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.

Driver Sleepiness and Risk of Car Crashes in Shenyang, a Chinese Northeastern City: Population-based Case-control Study

Objective To estimate the association of driver sleepiness with the risk of car crashes. Methods A population-based case-control study was conducted in Shenyang, a northeastern city in China, between November 2001 and July 2002. The case group comprised 406 car drivers involved in crashes, and 438 car drivers recruited at randomly selected sites, and on the day of week, and the time of day when they were driving on highways in the study region during the study period were used as control groups. Face-to-face interviews with drivers were conducted according to a well-structured questionnaire covering the circumstances of their current trip and their background information. Stanford sleepiness scale and Epworth sleepiness scale were used to quantify acute sleepiness and chronic sleepiness respectively. Results There was a strong association between chronic sleepiness and the risk of car crash. Significantly increased risk of crash was associated with drivers who identified themselves as sleepy (Epworth sleepiness score≥10 vs <10; adjusted odds ratio 2.07, 95% confidence interval 1.30 to 3.29), but no increased risk was associated with measures of acute sleepiness. Conclusions Chronic sleepiness in car drivers significantly increases the risk of car crash. Reductions in road traffic injuries may be achieved if fewer people drive when they are sleepy.

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.

Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome

Background Excessive daytime sleepiness （EDS） is often associated with obstructive sleep apnea hypopnea syndrome （OSAHS） and contributes to a number of comorbidities in these patients. Therefore, early detection of EDS is critical in disease management. We examined the association between Epworth Sleepiness Scale （ESS） and multiple sleep latency test （MSLT） and diagnostic accuracy of ESS in assessing EDS in OSAHS patients. Methods The ESS, MSLT and overnight polysomnography were administered to 107 Chinese patients to assess EDS and its correlations with polysomnographic parameters. The diagnostic accuracy of ESS in classifying EDS （mean sleep latency （MSL） 〈10 minutes） was evaluated by calculating the area under ROC curve. Results As the severity of OSAHS increased, MSL decreased with increase in ESS score. Conversely, patients with worsening EDS （shorter MSL） were characterized by advanced nocturnal hypoxaemia and sleep disruption compared to those with normal MSL, suggesting EDS is associated with more severe OSAHS. There was a negative correlation between ESS score and MSL and both moderately correlated with some polysomnographic nocturnal hypoxaemic parameters. The area under ROC curve of ESS for identifying EDS was 0.80 （95% CI： 0.71 to 0.88） and ESS score 〉12 provided the best predictive value with a sensitivity of 80% and specificity of 69%. Conclusion The ESS score moderately correlates with MSL and our ROC study supports ESS as a screening strategy for assessing EDS in OSAHS.

A Proposal on the Novel Method to Estimate Optimal Sleep Duration Based on Self-Reported Survey Data

Background: Many adolescents have a sleep debt. Individuals sleeping for their optimal sleep duration are expected to experience no sleepiness. Then, it is important to recognize one’s optimal sleep duration to reduce sleep debt. However, there is no simple method to determine this value. Since body mass index and sleep duration exhibit a U-shaped association, it is expected that a person taking optimal sleep duration would show no marked deviation from the mean body mass index value for the population evaluated. By using self-reported sleepiness and standardized body mass index, this study aimed to estimate individual optimal sleep duration. Methods: Data from 2540 grade 5 - 11 students were used. Students who declared no sleepiness during class and also had a gender- and grade-standardized body mass index of ±1.5 were termed ideal students. The average sleep durations of ideal students were compared with those of non-ideal students. The differences of sleep duration between ideal and no-ideal students were added to habitual sleep duration of each non-ideal student to obtain assumed optimal sleep duration. A multiple regression line to predict assumed optimal sleep duration was calculated using the least squares method. Results: The mean sleep duration of 666 ideal students exceeded the lower limit of daily sleep duration proposed as “may be appropriate” for children aged 6 - 17 years by National Sleep Foundation of the USA, being longer than those of non-ideal students. Significant regression formula for assumed optimal sleep duration was obtained (adjusted R2 = 0.996, p Conclusions: No contradiction was identified in the sleep duration obtained from ideal students as with optimal sleep duration. Although further studies to confirm the current estimation are needed, a simple formula to estimate individual optimal sleep duration through easily obtainable parameters was proposed.

Evaluation of Sleep Quality in Undergraduated Medical Students

Objective: The aim of this study was to evaluate the sleep quality of medical students to identify the main factors that affect sleep patterns. Methods: According to the methodology, 154 students participated in the research, attending from the first to the sixth year of the course. The Pittsburg Sleep Quality Index questionnaire and the Epworth sleepiness scale were applied. Descriptive statistics techniques were applied and demonstrated in the form of tables and graphs. The comparison of variables was carried out using statistical tests. Results: The results showed that most students do not sleep very well. It was observed that 68.83% of a total of 106 students are bad sleepers. Conclusion: It is concluded that medical students sleep a low number of hours by period, which could interfere in impairment of attention, learning and memory formation, interfering in academic performance. On the other hand, they showed greater daytime sleepiness compared to the general population.

Excessive Daytime Sleepiness in Parkinson＇s Disease： Clinical Implications and Management

Objective：Excessive daytime sleepiness （EDS） is one of the most common sleep abnormalities in patients with Parkinson’s disease （PD）, yet its multifactorial etiology complicates its treatment. This review summarized recent studies on the epidemiology, etiology, clinical implications, associated features, and evaluation of EDS in PD. The efficacy of pharmacologic and non-pharmacologic treatments for EDS in PD was also reviewed.Data Sources：English language articles indexed in PubMed and Cochrane databases and Chinese-language papers indexed in Wanfang and National Knowledge Infrastructure databases that were published between January 1987 and November 2017 were located using the following search terms： ＂sleepiness＂ , ＂sleep and Parkinson’s disease＂ , and ＂Parkinson’s disease and treatment＂ .Study Selection：Original research articles and critical reviews related to EDS in PD were selected.Results：EDS is a major health hazard and is associated with many motor and nonmotor symptoms of PD. Its causes are multifactorial. There are few specific guidelines for the treatment of EDS in PD. It is first necessary to identify and treat any possible factors causing EDS. Recent studies showed that some nonpharmacologic （i.e., cognitive behavioral therapy, light therapy, and repetitive transcranial magnetic stimulation） and pharmacologic （i.e., modafinil, methylphenidate, caffeine, istradefylline, sodium oxybate, and atomoxetine） treatments may be effective in treating EDS in PD.Conclusions：EDS is common in the PD population and can have an immensely negative impact on quality of life. Its causes are multifactorial, which complicates its treatment. Further investigations are required to determine the safety and efficacy of potential therapies and to develop novel treatment approaches for EDS in PD.

Subjective sleepiness in heart failure patients with sleep-related breathing disorder

Background Previous studies show that sleep-related breathing disorder （SRBD） is common in patients with heart failure （HF） and is associated with increased mortality. This study aimed to determine whether there was significant difference of subjective daytime sleepiness between HF patients with and without SRBD. Methods We enrolled, prospectively, 195 consecutive HF patients with left ventricular ejection fractions （LVEF） ≤45% and all subjects underwent polysomnography to measure the sleep structure between 2005 and 2008. Patients were then assigned to those with SRBD including obstructive and central sleep apnea （apnea-hypopnea index （AHI） ≥5/hour of sleep） and those without SRBD （AHI 〈5/hour） according to the sleep study. The subjective sleepiness was assessed with Epworth sleepiness scale （ESS）. Results Among 195 HF patients, the prevalence of obstructive sleep apnea （OSA） was 53% and of central sleep apnea （CSA） was 27%. There was no significant difference of ESS scores between patients without SRBD （NSA） and with SRBD （NSA vs OSA： 6.7±0.6 vs 7.6±0.4, P=0.105 and NSA vs CSA： 6.7±0.6 vs 7.4±K）.5, P=0.235, respectively）, indicating that SRBD patients had no more subjective daytime sleepiness. Compared with NSA, patients with SRBD had increased arousal index （Arl） （NSA vs OSA： 14.1±1.4 vs 26.3 ±1.5, P〈0.001 and NSAvs CSA： 14.1±1.4 vs 31.3±3.5, P 〈0.001, respectively）, more awake number after sleep onset （NSA vs OSA： 19.2±1.5 vs 26.2±1.4, P=0.01 and NSA vs CSA： 19.2±1.5 vs 36.9±4.4, P 〈0.001, respectively）, and reduced proportion of slow-wave sleep （SWS） （NSA vs OSA： 13.8±1.7 vs 9.3±0.7, P=0.024 and NSA vs CSA： 13.8±1.7 vs 8.9±0.9, P=0.024, respectively）. Conclusions OSA and CSA remain common in patients with HF on optimal contemporary therapy. Patients with both HF and SRBD have no significant subjective daytime sleepiness compared with patients without SRBD, despite of significantly increased awake number, arousal and decreased proportion of deep sleep stages. It is not a credible way and means to exclude SRBD in patients with HF according to the absence of subjective daytime sleepiness.

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.

Changes in mean cerebral blood flow velocity during cognitive task-induced cerebral fatigue in high performance fighter pilots

BACKGROUND： Several studies have demonstrated that sustained cognitive tasks can induce cognitive fatigue and that the mean cerebral blood flow velocity changes in some cerebral regions during cerebral fatigue. OBJECTIVE： To dynamically monitor the changes in mean cerebral blood flow velocity in different brain regions of high performance fighter pilots during mental arithmetic tasks and consecutive performance tasks. DESIGN, TIME AND SETTING： The present neurophysiological trial, based on controlled observation, was performed at the Laboratory of Neurophysiology, Institute of Aviation Medicine, Air Force of China between January 2003 and December 2005. PARTICIPANTS： Forty-five males, high performance fighter pilots, averaging （27.6±2.5） years, were recruited for this study. METHODS： The mean cerebral blood flow velocity in the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery of subjects was dynamically tested using transcranial Doppler during 5- hour mental arithmetic tasks and during 5- hour consecutive performance tasks. The neurobehavioral ability index was analyzed throughout each trial according to the number of correct responses, false responses, and lost responses. Simultaneously, cerebral cognitive fatigue-induced lethargy was assessed by the Stanford Sleepiness Scale. MAIN OUTCOME MEASURES： Changes in mean cerebral blood flow velocity in the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery; neurobehavioral ability index of mental arithmetic and consecutive performance tasks; Stanford Sleepiness Scale scores. RESULTS： During mental arithmetic tasks, the mean cerebral blood flow velocity in the anterior cerebral artery increased during hour 2 and decreased after hour 4. There was no significant change in mean cerebral blood flow velocity in the middle cerebral artery and posterior cerebral artery. During hour 4, cerebral cognitive fatigue was observed and, simultaneously, Stanford Sleepiness Scale scores demonstrated the presence of fatigue. During such a stage, the neurobehavioral ability index decreased, indicating a decline in performance ability. During consecutive performance tasks, the mean cerebral blood flow velocity declined earlier in the posterior cerebral artery compared to the middle cerebral artery. CONCLUSION： Five- hour mental arithmetic tasks have few effects on cerebral functions and do not lead to a significant change in mean cerebral blood flow velocity. Five-hour consecutive performance tasks can induce cerebral cognitive fatigue, and a marked decline in mean cerebral blood flow velocity.

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.