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Background and Objectives: Diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common disorders that not only often coexist but also have a bidirectional association where each condition exacerbates the other. The present study was performed to ascertain the occurrence and predictors of risk factors of OSA in patients with type 2DM. Materials and Methods: A cross-sectional hospital-based study recruiting 164 patients for over 2 months was conducted, in which each diabetic patient was assigned to complete a questionnaire on various variables followed by a general physical examination for associated comorbidities diabetic complications (neuropathy, nephropathy, and retinopathy). Their fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were recorded, following which they were administered and assessed using Berlin Questionnaire and Epworth Sleepiness Score for risk category and daytime sleepiness. Patients with already diagnosed OSA including ones receiving treatment for it were excluded from the study. Results: Of the 164 diabetic patients recruited in the study, 64 (39%) were at high risk for OSA in contrast to the 100 (61%) who were at low risk for OSA. Neck circumference, waist circumference, presence of hypertension and more than one comorbidities along with patients who experienced witnessed apnea at least three times a week, excessive daytime sleepiness, and habitual snorers found to be significant risk factors and practices in posing DM patients at a higher risk for OSA. Patients with body mass index ≥25 were more likely to have a high risk of OSA. FBG and HbA1c were not significant risk factors for OSA. Conclusions: OSA has a high prevalence in subjects with T2DM which reinforces the clinicians to remain observant for signs and symptoms of OSA in diabetic patients and monitor their compliance in terms of weight management, diet control, and medication adherence.

Introduction: Globally, stroke is a leading cause of death and disability. Obstructive sleep apnea (OSA) is globally being recognized as an emerging public health problem and a risk factor for stroke. Epworth Sleepiness Score (ESS) is increasingly being used as a screening tool to determine the likelihood of OSA in a patient before polysomnography (PSG). However, ESS questionnaires in patients with acute stroke and their comparison with overnight PSG have not been studied. We conducted this study at a tertiary care respiratory center in Mumbai to determine the effectiveness of ESS in predicting the prevalence of sleep apnea in acute ischemic stroke. Materials and Methods: Twenty-eight patients of acute stroke were included in the study. These patients were subjected to ESS and technician attended overnight PSG. Apnea–Hypopnea Index, oxygen desaturation index, and minimum saturation were determined at the overnight PSG. Results: Majority of patients belonged to 61–80 years' age group (53.6%) and were predominantly male (89.3%). Only 5 patients (17.9%) showed an ESS of more than 8, whereas 23 patients (82.1%) showed evidence of OSA on PSG. Sensitivity of ESS in predicting OSA in patients with acute stroke was 17.3%, whereas specificity was 80%. Conclusion: The use of ESS in patients of acute stroke to screen for sleep-disordered breathing (SDB) should be avoided. A PSG may be considered in these patients as early diagnosis of SDB in these patients can help in improving recovery.

Introduction: Sleep is a physiological function, considered essential for functions like growth, tissue repair, learning and consolidation of memory. It is a significant determinant of various anthropometric parameters besides conventional factors like level of physical activity, dietary habits and genetic composition of an individual. An average adult needs 7-9 hours of sleep/day. Aim: To determine the effect of duration of sleep and level of physical activity on various anthropometric parameters. Materials and Methods: The study was conducted on 408 subjects, divided into two groups, based on their sleep duration: adequate sleep duration (≥7 hours/day) and inadequate sleep duration (

Introduction: Sleep is a physiological function, considered essential for functions like growth, tissue repair, learning and consolidation of memory. It is a significant determinant of various anthropometric parameters besides conventional factors like level of physical activity, dietary habits and genetic composition of an individual. An average adult needs 7-9 hours of sleep/day. Aim: To determine the effect of duration of sleep and level of physical activity on various anthropometric parameters. Materials and Methods: The study was conducted on 408 subjects, divided into two groups, based on their sleep duration: adequate sleep duration (≥7 hours/day) and inadequate sleep duration (<7 hours/day). The subjects were also assessed for their daytime sleepiness and level of physical activity using the ESS (Epworth Sleepiness Scale) and GPPAQ (General Practice Physical Activity Questionnaire) respectively. Various anthropometric measurements were done in each of the subjects: weight, height, hip circumference, waist circumference, Waist/ Hip ratio (W/H) ratio and Body Mass Index (BMI). Chi-Square test was used to compare the data between the two groups. Results: There was no statistical difference in the ESS scores when comparison was made between the two groups. Most of the subjects were found to be moderately physically active in both the groups. All the anthropometric parameters except the W/H ratio were found to be higher in those getting inadequate sleep. Conclusion: Participants sleeping for less than 7 hours/day were found to have higher anthropometric parameters in comparison to those getting adequate sleep. Duration of sleep was found to be negatively correlated with most of the parameters, but its significance could only be established for HC and W/H ratio. [ABSTRACT FROM AUTHOR]

Background: The increased prevalence of obstructive sleep apnea (OSA) mandates the presence of simple but accurate tools to identify patients with this disorder for early detection and prevention of various serious consequences. This study aimed at comparing four sleep questionnaires as regards their predictive probabilities for OSA. Methods: A cross-sectional study included 234 patients presenting to the sleep clinic. Four sleep questionnaires (Berlin, Epworth Sleepiness Scale [ESS], STOP, and STOP-Bang) were administered to the patients and scoring of the results of the questionnaires was done. Overnight attended polysomnography (PSG) was done for all patients and was considered the gold standard for the diagnosis of OSA. The sensitivity, specificity, positive and negative predictive values of the four questionnaires were calculated. Results: Of 234 screened patients; 87.1% had OSA, whereas 93.3%, 90.2%, 95.5%, and 68.3% were classified as being at high risk by the Berlin, STOP, STOP-Bang questionnaires and ESS, respectively. The STOP-Bang, Berlin and STOP questionnaires had the highest sensitivity to predict OSA (97.55%, 95.07% and 91.67%, respectively), moderate-to-severe OSA (97.74%, 95.48% and 94.35%, respectively) and severe OSA (98.65%, 97.3% and 95.95%, respectively), but with a very low specificity for OSA patients (26.32%, 25% and 25%, respectively), moderate-to-severe OSA patients (3.7%, 7.41% and 25.93%, respectively) and severe OSA patients (5.36%, 10.71% and 19.64%, respectively), while the ESS had the highest specificity to predict OSA, moderate-to-severe OSA and severe OSA (75%, 48.15% and 46.43%, respectively) but with the lowest sensitivity (72.55%, 75.71% and 79.73%, respectively). Conclusions: The sensitivity of Berlin, STOP and STOP-Bang questionnaires was very high yet, the low specificity of these questionnaires results in increased false positives and failure of exclusion of individuals at low risk.

Background: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Despite correct treatment with positive airway pressure (PAP), obstructive sleep apnea (OSA) patients sometimes remain subjectively somnolent. The reliability of the Epworth Sleepiness Scale (ESS) has been established for healthy subjects and patients under stable conditions; the ESS may eventually vary among treated OSA patients, biasing the results of a cross-sectional analysis of persisting sleepiness. The objective of this study was to depict the evolution of subjective vigilance under treatment using an index of ESS variability (ΔESS). Methods: In 80 OSA patients (apnea–hypopnea index [AHI]=54±26/h), initially somnolent (ESS=15±3) and treated with auto-titrating PAP (APAP) (oxyhaemoglobin desaturation index 3% [ODIapap]=3.4±2.2/h; daily APAP use=5.3±1.5h) during 434±73 days, ESS scores were regularly collected four times every 109±36 days. DESS was calculated and data mining methods (Segmentation and Decision Tree) were used to determine homogeneous groups according to the evolution of ESS scores. Results: When assessed cross-sectionally, 14–25% of the subjects were recognized as somnolent, depending on the moment when ESS was administered. Using data mining methods, three groups were clearly identifiable: two without residual somnolence – group 1, n =38 (47%), with high ΔESS=−2.9±0.8, baseline ESS=16.3±3.3, AHI=58.5±26.1/h, mean ESSapap =5.1±2.4 and group 2, n =31 (39%), with low ΔESS=−1.1±0.5, baseline ESS=13.2±1.4, AHI=53±27.3/h, mean ESSapap =8.8±1.9; and one with persisting sleepiness; group 3, n =11 (14%), with low ΔESS=−0.3±0.8, baseline ESS=16.3±3, AHI=38.7±10.8/h, mean ESSapap =14.1±1.9. Compliance to PAP was high and comparable in the three groups. Age and body mass index (BMI) did not differ. Conclusion: Data mining methods helped to identify 14% of subjects with persisting sleepiness. Validation needs to be done on a larger population in order to determine predictive rules. [Copyright &y& Elsevier]

Background Parkinsonian patients with excessive day- time sleepiness (EDS), hallucinations, REM sleep behavior disorder (RBD), short mean sleep latencies, and sleep-onset REM periods (SOREMP) on multiple sleep latency tests (MSLT) have been re- ported. In these patients a narcolepsy-like pathophysiology of sleep-wake disturbances has been suggested. Patients and methods [ABSTRACT FROM AUTHOR]

In the absence of a golden standard for the diagnosis of narcolepsy, the clinical spectrum of disorder remains controversial. The aims of this study were (1) to determine frequency and characteristics of sleep–wake symptoms in patients with narcolepsy with cataplexy, (2) to compare clinical characteristics with results of ancillary tests, and (3) to identify factors that discriminate narcolepsy from other conditions with excessive daytime sleepiness (EDS). We prospectively studied 57 narcoleptics with cataplexy, 56 patients with non-narcoleptic hypersomnia (H), and 40 normal controls (No). Based on suggested and published criteria, we differentiated between narcoleptics with definite cataplexy (N) and narcoleptics without definite cataplexy (possible cataplexy, NpC). Assessment consisted of questionnaires [all patients and controls, including the Ullanlinna Narcolepsy Score (UNS)], polysomnography (all patients), multiple sleep latency test (MSLT) and human leukocyte antigen typing (in most narcoleptics). A new narcolepsy score based on five questions was developed. Data were compared with those of 12 hypocretin-deficient narcoleptics (N-hd). There were significant differences between N and NpC (including mean sleep latency on MSLT), but none between N and N-hd. A score of sleep propensity during active situations (SPAS) and the frequency of sleep paralysis/hallucinations at sleep onset, dreams of flying, and history of sleep shouting discriminated N from H and No (P < 0.001). Cataplexy-like symptoms in H (18%) and No (8%) could be discriminated from‘true’ cataplexy in N on the basis of topography of motor effects, triggering emotions and triggering situations (P < 0.001). Our narcolepsy score had a similar sensitivity (96% versus 98%) but a higher specificity (98% versus 56%) than the UNS. Analysis of co-occurring symptoms in narcolepsy revealed two symptom complexes: EDS, cataplexy, automatic behaviors; and sleep paralysis, hallucinations, parasomnias. Low/undetectable cerebrospinal fluid hypocretin-1 levels and a history of definite cataplexy identify similar subgroups of narcoleptics. Specific questions on severity of EDS (SPAS score) and characteristics of cataplexy allow the recognition of subgroups of narcoleptics and their differentiation from non-narcoleptic EDS patients, including those reporting cataplexy-like episodes. The existence of co-occurring symptoms supports the hypothesis of a distinct pathophysiology of single narcoleptic symptoms. [ABSTRACT FROM AUTHOR]

SUMMARY The evolution of subjective sleep and sleep electroencephalogram (EEG) after hemispheric stroke have been rarely studied and the relationship of sleep variables to stroke outcome is essentially unknown. We studied 27 patients with first hemispheric ischaemic stroke and no sleep apnoea in the acute (1–8 days), subacute (9–35 days), and chronic phase (5–24 months) after stroke. Clinical assessment included estimated sleep time per 24 h (EST) and Epworth sleepiness score (ESS) before stroke, as well as EST, ESS and clinical outcome after stroke. Sleep EEG data from stroke patients were compared with data from 11 hospitalized controls and published norms. Changes in EST (>2 h, 38% of patients) and ESS (>3 points, 26%) were frequent but correlated poorly with sleep EEG changes. In the chronic phase no significant differences in sleep EEG between controls and patients were found. High sleep efficiency and low wakefulness after sleep onset in the acute phase were associated with a good long-term outcome. These two sleep EEG variables improved significantly from the acute to the subacute and chronic phase. In conclusion, hemispheric strokes can cause insomnia, hypersomnia or changes in sleep needs but only rarely persisting sleep EEG abnormalities. High sleep EEG continuity in the acute phase of stroke heralds a good clinical outcome. [ABSTRACT FROM AUTHOR]

Following treatment with continuous positive airway pressure (CPAP), some patients with obstructive sleep apnoea (OSA) remain sleepy despite effective CPAP and attention to other diagnoses that can provoke sleepiness. It is unclear if this residual sleepiness is an irreversible result of their previous OSA and merits consideration for pharmacological treatment or simply because of the many and varied causes of sleepiness normally found in the community. We have measured levels of sleepiness, using the Epworth Sleepiness Score (ESS), in 572 patients on CPAP and compared them with a control group of 525 subjects from a community survey, which would have included the usual lifestyle reasons for sleepiness as well as any undiagnosed sleep disorders. There was no difference in the percentage of patients with an ESS >10 in the CPAP group compared with the controls (16.1 versus 14.3, P = 0.54). Thus, although there clearly are sleepy patients within the CPAP group, the prevalence is no higher than in the community. We question whether so-called ‘post-CPAP sleepiness’ should be regarded as any more abnormal and worthy of treatment than a ‘normal’ population. Post-CPAP sleepiness as a specific disorder may not exist. [ABSTRACT FROM AUTHOR]

Background/Aims Health-impairing lifestyle during adolescence is an important marker for poor health. An unhealthy lifestyle may lead to physical and psychological problems in adulthood. Most of the prior researches were done among the adult population. Therefore, we assessed the chronotype pattern and correlation of health-impairing lifestyles with sleep quality according to circadian typology in medical students. Material and Methods In this cross-sectional research, a total of 203 subjects were enrolled. All subjects were divided into definite evening chronotype (n = 73), intermediate chronotype (n = 87), and definite morning chronotype (n = 43). Electronic media use at bedtime and duration of media use, the timing of dinner, smoking, tobacco chewing, and alcohol consumption were assessed with the help of a preformed proforma. Physical activity, sleep quality, daytime sleepiness, and chronotype were assessed by International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS), and Morningness-Eveningness Questionnaire Self-assessment version (MEQ-SA), respectively. Results Subjects of the evening chronotype were suffering more with poor sleep quality. Evening chronotype had a significant (p < 0.05) positive correlation between poor sleep quality and sex, tobacco smoking, alcohol drinking, type of diet, and timing of dinner. Conclusion Circadian typology demonstrated the significant correlation of health-impairing lifestyles with sleep quality. From this observation, it might be a better way to plan their daily activities, in accordance with their chronotypes, benefiting not only their academic performance but also their quality of life., Competing Interests: The authors have declared that no competing interests exist.