Relationship between Occurrence and Progression of Lung Cancer and Nocturnal Intermittent Hypoxia, Apnea and Daytime Sleepiness

The possible relationship between lung cancer and nocturnal intermittent hypoxia,apnea and daytime sleepiness,especially the possible relationship between the occurrence and progression of lung cancer and obstructive sleep apnea syndrome (OSAS) was explored.Forty-five cases of primary lung cancer suitable for surgical resection at the Third Affiliated Hospital of Kunming Medical University between January 2017 and December 2017 were recruited (lung cancer group),and there were 45 patients in the control group who had no significant differences in age,sex and other general data from lung cancer group.The analyzed covariates included general situation,snore score,the Epworth Sleeping Scale (ESS),Pittsburgh Sleep Quality Index (PSQI),apnea and hypopneas index (AHI),oxygen desaturation index 4 (ODk),lowest arterial oxygen saturation [LSpCh (%)],oxygen below 90% of the time [T90%(min)],the percentage of the total recorded time spend below 90% oxygen saturation (TS90%),to explore the possible relationship between lung cancer and above indicators.The participants were followed up for one year.The results showed that:(1) There was significant difference in body mass index (BMI),ESS,AHI,T90%(min),TS90%,ODh,snore score and LSpCh (%) between lung cancer group and control group (P<0.05).There was no statistically significant difference in age,gender,PSQI score,incidence of concurrent hypertension,diabetes and coronary heart disease (CHD),and smoking history between the two groups (P>0.05);(2) Patients in the lung cancer group were divided into OSAS subgroup and non- OSAS subgroup according to the international standard for the diagnosis of OSAS.There was significant difference in BMI,age,staging,incidence of concurrent hypertension and concurrent CHD,snore score,ESS score,T90%(min),TS90%,ODh and LSpCh (%) between OSAS subgroup and non-OSAS subgroup (P<0.05).There was no statistically significant difference in gender,PSQI score,incidence of concurrent diabetes,smoking history and lung cancer type between the two groups (P>0.05);(3) AHI was strongly negatively correlated with the LSpCh (%) and positively with ESS,staging,snoring score,T90%(min),TS90%,ODh and BMI (P<0.05);(4) There were 3 deaths,5 cases of recurrence,and 4 cases of metastasis in OSAS subgroup;and there was 1 death,4 cases of recurrence and 2 cases of metastasis in non-OSAS subgroup during the follow-up period of one year,respectively.There was no significant difference in mortality,recurrence rate and metastasis rate between the two subgroups,and the total rate of deterioration in OSAS subgroup was significantly increased compared to the non-OSAS subgroup (P<0.05).It was concluded that the patients with lung cancer are prone to nocturnal hypoxemia,apnea,snoring and daytime sleepiness compared to control group.The incidence of OSAS in patients with lung cancer was higher,and the difference in the hypoxemia-related indicators was statistically significant.The mortality,recurrence rate,and metastasis rate increases in lung cancer patients with OSAS during the one-year follow-up period,suggesting that OSAS may be a contributing factor to the occurrence and progression of lung cancer.

Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude

AIM:To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients.METHODS:Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed.Validated questionnaires:the Pittsburg Sleep Quality Index(PSQI)and Epworth Sleepiness Scale(ESS)were administered prospectively.Subjects with nonglaucomatous optic neuropathy or concomitant retinal pathology were excluded.Glaucoma severity was based on HVF 24-2 perimetry.Binocular single vision was represented based on the better eye.Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared.RESULTS:A total of 79 primary open angle glaucoma(POAG),27 primary angle-closure glaucoma(PACG)patients,and 89 controls were recruited.PACG patients had higher median PSQI scores(P=0.004)and poorer sleep quality(P<0.001).Compared to controls,PACG patients were 3.34 times more likely to have poor sleep quality(P=0.008),which remained significant after adjustment for demographics(P=0.016)and predictive variables(P=0.013).PACG patients have poorer sleep quality when visual acuity(VA)was 6/15 or worse(P=0.009).Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance.CONCLUSION:PACG patients have poorer sleep quality but not daytime sleepiness.This is important in South-East Asian population with heavy disease burden.Evaluations on sleep disturbances can be considered to provide more ho istic care.

Obstructive sleep apnea syndrome: The case of residual sleepiness

The case of a 62-year-old male illustrated the medical emergent need for treatment. Severe excessive daytime sleepiness, neurocognitive functioning symptoms were evident from his chronic untreated sleepiness. An all-night polysomnogram confirmed the diagnosis of Obstructive Sleep Apnea (OSA). The implication of this case’s chronic untreated experience of OSA is discussed in terms of neurocognitive/brain structure laboratory findings. Results at intake, one and three months of this case’s sleep and cognitive functioning are reported.

Insomnia and Excessive Daytime Sleepiness in Parkinson’s Disease Patient—A Review Article

Sleep-wake disorders play an important role among non-motor symptoms in Parkinson’s Disease, being a constant subject of research in recent years. There are a multitude of sleep-wake disturbances that worsen the patient’s quality of life, insomnia and excessive daytime sleepiness being two of the most frequent complaints. The aim of this review is to highlight the most relevant clinical trials conducted during the last 5 years, focusing on the problematic of insomnia and daytime sleepiness correlated with Parkinson’s Disease and its treatment. Three electronic databases (Pubmed, Science Direct and Google Scholar) were searched during March and April 2020 for articles on this topic, finally selecting 21 most relevant articles that we have included in this review. Interesting aspects regarding correlation between sleep-wake disorders and Parkinson’s disease were found, showing that non-motor symptoms may be independent of the disease itself. We discussed the most recent advances in treatment opportunities and the adverse effects, with insomnia and daytime sleepiness among the most common complaints. Besides newly developed pharmacological therapy, consisting in mostly dopaminergic agonists or levodopa adjuvant drugs. Other possibly effective therapies on sleep-wake disorders such as deep brain stimulation, dietary changes, bright light therapy and alternative medicine protocols are also reviewed. Insomnia and excessive daytime sleepiness are common complaints in Parkinson’s disease patients, being either self-standing non-motor symptoms or adverse effects of the antiparkinsonian medication, diminishing patient’s quality of life. The effervescence of research on this topic shows promising results, with new clinical trials still to come in the near future.

Original Research: Pupillary Constriction Velocity and Latency to Predict Excessive Daytime Sleepiness

Background: Excessive daytime sleepiness (EDS) is common in adults. A need exists for an easier and faster objective clinical measures of EDS. The autonomic nervous system controls pupil size and prior pupillometry studies have demonstrated associations with sleepiness. We used a novel portable device to assess pupillometry and prospectively evaluated a sleep clinic cohort. Methods: Following IRB approval Pupillometry (The ForSiteTM, NeurOptics, Irvine, CA), was performed on 113 sleep clinic patients. Constriction and dilation velocity and latencies, minimum and maximum aperture were obtained along with Epworth Sleepiness Score (ESS), 10 point Visual Analog Scale (VAS), BMI, gender, age and AHI. Three sets of measures were obtained and analyzed with ANOVA, t-test, Linear Regression and Pearson correlation coefficients (SAS, Cary, NC). Results: Both constriction velocity and latency correlated with VAS (n = 88, r = 0.28, p = 0.007 and r = 0.31, p = 0.004). Only constriction velocity correlated with AHI (n = 78, r = -0.27, p = 0.016). Multivariate linear regression which includes VAS and age predicted constriction velocity (r = 0.36, p = 0.002) and latency (r = 0.38, p = 0.001). Using Pearson correlation, AHI and VAS combined were associated with constriction velocity (-0.273 (0.016), and 0.284 (0.007), respectively). Using a maximum constriction velocity threshold value (age adjusted) of 2.8, VAS ≥ 6 was predicted with a sensitivity of 83% and specificity of 84%. Conclusions: Pupillary constriction velocity and latency predict self-reported VAS state of sleepiness. While both are affected by age, only constriction velocity is affected by apnea severity. These data suggest that a portable pupillometer may provide a method to identify individuals with abnormal sleepiness.

Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment

The purpose of this study was to assess factors associated with subjective sleep evaluation, chiefly excessive daytime sleepiness (EDS) in obstructive sleep apnea syndrome (OSAS) adult outpatients under continuous positive airway pressure (CPAP) treatment. One thousand and forty-eight OSAS outpatients (mean age: 51.4% male: 90.5%) who were treated by CPAP were consecutively collected. Age, sex, CPAP compliance (CPAP usage as their device of nights with application-time of at least 4 hours per night objectively;%usage ≥ 4 h/d), and Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) of the patients showing EDS (Japanese version of the Epworth Sleepiness Scale;JESS ≥ 11) were compared cross-sectionally with those of the patients who did not show EDS (JESS < 11). Nineteen point two % of all patients showed EDS subjectively. Two hundred one patients were classified to an EDS(+) group and an 847 patients were classified to EDS(–) group. Age and global PSQI-J scores were significantly different between the two groups. Logistic regression showed that EDS was significantly associated with global PSQI-J scores, but not with age. Among PSQI-J components, overall sleep quality, duration of sleep, sleep disturbance, and day dysfunction due to sleepiness were significantly higher in the EDS(+) group. Especially, 19.4% of patient in the EDS(+) group reported actual sleep time during the past month to be less than 5 hours/day. Although functional relationship should be further evaluated, insufficient sleep is the main factor associated with EDS in the OSAS patients under CPAP treatment.

Day Time Sleepiness and Quality of Life Predicts Perceived Stress among Youth

The study examined the predictor of perceived stress among youth.The variables used in the current study were day time sleepiness,quality of life and perceived stress.The sample consists of 150 youth(81Male&69 Female)with in the age range of 18-24 years.The Epworth Sleepiness Scale(ESS),World Health Organization Quality of Life(WHO-BRIEF),and Perceived Stress Scale(PSS)were used.The data were interpreted after obtaining the descriptive statistics i.e.Mean and SD,Pearson’s Product Moment correlation and step wise multiple regression analysis.The findings indicated that day time sleepiness and quality of life have a significant positive relation with perceived stress among youth.The step wise regression analysis found day time sleepiness and psychological health related quality of life are the predictors of perceived stress.Both the variable accounts for 39%of total variance in perceived stress among youth.

Influence of excessive daytime sleepiness and sleep quality on anxiety and depression in patients with obstructive sleep apnea hypopnea syndrome.

Objective To explore the factors that contribute tothe anxiety and depression in obstructive sleep apnea hypopneasyndrome (OSAHS) patients in terms of excessivedaytime sleepiness (EDS) and sleep quality. MethodsA total of 196 OSAHS patients,including 103 severepatients and 93 mild-moderate patients,were enrolled.Polysomnography was carried on at the sleep center of theFirst Hospital of China Medical University between May2013 and November 2015. According to the Epworthsleepiness scale (ESS) and the subject daytime sleepinesssymptom,all patients were divided into EDS groupand non-EDS group. The patients' general informationand subjective symptoms were recorded. Emotional stateswere assessed with self-rating anxiety scale ( SAS) andself-rating depression scale ( SDS). Sleep quality wasevaluated with Pittsburgh sleep quality index ( PSQI).The anxiety and depression related factors were studiedby regression analysis.

Cognitive and Emotional Factors Related to Obstructive Sleep Apnea Diagnoses: A Brief Review

Sleep apnea is a clinical condition characterized by cessation of breathing in the sleeper due to pharyngeal airway closure. The reduction in air exchange results in decreased cerebral blood circulation with consequential behavioral deficits cognitively and emotionally. Untreated sleep apnea is associated with chronic illnesses of depression, cardiovascular disorder, obesity and diabetes mellitus. Measured cognitive behavior before and following CPAP treatment demonstrates the cognitive deficit as the effectiveness of CPAP treatment. Emotional factors related to sleep apnea diagnosis and adherence to treatment are facilitated in patients with cognitive behavior therapy (CBT) interventions by sleep specialists. This is a brief review paper that presents findings about cognition and emotional factors related to sleep apnea. This is a brief review paper.

利用插入 SLEEPY 时间片降低单片机系统的功耗及负载效应

提出了采用插入ｓｌｅｅｐｙ状态，利用ＣＰＵ时间片操作来降低单片机系统负载效应并降低功耗的方法，已应用于某现场的无源流量计，实践证明该方法是有效的．文中对其工作原理进行了论证，并建立了实验电路及程序．

Analysis of sleep characteristics and clinical outcomes of 139 adult patients with infective endocarditis after surgery

BACKGROUND Little is known about the postoperative sleep quality of infective endocarditis patients during hospitalization and after discharge.AIM To investigate the sleep characteristics of infective endocarditis patients and to identify potential risk factors for disturbed sleep quality after surgery.METHODS The Pittsburgh Sleep Quality Index(PSQI)and the Epworth Sleepiness Scale were used to assess patient sleep quality.Logistic regression was used to explore the potential risk factors.RESULTS The study population(n=139)had an average age of 43.40±14.56 years,and 67.6%were men(n=94).Disturbed sleep quality was observed in 86 patients(61.9%)during hospitalization and remained in 46 patients(33.1%)at 6 mo after surgery.However,both PSQI and Epworth Sleepiness Scale scores showed significant improvements at 6 mo(P<0.001 and P=0.001,respectively).Multivariable logistic regression analysis showed that the potential risk factors were age(odds ratio=1.125,95%confidence interval:1.068-1.186)and PSQI assessed during hospitalization(odds ratio=1.759,95%confidence interval:1.436-2.155).The same analysis in patients with PSQI≥8 during hospitalization suggested that not using sleep medication(odds ratio=15.893,95%confidence interval:2.385-105.889)may be another risk factor.CONCLUSION The incidence of disturbed sleep after infective endocarditis surgery is high.However,the situation improves significantly over time.Age and early postoperative high PSQI score are risk factors for disturbed sleep quality at 6 mo after surgery.

Mandibular advancement devices in the treatment of obstructive sleep apnea and snoring in community dental care: A pilot study on self-reported sleep quality

Background: The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) patients is sometimes limited because of intolerance. Mandibular advancement devices (MAD) are proven to be efficient in treating mild to moderate sleep apnea and snoring. We examined patients who had been treated in Community Dental Care with a titrable Herbst-type MAD. The aim of the study was to evaluate the quality of sleep based on self report. Methods: A questionnaire was mailed to patients (n = 184) who had received treatment for OSA or snoring between 2007 and2010 inthe Helsinki Health Centre Oral Care Unit. The patients were referred to the clinic for primary treatment, or because another treatment modality had failed. Results: Of the respondents (n = 142, 78.4%), OSA had been diagnosed in 74%, while the MAD was applied for snoring to the remaining. Among all respondents, 78.4% had worn the MAD at least three nights per week. With the MAD in situ, sleep was felt significantly less disrupted (p < 0.001) and more restorative (p < 0.001), and snoring was markedly reduced (p < 0.001). Daytime tiredness was also markedly less frequent (p < 0.001). Conclusions: Treatment with a MAD improved perceived sleep quality and awoke alertness in mild and moderate OSA patients and in snorers. This study supports such treatment to be initiated and monitored in community dental care.

Sleep breathing disorders in female population of Dubai, UAE

PURPOSE: United Arab Emirates (UAE) is part of the GCC countries and ranks 18 on 2007 WHO list of the fattest countries with 68.3% of its citizens with an unhealthy weight. The WHO data in 2008 state that the prevalence of overweight in UAE is 71%, while it is 61% in the UK, 54% in Germany, and 45% in France. The increasing overweight and obesity in the UAE are closely related to high social-economic development. Accordingly, the medical authority has observed that the rates of hypertension and diabetes mellitus type 2 appear to be one of the highest rates worldwide. We presume that the increase prevalence of obesity in the UAE would be linked to the increase in prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in women followed up in the primary health care (PHC) setting in Dubai and the relationship between obesity and sleep apnea in females in the UAE. DESIGN: Prospective observational community-based survey. SETTING: 20 primary health centers in Dubai. PARTICI-PANTS: Consecutive female patients who were older than 14 years, regardless of the reason of their visit. METHODS: In this prospective survey, trained medical nurse administered the Berlin Questionnaire (which includes questions about self-reported snoring, witnessed apneas, daytime sleepiness, hypertension, and obesity) to a consecutive random sample of female patients in the age group older than 14 years, attending the PHC center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire, individuals were classified into high-risk and low-risk groups for OSAS. RESULTS: Based on the responses and measurement of the Berlin Questionnaire of 704 female subjects studied, 137 respondents met the criteria for the high-risk scoring. This gives a prevalence rate of 19.5% while the remainders of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 ± 11.73 years. The highest prevalence was noticed between age group 51 to 60 years. 70% of the high risk group patients had Body Mass Index (BMI) ≥30 kg/m2 and nearly 75% of the low risk group had BMI 2 and the Mean BMI was 33.59 ± 6.44 kg/m2. CONCLUSIONS: One in five women in Dubai, UAE is at high risk of having OSAS. Awareness by the primary care medical community about this disorder in females should be increased so that the patients would benefit from proper evaluation and treatment of OSAS.

Severe obstructive sleep apnea and long distance truck driving: A case report

Introduction: Untreated sleep disorders can increase driver crash risk by up to 7 fold, and truck drivers have a variety of risk factors for sleep disorders. Measures currently used to identify drivers at risk depend predominantly on the ability of the driver to identify and report themselves as sleepy. Methods: This case report presents a 54 year old long distance truck driver who participated in a case-control study, underwent at home breathing monitoring and was followed up with an in-depth interview. Results: Self-reported measures did not identify this driver as at risk of sleepiness or sleep apnea;yet he was subsequently diagnosed with severe sleep apnea using an at home monitor and polysomnography. Conclusions: Self-assessment of risk factors is insufficient as a screen for sleep apnea. General practitioners are in an ideal position to identify potential sleep apnea sufferers and can initiate the enquiry process that leads to diagnostic testing.

Sleep Fragmentation and Risk of Automobile Accidents in Patients with Obstructive Sleep Apnea—Sleep Fragmentation and Automobile Accidents in OSA

Objectives: Automobile accidents related to obstructive sleep apnea (OSA) represent an important public health concern. Frequent arousal response during sleep is responsible for the symptoms of daytime sleepiness and an increased risk of automobile accidents in patients with OSA. We therefore investigated the potential relationships between the intensity of arousal and occurrence of automobile accidents in OSA. Methods: We determined the incidence of automobile accidents in the past 5 years among 51 men with OSA (age, 58.5 ± 10.4 years) using a questionnaire. Daytime sleepiness was rated with the Epworth Sleepiness Scale (ESS). We calculated an automobile accident score, with two points per automobile accident causing damage and one point per near miss. Standard polysomnography was performed for all patients, and arousals were classified as electroencephalographic (EEG) arousal of an abrupt shift in EEG frequency alone and Movement arousal, which was defined as EEG arousal with increased electromyographic activity persisting for ≥3 s. The number of EEG or Movement arousals per hour (arousal index) was determined. Results: The Movement arousal index was significantly greater in the 27 patients who experienced at least one automobile accident causing damage than in the resting 24 patients who had no history of automobile accidents. Multiple regression analysis including age, body mass index, and sleep parameters revealed that the Movement arousal index was the most significant factor of risk for automobile accidents (β = 0.563, P = 0.017) as well as the ESS score (β = 0.417, P = 0.022). Conclusion: Movement arousal during sleep contributes to daytime sleepiness and the resulting frequent involvement of OSA patients in automobile accidents.

Twenty-Hour Sleep Deprivation Does Not Affect Perceived Vection Strength

We examined the effect of sleep deprivation on self-motion perception (vection). We measured the strength of vection, its latency, and its duration in two conditions: Sleep-Deprivation and Normal-Sleep (by using the between-subject design). For the Sleep-Deprivation condition, participants did not sleep for about 20 hours. We also recorded subjective sleepiness with a subjective rating scale that was filled out by the participants. Results showed that vection strength did not differ between the two conditions. Sleep deprivation did not have any clear effect on vection. As expected, subjective sleepiness significantly increased following sleep deprivation. Further, subjective sleepiness significantly correlated with vection latency and duration only in the Normal-Sleep condition. Vection was immune to sleep deprivation. We conclude that when people are not deprived of sleep, sleepiness can enhance the perceived strength of vection.

Insomnia Fighting with Red Led Pulsations

This study shows how and why luminous red pulsations can distract the mind and facilitate sleep by preventing disruptive thoughts and memories. The rgb LED produces a miniature dusk-to-dawn flight device to pass from red at night to white at dawn, potentially followed by luminotherapy. Combined in a single portable device, these luminous parameters are useful in the fight against insomnia through cognitive behavioral therapy CBT.

Differences between Istradefylline Responders and Non-Responders in Parkinson’s Disease

Background: Istradefylline is a selective adenosine A2A receptor antagonist approved for Parkinson’s disease (PD) patients with wearing-off symptoms. The Japanese phase III trial showed that 20 mg of orally administrated istradefylline decreased the Off-time. However, istradefylline showed prominent effects in some patients and no benefits in others. We examined the differences in characteristics between responders and non-responders who received 8 weeks of 20 mg/day istradefylline. Methods: Thirty-one patients were enrolled (age, 65.4 [SD 10.4] years;disease duration, 10.4 [SD 6.1] years;daily levodopa dosage, 553.2 [SD 228.7] mg;frequency of levodopa consumption, 4.7 [SD 1.5] times;levodopa equivalent dose, 811.2 [SD 307.5] mg). Results: There were significant differences (p Conclusions: Younger or female patients who are not excessively sleepy during daytime are better candidates for the istradefylline therapy.

The Treatment Strategy of Patients with Sleep Apnea Syndrome in Our Department and Subsequent Course

It is known that acute or chronic heart failure can develop in patients with grave sleep apnea syndrome (SAS), and known to have the social problem including an accident and the decrease of the labor will. Several medical treatments are now available for SAS. We considered problems of the treatment based on the practice situation of our department about the present conditions and subsequent treatment. The subjects consisted of 306 patients. We measured Epworth Sleepiness Scale (ESS) and apnea hypopnea index (AHI) after polysomnography in all patients at the first time and 6 months later. So, it was found that AHI and ESS decreased when we could be treated in the SAS patients appropriately. It was confirmed that the choice of the appropriate regimen was important.