (ICSD-3) criteria, following a thorough diagnostic evaluation. The final cohort, after excluding participants with incomplete data or significant comorbid sleep-related respiratory conditions, comprised 69 subjects, including 49 females and 20 males, with an average age of 40 years. Data were collected through polysomnography (PSG), MSLT, and standardized questionnaires. A two-step cluster analysis was employed to navigate the heterogeneity within IH, focusing on objective time allocation across different sleep stages and sleep efficiency derived from PSG. The study also aimed to track subgroup-specific changes in symptomatology over time, with follow-ups ranging from 21 to 179 months post-diagnosis., Results: The two-step cluster analysis yielded two distinct groups with a satisfactory silhouette coefficient: Cluster 1 (n = 29; 42 %) and Cluster 2 (n = 40; 58 %). Cluster 1 exhibited increased deep sleep duration, reduced stage 2 sleep, and higher sleep maintenance efficiency compared to Cluster 2. Further analyses of non-clustering variables indicated shorter wake after sleep onset in Cluster 1, but no significant differences in other sleep parameters, MSLT outcomes, body mass index, age, or self-reported measures of sleep inertia or medication usage. Long-term follow-up assessments showed an overall improvement in excessive daytime sleepiness, with no significant inter-cluster differences., Conclusion: This exploratory two-step cluster analysis of IH-diagnosed patients discerned two subgroups with distinct nocturnal sleep characteristics, aligning with prior findings and endorsing the notion that IH may encompass several phenotypes, each potentially requiring tailored therapeutic strategies. Further research is imperative to substantiate these findings., Competing Interests: Declaration of competing interest Nothing to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Patients with delayed sleep-wake phase disorder (DSWPD) suffer from difficulties in sleep initiation at night, difficulties in waking up at the socially required time, and daytime somnolence. About half of the patients resist conventional light therapy and melatonin therapy. Therapy using hypnotics is not recommended due to its adverse effects. Recently, suvorexant, an orexin receptor antagonist, has become available for clinical use. The drug is relatively safer than traditional hypnotics such as benzodiazepines. We report three DSWPD patients who were successfully treated by the combination therapy of suvorexant and ramelteon. The first case was a 19-year-old woman who was experiencing difficulties in sleep initiation, difficulty in waking up in the morning, and daytime somnolence. She showed a prompt response to the combination therapy of suvorexant and ramelteon. Her sleep phase advanced, and her daytime somnolence reduced. The second and third cases were 21-year-old and 17-year-old men, respectively, who also showed significant sleep phase advances. Although case 2 was resistant to ramelteon treatment, his sleep phase advanced after suvorexant started. His difficulty in falling asleep and his habit of daytime napping disappeared after the combination therapy of suvorexant and ramelteon was started. Case 3 also showed a prompt response. His difficulties in falling asleep and waking up in the morning were ameliorated immediately after suvorexant with ramelteon was started. No obvious side effects were observed. Therapy using the combination therapy of suvorexant and ramelteon might be a reasonable option for DSWPD patients. [ABSTRACT FROM AUTHOR]

Rationale: Studies looking at the effect of antiseizure medications (ASMs) on the sleep microstructure of subjects with epilepsy are scarce. This study aims to evaluate the impact of eslicarbazepine (ESL) as add-on therapy on the sleep microstructure in temporal lobe epilepsy (TLE).Methods: Twelve patients affected by TLE were recruited to undergo overnight polysomnography and a subjective evaluation of nocturnal sleep utilizing the Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence through the Epworth Sleepiness Scale (ESS) before and after three months of treatment with ESL as add-on therapy. Ten healthy controls (HC) matched for age, sex and BMI were recruited. Scoring and analysis of sleep macrostructure and cyclic alternating pattern (CAP) parameters were performed.Results: Ten patients completed the study. The comparison between patients in basal condition (T0) and HC showed a significant lower sleep efficiency (p = 0.049), REM percentage (p = 0.002), higher REM latency (p = 0.02), N2 (p = 0.001) and WASO (p = 0.01). Regarding CAP, patients at T0 showed higher CAP rate in N1 (p = 0.01), lower A1 (%) (p = 0.03), higher A3 (%) (p = 0.01), higher mean duration of A (p = 0.02) and A3 (p = 0.006), A3 index (p = 0.02) than HC. ESL did not induce any significant changes in nocturnal macrostructural polysomnographic variables and PSQI scores. Furthermore, the ESS score showed no modification after treatment. Lower CAP rate in N3 (p = 0.02), phase A2 index (p = 0.02) average number of CAP cycle per sequences and mean duration of CAP sequences (both p = 0.02) was evident after ESL. A trend toward significance was evident for the decrease of CAP rate in N1 (p = 0.09) and N2 (p = 0.09), and for the increase of B phase mean duration (p = 0.07).Conclusion: We found significant improvement in sleep continuity as measured by CAP after ESL. These findings suggest that ESL may positively modulate sleep fragmentation in patients with TLE, and hence enhance sleep quality. Our results suggest a favourable sleep profile with the use of ESL. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review synthesizes the most recent literature on neuropsychological deficits in adults with Parkinson's disease who experience excessive daytime sleepiness (EDS). Confounds and methodological limitations are explored. A framework entitled the Cascade Model of Excessive Daytime Sleepiness (CMEDS) is proposed to explain the role of EDS in contributing to cognitive impairment for patients with Parkinson's disease. Method: Systematic search through PubMed, PsychInfo and citation records. In total, 175 articles were screened for possible inclusion. Eight studies were included, encompassing 1373 patients with Parkinson's disease − 442 of whom had Parkinson's disease with EDS. Results: For Parkinson's disease patients with EDS, global deficits, executive dysfunction and deficits in processing speed were found beyond the typical cognitive phenotype of patients without EDS. Language skills, memory and visuospatial skills appeared to be similar between those with and without EDS. In untreated, de novo, patients, there were no cognitive differences between the EDS groups. Conclusion: This review suggests that Parkinson's disease patients suffering from EDS may have additional cognitive deficits globally, in executive control, and in processing speed. As suggested by the CMEDS framework, the impact of EDS on cognition may be related to Parkinson's disease pathology, comorbidities and medication use. [ABSTRACT FROM AUTHOR]

This prospective uncontrolled study evaluated the effect of low-dose adjunctive perampanel therapy (4 mg/day for 3 months) on the sleep-wake cycle and daytime somnolence in adult patients (n = 10) with focal seizures. A >50% reduction in the number of seizures was reported in 80% of the study patients; treatment had no significant effect on any sleep parameters as evident by the Maintenance of Wakefulness Test, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale scores. Two patients reported dizziness with treatment. In conclusion, low-dose perampanel may improve seizure control without affecting the sleep characteristics or daytime somnolence in patients with epilepsy.

In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under-diagnosed and under-treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: Sleep may underlie psychiatric symptoms in young children. However, not many studies have reported on sleep and its associations with symptoms in young child psychiatric patients. Objectives: To assess the amount and quality of sleep and how sleep associates with psychiatric symptoms in young child psychiatric patients. Furthermore, we evaluated how sleep and daytime somnolence differed in patients and their age- and gender-matched controls. Method: The sample consisted of 139 3- to 7-year-old child psychiatric outpatients and 139 age- and gender-matched controls from community. We evaluated sleep and daytime somnolence with the Sleep Disturbance Scale for Children in all children and psychiatric symptoms with Child Behaviour Checklist (CBCL) in the patient group. Family background information was collected from the patients. Results: Of the patients, 31.6% had a significant sleep problem and 14.4% slept too little. The most typical sleep problems were restless sleep (31.7%), morning tiredness (21.6%) and difficulties getting to sleep at night (18.7%). All types of sleep problems were associated with CBCL total, internalising and externalising problems (all p-values < .01). We observed a strong association between all types of sleep problems and emotionally reactive subscale (p-value < .001). Furthermore, parent-reported sleep problems increased significantly the risk of having high scores on total (odds ratio (OR) = 5.3, 95% confidence interval (CI) = [2.2, 12.6], p < .001), external (OR = 3.7, 95%, CI = [1.6, 8.5], p < .01) and internal (OR = 2.5, 95% CI = [1.1, 5.5], p < .05) scores after controlling for age, gender, family structure and parent’s educational level. Even mild sleep disturbance increased the intensity of psychiatric symptoms. Compared to controls, patients slept less (p < .001) and had significantly more frequent restless sleep, nightmares and morning and daytime somnolence. Conclusion: Sleep problems and too little sleep are prevalent in young child psychiatric patients, and they relate strongly to the intensity of psychiatric symptoms. Identification and treatment of sleep problems should be a routine part of the treatment plan for young child psychiatric patients. The results emphasise the need for assessing sleep in young child psychiatric patients, as treating the sleep problem may reduce psychiatric symptoms. [ABSTRACT FROM AUTHOR]

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Background: Nonmotor symptoms in dystonia are increasingly recognized to impair the quality of life. The primary objective of this study was to determine the prevalence of fatigue and sleep disturbances in dystonia and to ascertain their impact on quality of life using standardized questionnaires. Methods: Dystonia patients presenting to a Botulinum toxin clinic were prospectively administered Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory (MFI), Epworth Sleepiness Scale (ESS) and Parkinson's Disease Sleep Scale (PDSS) for assessment of fatigue and sleep disturbances. Health-related Quality of life (HRQOL) was determined using MOS SF-36 scale and depressive symptoms were assessed using the Beck Depression Inventory II. Results: Ninety-one patients with dystonia participated (66 women, 25 men, mean age 60 ± 17 years). Nine subjects had generalized dystonia, 18 segmental dystonia and 64 had focal dystonia. Moderate to severe fatigue was present in 43% of the cohort (FSS), excessive daytime somnolence in 27% (ESS) and other sleep disturbances in 26% (PDSS). FSS and MFI scores correlated significantly with HRQOL even when controlled for depression and sleep disturbances. Excessive daytime somnolence and nocturnal sleep disturbances correlated significantly with the HRQOL; however, these effects were not seen for daytime somnolence when controlled for depression. Psychometric testing found adequate reliabilities and convergent validities for both fatigue and sleep scales. Conclusion: Fatigue and sleep disturbances revealed high prevalence rates in this large, first of its dystonia study. They negatively impacted the quality of life even when controlled for comorbid depression. [ABSTRACT FROM AUTHOR]

Background: Daytime sleepiness and sleep disorders are frequently reported in Parkinson's disease (PD). However, their impact on quality of life has been underestimated and few clinical trials have been performed.Objectives: We aimed to assess the efficacy and safety of pharmacological interventions for daytime sleepiness and sleep disorders in PD.Methods: Systematic review of randomized controlled trials comparing any pharmacological intervention with no intervention or placebo for the treatment of daytime sleepiness and sleep problems in PD patients.Results: Ten studies (n = 338 patients) were included. Four trials addressed interventions for excessive daytime sleepiness. Meta-analysis of the three trials evaluating modafinil showed a significant reduction in sleepiness, as assessed by the Epworth Sleepiness Scale (ESS) (- 2.24 points, 95% CI - 3.90 to - 0.57, p < 0.05). In one study, treatment with caffeine was associated with a non-significant improvement of 1.71 points in ESS (95% CI, - 3.57 to 0.13). The six remaining trials assessed interventions for insomnia and REM sleep Behaviour Disorder (RBD). Single study results suggest that doxepin and YXQN granules might be efficacious, while pergolide may be deleterious for insomnia and that rivastigmine may be used to treat RBD in PD patients. However, there is insufficient evidence to support or refute the efficacy of any of these interventions. No relevant side effects were reported.Conclusions: Whilst providing recommendations, this systematic review depicts the lack of a body of evidence regarding the treatment of sleep disorders in PD patients; hence, further studies are warranted. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the association between self-reported sleep problems and cognitive decline in community-dwelling older people. We hypothesized that daytime somnolence predicts subsequent cognitive decline. Methods: This is a longitudinal study in a 3.2-year follow-up, with 18-month intervals. The setting is the Washington Heights-Inwood Community Aging Project. There were 1098 participants, who were over 65 years old and recruited from the community. Sleep problems were estimated using five sleep categories derived from the RAND Medical Outcome Study Sleep Scale: sleep disturbance, snoring, awaken short of breath/with a headache, sleep adequacy, and daytime somnolence. Four distinct cognitive composite scores were calculated: memory, language, speed of processing, and executive functioning. We used generalized estimating equations analyses with cognitive scores as the outcome, and time, sleep categories and their interactions as the main predictors. Models were initially unadjusted and then adjusted for age, gender, education, ethnicity, depression, and apolipoprotein E-ε4 genotype. Results: Increased daytime somnolence (including feeling drowsy/sleepy, having trouble staying awake, and taking naps during the day) was linked to slower speed of processing both cross-sectionally (B = -0.143, p = 0.047) and longitudinally (B = -0.003, p = 0.027). After excluding the demented participants at baseline, the results remained significant (B = -0.003, p = 0.021). Conclusions: Our findings suggest that daytime somnolence may be an early sign of cognitive decline in the older population. [ABSTRACT FROM AUTHOR]

To investigate the effects of regular arousal nursing on prognosis of nerve function in daytime somnolence patients with acute cerebral infarction. Methods 202 hospitalized patients were randomly divided into the control group(n=100) and study group (n=102). For the control group， the routine nursing was adopted while for the study group routine nursing as well as regular arousal nursing were used so as to compare the incidence rate of sleep-wake rhythm disturbance and the scores of NIHSS， Glasgow and Rankin. Result The incidence of diurnal rhythm disorders in the control group was 47%. The average NIHSS scores were 26.3±2.1 on the 7th day，22.5±2.3 on the 14th day and 17.4±2.0 on the 21st day respectively; the average Glasgow scores were 6.3±1.1 on the 7th day， 8.5±1.2 on the 14th day and 11.2±1.0 on the 21st day respectively and the average Rankin score was 4.3±0.8. The incidence rate of sleep-wake rhythm disturbance in the study group was 10.8%. NIHSS scores(average)were 21.9±1.8 on the 7th day， 16.2±1.9)on the 14th day and 13.3±1.7 on the 21st day respectively；Glasgow scores(average)were 8.9 ±0.7)on the 7th day， 10.8 ±0.6 on the 14th day and 13.6 ±0.6 on the 21st day respectively and Rankin score(average)was 2.1 ±0.3.The difference between the 2 groups was statistically significant(P < 0.05)．Conclusion Regular wake-up care can effectively improve the neurological function in patients with acute cerebral infarction during daytime sleepiness. [ABSTRACT FROM AUTHOR]

Objective This study was undertaken to determine the frequency and correlates of excessive daytime sleepiness in de novo, untreated Parkinson's disease (PD) patients compared with the matched healthy controls. Methods Data were obtained from the Parkinson's Progression Markers Initiative, an international study of de novo, untreated PD patients and healthy controls. At baseline, participants were assessed with a wide range of motor and nonmotor scales, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Excessive daytime sleepiness was assessed based on the Epworth Sleepiness scale (ESS), with a cutoff of 10. Results Four hundred twenty-three PD subjects and 196 healthy controls were recruited into the study. Mean ESS (min, max) score was 5.8 (0, 20) for the PD subjects and 5.6 (0, 19) for healthy controls ( P = 0.54). Sixty-six (15.6%) PD subjects and 24 (12%) healthy controls had ESS of at least 10 ( P = 0.28). No difference was seen in demographic characteristics, age of onset, disease duration, PD subtype, cognitive status, or utilization of sedatives between the PD sleepiness-positive versus the negative group. The sleepiness-positive group had higher MDS-UPDRS Part I and II but not III scores, and higher depression and autonomic dysfunction scores. Sleepiness was associated with a marginal reduction of A-beta ( P = 0.05) but not alpha-synuclein spinal fluid levels in PD. Conclusions This largest case control study demonstrates no difference in prevalence of excessive sleepiness in subjects with de novo untreated PD compared with healthy controls. The only clinical correlates of sleepiness were mood and autonomic dysfunction. Ongoing longitudinal analyses will be essential to further examine clinical and biological correlates of sleepiness in PD and specifically the role of dopaminergic therapy. © 2015 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Studies in patients seeking attention for nasal obstruction or pharyngeal disorders suggest that craniofacial abnormalities correlate with obstructive sleep apnea, but there is little information on the relevance of this association in the population at large. We aimed to determine whether characteristics of facial morphology correlate with excessive daytime somnolence (EDS) in a population-based, door-to-door survey. Residents of a village in rural Ecuador were screened with the Epworth sleepiness scale to assess EDS and underwent physical examination with attention to nasal septum deflection, mandibular retrognathia and presence of Friedman's palate position type IV. From 665 participants aged ≥40 years, 155 had EDS, 98 had nasal septum deflection, 47 had mandibular retrognathia and 528 had a Friedman's palate position type IV. In a logistic regression model adjusted for age, sex, body mass index, and nightly sleep hours, persons with nasal septum deflection were twice as likely to have EDS ( p = 0.009). The other two variables were not associated with EDS. Identification of nasal septum deflection may be a cost-effective method of detecting persons at risk for obstructive sleep apnea in remote areas where sophisticated technology is not readily available. [ABSTRACT FROM AUTHOR]

Purpose: Previously, sleep in chronic obstructive pulmonary disease (COPD) has been objectively investigated only by lab-based polysomnography. The main purpose of this study was to evaluate sleep quality in COPD patients in their home environment using actigraphy. We also investigated the factors associated with sleep impairment and the relationship between objective and subjective sleep quality and daytime somnolence in these patients. Methods: Twenty-six patients with moderate to very severe COPD and 15 controls were studied by actigraphy for at least 5 days. Subjective sleep quality was evaluated by the Pittsburgh Sleep Quality Index and daytime sleepiness by the Epworth Sleepiness Scale (ESS). Dyspnea was quantified by the modified Medical Research Council (MMRC) scale. Results: COPD patients showed increased sleep latency ( p = 0.003), mean activity ( p = 0.003), and wake after sleep onset ( p = 0.003) and reduced total sleep time (TST; p = 0.024) and sleep efficiency ( p = 0.001), as compared to controls. In patients, severity of dyspnea was correlated with sleep activity ( r = 0.41; p = 0.04) and TST ( r = −0.46; p = 0.02) and multiple regression analysis showed that MMRC score was the best predictor of TST ( p = 0.02) and sleep efficiency ( p = 0.03). Actigraphy measures during daytime were not significantly different between patients and controls. Subjective sleep quality was poorer in patients than controls ( p = 0.043). ESS scores were not significantly different between the two groups. Actigraphy measures were not correlated with subjective sleep quality or daytime somnolence in both groups. Conclusions: Nocturnal sleep is markedly impaired in stable COPD patients studied by actigraphy in their home environment and this impairment is related to severity of dyspnea. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to evaluate the effects of zonisamide (ZNS) as adjunctive therapy on sleep-wake cycle and daytime somnolence in adult patients affected by focal epilepsy. Methods: Thirteen patients affected by focal epilepsy were recruited to undergo a 24-hour ambulatory polysomnography, Multiple Sleep Latency Test (MSLT), and a subjective evaluation of nocturnal sleep by means of the Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence by means of the Epworth Sleepiness Scale (ESS) before and after 3months of treatment with ZNS as add-on therapy. Results: Twelve patients completed the study. Zonisamide therapy reduced seizures by >50% in 8 out of 12 patients. Zonisamide did not induce any significant changes in nocturnal polysomnographic variables and in PSQI scores. In addition, mean sleep latency and ESS score were unmodified after treatment. Conclusion: Zonisamide seems to be effective and safe in focal epilepsy. Both subjective and objective sleep parameters showed no detrimental effects on nocturnal sleep and daytime somnolence in patients with focal epilepsy using ZNS. Since some AEDs induce sleep impairment, which is known to trigger EEG abnormalities and seizures and to worsen quality of life, our findings suggest a positive profile of ZNS. [Copyright &y& Elsevier]

Abstract: Context: Fatigue has been identified in more than one-half of patients with sarcoidosis. Although fatigue is not synonymous with impaired quality of life, most studies of sarcoidosis identify fatigue as a major cause of impaired quality of life. Objectives: To test the hypothesis that stimulants may have a role in the treatment of fatigued sarcoidosis patients, even without objective evidence of daytime sleepiness. Methods: This was a double-blind, placebo-controlled, crossover study of sarcoidosis patients followed up in one sarcoidosis clinic Sarcoidosis patients with fatigue received either armodafinil or placebo with eight weeks of therapy for each arm and a two week washout period before crossover to the other treatment. Initial armodafinil dose was 150mg and increased to 250mg after four weeks. Patients underwent polysomnography and multiple sleep latency testing (MSLT) the following day. Patients with an apnea/hypopnea index <6/hour received either armodafinil or placebo. Polysomnography with MSLT was repeated after each treatment arm. Results: Fifteen patients received the study drug. Fatigue was assessed using the Fatigue Assessment Scale (the lower the score, the less the fatigue) and the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F) (the higher the score, the less the fatigue). After eight weeks of therapy, there was a significant improvement in the Fatigue Assessment Scale during armodafinil treatment (median −4.5, range −20, 5) compared with placebo treatment (median 3.5, range −9, 14, P <0.05) and for the FACIT-F (armodafinil: median 9, range −12, 26 vs. placebo: median −5, range −17, 11, P <0.005). This improvement in fatigue was seen for both those with and without shortened sleep onset latency time during the MSLT. Conclusion: Armodafinil treatment led to a significant reduction in fatigue in sarcoidosis patients. This effect was seen even in patients who did not have excessive daytime somnolence. [Copyright &y& Elsevier]

Abstract: This review focuses on the complex integration between cardiovascular reflexes and central autonomic influences controlling physiological sleep-dependent changes in arterial blood pressure and heart rate. A brief introduction on the anatomic and functional organization of the arterial baroreflex and the methods available to assess its function in humans is followed by an analysis of the functional interaction between autonomic nervous system and sleep mechanisms at the highest levels of brain organization. An insight into these interactions is important to shed light on the physiopathology of the most frequent complications of obstructive sleep apnea syndrome, such as sustained arterial hypertension, and excessive daytime sleepiness. [Copyright &y& Elsevier]

Abstract: Background: Sleep disturbances such as sleep fragmentation, sleep disordered breathing (SDB), periodic limb movements (PLM), excessive daytime somnolence (EDS) and insomnia are prevalent in Parkinson''s disease (PD). However, studies in the Asian population are limited. Methods: This was a cross-sectional study involving 46 Malaysians with PD using polysomnography (PSG) and standardized translated Parkinson''s disease sleep scale (PDSS). Overnight PSG recordings, UPDRS and PDSS scores, and baseline demographic data were obtained. Results: Data from 44 patients were analysed. Thirty-six patients (81.8%) had PSG-quantified sleep disorders. Twenty-three (52.3%) had sleep fragmentation, 24 (54.6%) had SDB and 14 (32%) had PLM. EDS was present in 9.1%. Insomnia was reported by 31.8%. Patients with sleep fragmentation had significantly higher UPDRS scores and lower PDSS insomnia sub-scores. The UPDRS scores correlated negatively with the TST and sleep efficiency. All patients with EDS had SDB (p =0.056). The PDSS insomnia sub-items correlated with sleep fragmentation on PSG. Conclusion: : The prevalence of sleep disorders based on PSG and PDSS in our PD patients was high, the commonest being sleep fragmentation and SDB, while EDS was the least prevalent. Problem specific sub-items of the PDSS were more accurate in predicting the relevant PSG-related changes compared to the PDSS as a whole. [Copyright &y& Elsevier]

Background and purpose: To evaluate the effects of pregabalin (PGB) adjunctive therapy on sleepwake cycle and daytime somnolence in adult patients affected by partial epilepsy. Methods: Twelve patients affected by partial epilepsy underwent a 24-h ambulatory polysomnography and a subjective evaluation of daytime somnolence by means of the Epworth Sleepiness Scale (ESS), before and after 3 months treatment with PGB. Results: Pregabalin therapy reduced seizures by >50% in 8 out of 12 patients. It induced a significant increase of REM sleep and a decrease of stage 2 NREM sleep (S2). A significant increase of the ESS score was observed without reaching the pathological cut-off value (mean ESS score <10). No statistical correlation between REM sleep and seizure frequency was observed. Discussion: Pregabalin seems to be effective and safe in partial epilepsy. The increase of REM sleep may be indicative of an improvement of nocturnal sleep quality considering the involvement of REM sleep in learning and memory processes. REM sleep enhancement may be the result of both a direct effect of PGB on sleep generators and an indirect effect due to its clinical efficacy. The increase of ESS score within normal range suggests that daytime somnolence is a minor adverse effect of PGB. [ABSTRACT FROM AUTHOR]

Sleep disturbance and excessive daytime sleepiness have been reported in patients with hepatic cirrhosis. The objective of this study was to evaluate daytime somnolence and sleep complaints in a group of 178 patients with cirrhosis compared to a control group. Sleep features and excessive daytime sleepiness were evaluated by the Basic Nordic Sleep Questionnaire (BNSQ) and the Epworth Sleepiness Scale (ESS). We collected clinical and laboratory data, neurological assessment and EEG recordings in cirrhotic patients. Patients with cirrhosis complained of more daytime sleepiness ( p<0.005), sleeping badly at least three times a week ( p<0.005), difficulties falling asleep ( p<0.01) and frequent nocturnal awakening ( p<0.005) than controls. We found a poor correlation between sleep disorders and clinical or laboratory parameters. Our results confirm previous literature reports suggesting a high prevalence of sleep disturbance in patients with cirrhosis. Insomnia and daytime sleepiness are the main complaints. Sleep disorders are probably a multifactorial phenomenon. [ABSTRACT FROM AUTHOR]

To investigatethe sleep-wake cycle and theeffects of cabergoline monotherapyin a homogenous group of de novoParkinson’s Disease (PD) patientswithout confounding comorbidfactors. Twelve de novo patients affected byidiopathic PD underwent twoambulatory polysomnographic (APSG)monitoring sessions. The firstwas performed at baseline, and thesecond recording one-month afterstable treatment with cabergolinemonotherapy. Subjective daytimesleepiness was evaluated by meansof the Epworth Sleepiness Scale.Data obtained in PD patients atbaseline were compared with thoseobtained in 12 age- and sexmatchedhealthy subjects. Diurnal sleep parameters did notshow significant differencesbetween controls and PD patientsat baseline. In PD patients, nosignificant changes in diurnal sleepwere observed between baselineand cabergoline treatment. Regardingnocturnal sleep, patients atbaseline showed a significantlylower sleep efficiency and a significantlyhigher Wakefulness AfterSleep Onset than controls. Withrespect to baseline, a significantincrease in REM latency and asignificant reduction in REM sleepwere observed during cabergolinetreatment. In the earlystage of PD, the neurodegenerativeprocess does not seem to be directlyresponsible for daytimesomnolence, but it may be directlyinvolved in the alteration of nocturnalsleep. Cabergoline monotherapydoes not affect daytimesleep propensity and, despite clinicalimprovement, it may have negativeeffects on REM sleep. [ABSTRACT FROM AUTHOR]

Background. Heterogeneity in clinical presentation and daytime somnolence in restless legs syndrome (RLS) have been poorly explored in the UK. Material and methods. Analysis of database of 152 cases of primary RLS compiled from clinical consultation using a structured questionnaire administration and clinical examination, spanning six years of referral. Standard evaluations included use of the Epworth Sleepiness Scale (ESS). Secondary RLS was excluded and polysomnography performed in some when clinically indicated. Results. The mean duration of RLS before appropriate treatment initiation was 12.7 years (age range of patients 26–90 years). 79% of patients had insomnia while 30% had excessive daytime sleepiness (EDS). Severe pain, restless arms and paroxysmal RLS causing lifestyle alterations also occurred. Conclusions. This study suggests that there is considerable delay before appropriate therapy in RLS. A large number have EDS and insomnia among others, is the commonest presenting feature. Phenotypic heterogeneity may cause diagnostic difficulty. [ABSTRACT FROM AUTHOR]