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Obstructive sleep apnoea (OSA) is associated with type 2 diabetes mellitus (T2DM). However, mechanisms mediating association between these two conditions remain unclear. This study investigated, whether the OSA-associated changes in adipose tissue lipolysis might contribute to impaired glucose homeostasis in patient with T2DM. Thirty-five matched subjects were recruited into three groups: T2DM + severe OSA (T2DM + OSA, n = 11), T2DM with mild/no OSA (T2DM, n = 10) and healthy controls (n = 14). Subcutaneous abdominal adipose tissue microdialysis assessed spontaneous, epinephrine- and isoprenaline-stimulated lipolysis. Glucose metabolism was assessed by intravenous glucose tolerance test. Spontaneous lipolysis was higher in the T2DM + OSA compared with the T2DM (60.34 ± 23.40 vs. 42.53 ± 10.16 μmol/L, p = 0.013), as well as epinephrine-stimulated lipolysis (236.84 ± 103.90 vs. 167.39 ± 52.17 µmol/L, p < 0.001). Isoprenaline-stimulated lipolysis was unaffected by the presence of OSA (p = 0.750). The α 2 anti-lipolytic effect was decreased in T2DM + OSA by 59% and 315% compared with T2DM and controls (p = 0.045 and p = 0.007, respectively). The severity of OSA (AHI) was positively associated with spontaneous (p = 0.037) and epinephrine-stimulated (p = 0.026) lipolysis. The α 2 -adrenergic anti-lipolytic effect (p = 0.043) decreased with increasing AHI. Spontaneous lipolysis was positively associated with Insulin resistance (r = 0.50, p = 0.002). Epinephrine-stimulated lipolysis was negatively associated with the Disposition index (r =  - 0.34, p = 0.048). AHI was positively associated with Insulin resistance (p = 0.017) and negatively with the Disposition index (p = 0.038). Severe OSA in patients with T2DM increased adipose tissue lipolysis, probably due to inhibition of the α 2 -adrenergic anti-lipolytic effect. We suggest that dysregulated lipolysis might contribute to OSA-associated impairments in insulin secretion and sensitivity.

The aim of this study was to determine the neurocognitive and neuropsychiatric effects of continuous positive airway pressure treatment on patients with obstructive sleep apnea. This cross-sectional, prospective, observational study included 126 patients with sleep apnea. The following tests were performed: the Montreal Cognitive Assessment for the evaluation of cognitive impairment, the Beck Depression Inventory, and the State-Trait Anxiety Inventory, together with the Epworth Sleepiness Scale for the evaluation of neuropsychiatric symptoms and a person's general level of daytime sleepiness. The first measurement did not show neurocognitive impairment or a higher level of depressive and anxiety symptoms in 126 patients with obstructive sleep apnea in comparison to normative standards. After the 3-month treatment indicated for 43 patients with obstructive sleep apnea, we did not find any significant improvement in cognitive performance (p = .213). However, patients with sleep apnea with continuous positive airway pressure treatment did show significantly less daytime sleepiness, anxiety and depressive symptoms (all p < .001). In conclusion, short-term (3 months) treatment of patients with obstructive sleep apnea can substantially alleviate their daytime sleepiness, as well as depressive and anxiety symptoms., (© 2018 European Sleep Research Society.)

Epidemiologic studies show that both atypical sleep time and obstructive sleep apnea (OSA) are independently associated with higher risk of metabolic disease development, particularly obesity and type 2 diabetes mellitus (T2DM). OSA is an independent risk factor for cardiovascular mortality, which is amongst the most common causes of death in T2DM. It is advisable to screen patients for OSA due to the high prevalence of the disease in T2DM patients. For screening are recommended questionnaires and home sleep monitoring. OSA diagnosis is then verified by home sleep apnea testing (using polygraphy) or by polysomnography. Positive airway pressure (PAP) is a gold standard in the treatment of moderate and severe OSA. PAP prevents hypoxia and sleep fragmentation, eliminating excessive daytime sleepiness and decreasing the risk of cardiovascular diseases. Studies have not yet shown an effect of PAP treatment on T2DM compensation and glucose metabolism. Despite this a positive effect of PAP on insulin resistance and glucose tolerance has been proven in patients with prediabetes. PAP therapy is advised in obese patients of the central type with OSA, bariatric surgery has been proven to decrease the severity of OSA.

Obstructive sleep apnea (OSA) is a common disorder in Type 2 diabetes (T2D) patients further increasing their already high cardiovascular risk. As T2D patients typically not report OSA symptoms, systematic screening for OSA in this population is warranted. We aimed to determine the readiness of T2D patients to undergo screening and to compare their adherence to continuous positive airway pressure (CPAP) therapy with "regular" sleep clinic patients who typically seek medical advice on their own initiative. We therefore recruited 494 consecutive T2D patients and offered them OSA screening using home sleep monitoring (type IV device). All participants in high risk of moderate-to-severe OSA were recommended home sleep apnea testing (HSAT) followed by CPAP therapy. Patients were followed-up for 12 months and outcomes compared to 228 consecutive sleep clinic patients undergoing HSAT. Among 307 screened T2D patients, 94 (31%) were identified at high risk of moderate-to-severe OSA. Subsequently, 54 patients underwent HSAT, 51 were recommended, and 38 patients initiated CPAP (acceptance 75%). Among 228 sleep clinic patients, 92 (40%) were recommended and 74 patients initiated CPAP (acceptance 80%). After 1 year, 15 (39%) T2D and 29 (39%) sleep clinic patients showed good CPAP adherence (use ≥ 4 h/night ≥ 70% nights). In conclusion, 20 T2D patients needed to be screened in order to obtain one successfully treated patient. OSA screening in T2D patients identified 31% with moderate-to-severe OSA. Once diagnosed, their CPAP acceptance and adherence did not differ from sleep clinic patients. However, the reasons for the high dropout during the screening-diagnostic process impacting the overall success of the screening program need to be identified and addressed.

Sleep apnoea (SA) is common in patients with hypertension. Nowadays, limited data on the prevalence of SA in nocturnal hypertension (NH) exist. Therefore, we studied the occurrence of SA in Czech patients and its association with 24-h ambulatory blood pressure monitoring (ABPM), breathing disturbances in sleep, anthropometric data, Mallampati score and Epworth sleepiness scale (ESS) using the Apnea Link device. Undiagnosed SA was found in 72.9 % patients (29.3 % mild, 26.6 % moderate, 17.0 % severe) of 188 patients with NH measured by ABPM. The median of the apnoea-hypopnoea index (AHI) was 12.0 (25th-75th percentile 5.0-23.8). Moderate/severe SA (AHI>/=15) was associated with BMI, waist circumference, mean night saturation (SpO(2)), t90, oxygen desaturation index (ODI), ESS (daytime BP only) (p0.09). A likelihood of moderate/severe SA was enhanced by ODI>14.5 events/h (odds ratio=57.49, 95 % CI=22.79-145.01), t90>6.5 % (8.07, 4.09-15.92), mean night SpO(2)<93.5 % (3.55, 1.92-6.59), BMI>29.05 kg/m(2) (6.22, 3.10-12.49), circum waist>105.5 cm (3.73, 1.57-8.83), but not by any ABPM parameter. In conclusion, a high incidence of SA (72.9 %) was observed in Czech patients with NH. SA severity was associated with body characteristics and oxygenation parameters, but not with ABMP parameters and Mallampati score.

Background: Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established., Methods: A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype., Results: The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity., Conclusions: Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS., Competing Interests: Competing Interests: JH reports that the ESADA database has received two enabling grants from ResMed and Philips Respironics and a Clinical Reseach Cooperation (CRC) grant from the European Respiratory Society. LG reports grants, personal fees and other from Resmed, grants, personal fees and non-financial support from Philips and Weinmann, personal fees from Breas and Mundipharma as well as non-financial support from Itamar, outside the submitted work. TP reports grants from ImThera, grants from Itamar, Heinen and Löwenstein, Resmed and from Philips / Respironics, outside the submitted work. TS reports grants from Paulo Foundation, grants from Governmental Grant of Turku University Hospital, grants from Finnish Anti-Tuberculosis Association Foundation, grants from Respiratory Alliance Foundation, grants from Väinö and Laina Kivi Foundation, grants from Ahokas Foundation, during the conduct of the study. MRB, RLR, WTMcN, UA, JAK, MP, PS, and JV have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The European Sleep Apnoea Database (ESADA) reflects a network of 22 sleep disorder centres in Europe enabled by a COST action B26 programme. This ongoing project aims to describe differences in standard clinical care of patients with obstructive sleep apnoea (OSA) and to establish a resource for genetic research in this disorder. Patients with suspected OSA are consecutively included and followed up according to local clinical standards. Anthropometrics, medical history, medication, daytime symptoms and sleep data (polysomnography or cardiorespiratory polygraphy) are recorded in a structured web-based report form. 5,103 patients (1,426 females, mean±sd age 51.8±12.6 yrs, 79.4% with apnoea/hypopnoea index (AHI) ≥5 events·h(-1)) were included from March 15, 2007 to August 1, 2009. Morbid obesity (body mass index ≥35 kg·m(-2)) was present in 21.1% of males and 28.6% of females. Cardiovascular, metabolic and pulmonary comorbidities were frequent (49.1%, 32.9% and 14.2%, respectively). Patients investigated with a polygraphic method had a lower AHI than those undergoing polysomnography (23.2±23.5 versus 29.1±26.3 events·h(-1), p<0.0001). The ESADA is a rapidly growing multicentre patient cohort that enables unique outcome research opportunities and genotyping. The first cross-sectional analysis reveals a high prevalence of cardiovascular and metabolic morbidity in patients investigated for OSA.

Objectives: In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services., Methods: Two questionnaires were sent to 39 physicians in 22 countries in Europe. In order to standardize the responses, the questionnaire was accompanied by an example., Results: Sleep centers from 21 countries (38 physicians) participated. A broad consistency among countries with respect to the following was found: pathways included referral to sleep physicians/sleep laboratories, necessity for objective diagnosis (primarily by polysomnography), use of polygraphic methods, analysis of polysomnography (PSG), indications for positive airway pressure (PAP) therapy, application of standard continuous PAP (CPAP) therapy (100% with an CPAP/APAP ratio of 2.24:1), and the need (90.5%) and management of follow-up. Differences were apparent in reimbursement of the diagnostic procedures and follow-up, in the procedures for PAP titration from home APAP titration with portable sleep apnea monitoring (38.1%) up to hospital monitoring with PSG and APAP (85.7%), and in the qualification requirements of sleep physicians., Conclusions: Management of OSA in different European countries is similar except for reimbursement rules, qualification of sleep specialists and procedures for titration of the CPAP treatment. A European network (such as the one accomplished by the European Cooperation in Science and Technology [COST] B26 Action) could be helpful for implementing these findings into health-service research in order to standardize management in a cost effective perspective., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background: Narcolepsy is associated with altered metabolic functions. We sought to investigate the effect of narcolepsy on pregnancy and newborns., Material/methods: A retrospective cohort study of patients in whom the first symptoms of narcolepsy appeared before or after pregnancy. Our study included 54 women, mothers of a total of 110 children (37 with symptoms of narcolepsy before and during pregnancy, 17 developed the narcolepsy syndrome only after childbirth). With only 1 exception, none of the patients were treated with drugs during pregnancy., Results: We did not find any significant differences between the 2 groups in the registered parameters of: age of mothers at delivery, history of spontaneous abortion, alcohol and nicotine consumption, medication, complications during pregnancy, symptoms of narcolepsy, weight gain during pregnancy, length of pregnancy and delivery, complications during delivery, and weight and length of the newborn. The women experiencing symptoms of narcolepsy before or during pregnancy were found to have a significantly higher total number of pregnancy complications (35.8%) than those with later onset of symptoms (9.1%), although the complications were not clinically significant. More patients in the symptomatic group tended to have impaired glucose tolerance or type 2 diabetes, compared to the asymptomatic group., Conclusions: The study revealed no clinically relevant adverse effects of narcolepsy on pregnancy, childbirth or the newborn.

Background: Narcolepsy with cataplexy (NC) differs from narcolepsy without cataplexy (NwoC) in the cerebrospinal fluid levels of hypocretin. Since hypocretin is known to regulate not only wakefulness but also eating behaviour, we decided to compare the two entities for body mass index (BMI) and the presence of obesity., Methods: Clinical data on patients with NC and NwoC was studied and examined, including nocturnal polysomnography and the Multiple Sleep Latency Test (MSLT). The results were rated against a group of age- and sex-matched healthy controls., Results: The BMI in NC (29.1±SD=5.8) was significantly higher than in NwoC (25.4±4.4) or in the controls (25.8±3.9) (p<0.001, F=17.4, df= 323), while no difference in BMI was found between NwoC and the controls. The proportion of patients with BMI >30 was significantly greater in NC (39.0%) than in NwoC (13.8%) or than in the control group (13.0%). A negative correlation of BMI and sleep latency in MSLT (p=0.009) was found in the combined NC and NwoC groups., Conclusion: Unlike NC, NwoC has neither a higher BMI nor a higher incidence of obesity than the general population.

Obstructive sleep apnea (OSA) is a risk factor of hypertension, coronary artery disease and stroke. OSA is also considered a cause of accelerated atherogenesis. Advanced oxidation protein products (AOPP) are among the biochemical indicators of higher risk of atherogenesis as an independent risk factor for coronary artery disease. 20 men suffering from OSA were examined using night polygraphy, the AOPP were determined from their morning blood samples. The mean AOPP concentration in the patients group was 91.8 (SD=42.3) micromol/l, in the control group 76.2 (SD=35.3) pmol/l, the difference was not significant. The AOPP were found correlated with the AHI (apnoe/hypopnoe index) (R=0.485, P=0.030). The results support the hypothesis that OSA increases the oxidative stress and atherogenesis.

Objective: Responsible for sleep brain perfusion changes, obstructive sleep apnea (OSA) constitutes a cardiovascular risk. To find out about any diffuse damage to the brain tissue, we studied the S100B protein, whose serum level is known to rise in stroke and craniocerebral trauma., Methods: 60 men (mean age 51.7+/-11.8 years) referred to us for OSA without any major comorbidity were examined polygraphically. S100B was determined with electrochemiluminiscence immunoassay (ECLIA) from evening and morning blood samples., Results: All sixty men were diagnosed with OSA. The difference between the evening level of S100B 0.068+/-0.030 microg/l and the morning level 0.059+/-0.029 microg/l was significant (p=0.0004). Patients with mild OSA were found to have the evening S100B 0.063+/-0.023 microg/l, the morning level 0.042+/-0.012 microg/l, the difference being significant (p=0.00051). In moderate OSA the difference between the evening -0.070+/-0.017 microg/l and morning levels -0.055+/-0.025 microg/l was less significant (p=0.043). In severe OSA no difference was found between the evening and morning concentrations of S100B (0.070+/-0.036 microg/l and 0.070+/-0.031 microg/l respectively). The difference between the evening and morning S100B levels correlated negatively with AHI and ODI and positively with basal saturation and average minimal oxygen saturation., Conclusions: Sleep with signs of severe OSA influences S100B protein release.

Background: The restless legs syndrome (RLS) is divided into two forms: idiopathic and secondary. About half the cases of the former are found to have a positive family history. The lack of objective and quantitative parameters in familial RLS also represents a drawback for genetic studies. We tried to find a feature distinguishing the sporadic from the familial forms of the RLS., Methods: RLS patients were examined for clinical picture and laboratory markers including erythropoietin levels. Patients with a priori known causes of secondary RLS, were excluded. All biochemical and hematological parameters were standardized for sex and age groups relative to the population mean and standard deviation., Results: In our set of 311 patients (65.3% women, mean age 54.6 years, SD 14.7 years) 96 reported positive family history (64.6% women, mean age 53.1 years, SD 15.8 years). We found a significantly lower age at the onset of RLS symptoms in familial cases (mean 29.3 vs. 44.0, Z 5.9, p<0.0001), and, in sporadic cases, a significantly lower absolute count of red blood cells (Z -2.02, p=0.043 respectively). Erythropoietin levels in the familial cases were significantly lower than in the reference population (median -2.26 SDs from the mean). None of the other parameters were significantly different between the groups., Conclusions: Our results confirm previously published lower age at symptom onset in familial RLS and provide the first evidence of lower erythropoietin levels in RLS patients. These observations might help to identify the specific phenotype for genetic association studies.

Aim: To assess the success of genioglossus advancement and hyoid myotomy in the obstructive sleep apnoea syndrome (OSAS) therapy by comparing pre- and postoperative respiratory values during sleep. One of the surgical methods of widening the upper airways is to advance the spina mandibulae together with the genioglossus insertion. Thus the whole tongue is advanced, including its base. Hyoid myotomy itself, leads to a very unaesthetic filling up of soft tissues in the submental space. Therefore, the original window method of genioglossus advancement was modified and the so-called tenon and mortise genioplasty according to Delaire was applied., Patients and Methods: Thirty-one patients underwent genioglossus advancement by the modified genioplasty with hyoid myotomy (8 women and 23 men, mean age 53.2 years; range 35-69 years). Basic polysomnographic parameters were monitored (during sleep) before surgery and 7.3 months (range 3-6 months) postoperatively., Results: The cumulative success rate was 74%. Subjective assessment of daily sleepiness using the Epworth scale dropped from preoperative 9.6 to 4.7. The average respiratory disturbance index decreased from 20.9 preoperatively to 10.3, the oxygen desaturation index dropped from 15.1 to 8.8, the average preoperative values of baseline oxygen saturation and average desaturation values had been 95.1% and 86.5%, respectively, and had increased postoperatively to 96.0% and 90.3%, respectively. On the average, preoperative desaturation lasted 36.7s whereas it lasted for 31.0 s postoperatively., Conclusion: Polysomonographic monitoring proved that changing the upper airways can favourably impact upon respiratory parameters during sleep in OSAS.

Background: Narcolepsy with cataplexy is a debilitating sleep disease of which some symptoms can be treated with antidepressants. The antidepressant escitalopram is considered the most specific serotonin reuptake inhibitor., Patients and Methods: Ten patients (5 men and 5 women, age range 18-77 years) suffering from narcolepsy with cataplexy occurring at least weekly were treated with escitalopram 5 or 10 mg a day for 28-98 days. These patients were barred from taking any drugs influencing cataplexy and also had no other diseases affecting sleep or vigilance., Results: The mean number of cataplexies per week in 8 compliant patients declined significantly from 6.7 (+/-SD=7.2) to 0.3 (+/-0.6), P=0.02 (Sign test). Cataplexy completely disappeared in 6 patients. Subjective daytime sleepiness, power of concentration, quality of night sleep and mood remained unchanged. During the treatment, two patients had ejaculation disturbances. Two patients withdrew from the therapy (one because of ejaculation disturbance, the other for unknown reason)., Conclusion: Escitalopram proved to have anticataplectic effects in this small-scale open-label study.

Background: The aim of our study was to compare the results obtained by simultaneous polysomnographic and actigraphic recording and thus to estimate the specificity and sensitivity of actigraphic evaluation of periodic leg movements in sleep (PLMS). As a standard method, PLMS are detected by means of polysomnography, including superficial EMG of anterior tibial muscles. Since 1995, there have been efforts to detect PLMS by means of actigraphy, which is more convenient for both patient and investigator., Methods and Results: Recordings were done during 44 nights in 42 patients (10 women, mean age 49.2, SD 13.1 years) in our sleep laboratory. The same criteria for periodic leg movements and the cut-off periodic leg movements index (PLMI > 5) were used in both methods. For the actigraphic way of PLMS detection, we found a specificity of 90%, sensitivity 60%, positive predictive value 88.2%, negative predictive value 64.3 % and total diagnostic accuracy of 73.3%. A close correlation (Spearman's coefficient rho > 0.64, p < 0.0001) between PLMI resulting from either method of recording was observed, though the PLMI actigraph proved to be significantly lower (Sign test--p < 0.01)., Conclusions: Our study has proven good specificity a negative predictive value of the actigraphic recording. To improve its sensitivity, we suggest to reduce the threshold of significant presence PLMS, as expressed by PLMI, from 5 to 3. Actigraphy seems to be a suitable method from PLMS screening in the general population for both clinical and research purposes.

Obstructive sleep apnoea syndrome (OSAS) is a potentially life-threatening disorder. It is characterized by at least five episodes of apnoea or hypopnoea during sleep lasting for more than 10 seconds. Apnoea or hypopnoea are accompanied by respiratory efforts. Changes of the facial skeleton by mandibular or maxillo-mandibular advancement belong to surgical techniques which might affect moderate and severe OSAS. In the surgical procedure mandible alone or the upper and lower jaws are moved forward by at least 10 mm. Thus also muscles fixed to the facial skeleton and upper airway dilatators are moved forward. The discussion also mentions possible complications and limitations of this surgical technique.

Background: Terguride as a partial D2-receptors agonist seems suitable for treatment of restless legs syndrome (RLS)., Methods: Nine RLS patients without previous dopaminergic therapy received a daily dose of terguride (0.25 mg) 29.9+/-16.9 (SD) days., Results: Two patients enrolled in the study failed to turn up for a successive check up. The seven subjects who were re-examined complied with the therapy. Their RLS symptoms improved (as measured on the International RLS intensity scale), decreasing from 24.3+/-5.3 to 14+/-4.7 (p=0.014). However, the terguride treatment did not significantly alter the daytime sleepiness or the subjective duration of nocturnal sleep. The daily dose was doubled in three patients who reported insufficient RLS improvement. One of the three patients later reported augmentation.

Excessive daytime sleepiness arises frequently as a consequence of insufficient or shortened nocturnal sleep, or as a result of poor sleeps hygiene. One of the most common dyssomnias with imperative sleepiness is narcolepsy. Narcolepsy is a chronic disease that greatly affects quality of life. The present study of 57 patients shows that the negative assessment is partly due to the subjective views exhibited by the narcoleptic personality prone to underestimation, negative self-image and depressive disposition. The personality traits may be due to an adaptation reaction to the disease but also to the biological predisposition. Comparison with population data for our Republic brought no evidence of progress at education or family life being adversely affected by narcolepsy, however, decreased assertion in employment and limitation in self-realization in free time was an explicit consequence of the disease. All 57 patients reported excessive daytime sleepiness as the most discomforting symptom that in 40% of them was responsible for career curtailment in a productive age and for living on partial or full disability.