Sleep Disorders The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Periodic Breathing and Behavioral Awakenings at High Altitude Mon, 21 Sep 2015 13:01:17 +0000 Objectives. To study the relationship between nocturnal periodic breathing episodes and behavioral awakenings at high altitude. Methods. Observational study. It is 6-day ascent of 4 healthy subjects from Besisahar (760 meters) to Manang (3540 meters) in Nepal in March 2012. A recording pulse oximeter was worn by each subject to measure their oxygen saturation and the presence of periodic breathing continuously through the night. An actigraph was simultaneously worn in order to determine nocturnal behavioral awakenings. There were no interventions. Results. 187-hour sleep at high altitude was analyzed, and of this, 145 hours (78%) had at least one PB event. At high altitude, 10.5% (95% CI 6.5–14.6%) of total sleep time was spent in PB while 15 out of 50 awakenings (30%, 95% CI: 18–45%) occurring at high altitudes were associated with PB (). Conclusions. Our data reveals a higher than expected number of behavioral awakenings associated with PB compared to what would be expected by chance. This suggests that PB likely plays a role in behavioral awakenings at high altitude. Daniel J. Shogilev, John B. Tanner, Yuchiao Chang, and N. Stuart Harris Copyright © 2015 Daniel J. Shogilev et al. All rights reserved. Perceived Immune Status and Sleep: A Survey among Dutch Students Thu, 10 Sep 2015 09:22:08 +0000 Reduced immune functioning may have a negative impact on sleep and health, and vice versa. A survey among Dutch young adults (18–35 years old) was administered to collect information on perception of reduced immunity and its relationship to sleep disorders, sleep duration, and quality. Sleep disorders were assessed with the SLEEP-50 questionnaire subscales of sleep apnea, insomnia, circadian rhythm disorder, and daily functioning. Dutch young adults (N = 574) completed the survey. Among them, subjects (N = 209; 36.4%) reported perceived reduced immunity. Relative to those with a normal immune status, subjects reporting reduced immunity had significantly higher scores on sleep apnea (2.6 versus 3.6), insomnia (5.1 versus 6.8), and circadian rhythm disorder (2.1 versus 2.7). Subjects reporting reduced immunity also had significantly poorer daily functioning scores (5.4 versus 7.6, ). No differences were observed in total sleep time, but those reporting reduced immunity had significantly poorer ratings of sleep quality (6.8 versus 7.2, ). Our findings suggest that perceived reduced immunity is associated with sleep disturbances, impaired daily functioning, and a poorer sleep quality. Experimental studies including the assessment of immune biomarkers and objective measures of sleep (polysomnography) should confirm the current observations. Anouk A. M. T. Donners, Marilou D. P. Tromp, Johan Garssen, Thomas Roth, and Joris C. Verster Copyright © 2015 Anouk A. M. T. Donners et al. All rights reserved. Association of Sleep Quality and Waking Time with Prediabetes: The Qazvin Metabolic Diseases Study, Iran Mon, 17 Aug 2015 06:11:02 +0000 Aims. It is known that sleep has a major role in the regulation of endocrine functions and glucose metabolism. However, it is not clear whether the sleep pattern is affected at or prior to the onset of diabetes, among those with prediabetes. The purpose of this study was to determine the association of sleep patterns and prediabetes in Qazvin, Iran. Methods. A representative sample of residents of Qazvin was selected by multistage cluster random sampling method in 2011. Plasma glucose level and sleep quality were measured cross-sectionally as well as demographic characteristics. A logistic regression analysis was used to examine the association of sleep status and prediabetes. Results. Mean age was 39.3 ± 10.1 years. Of 958, 474 (49.47%) were female. Poor sleep quality was associated with 2.197-fold increased risk of prediabetes after adjustment for age, gender, body mass index, and metabolic syndrome. Conclusion. This study provides evidences that subjects with poor sleep quality are more likely to develop prediabetes than people with good sleep quality. Azam Ghorbani, Neda Esmailzadehha, Asghar Mohammadpoorasl, and Amir Ziaee Copyright © 2015 Azam Ghorbani et al. All rights reserved. Comparative Study between Sequential Automatic and Manual Home Respiratory Polygraphy Scoring Using a Three-Channel Device: Impact of the Manual Editing of Events to Identify Severe Obstructive Sleep Apnea Wed, 12 Aug 2015 08:17:35 +0000 Objective. According to current guidelines, autoscoring of respiratory events in respiratory polygraphy requires manual scoring. The aim of this study was to evaluate the agreement between automatic analysis and manual scoring to identify patients with suspected OSA. Methods. This retrospective study analyzed 791 records from respiratory polygraphy (RP) performed at home. The association grade between automatic scoring and manual scoring was evaluated using Kappa coefficient and the agreement using Bland and Altman test and intraclass correlation coefficient (CCI). To determine the accuracy in the identification of  eV/h, the ROC curve analysis was used. Results. The population analyzed consisted of 493 male (62.3%) and 298 female patients, with an average age of years and BMI of  kg/m2. There was no significant difference between automatic and manual apnea/hypopnea indexes (aAHI, mAHI): aAHI 17.25 (SD: 17.42) versus mAHI (p; NS). The agreement between mAHI and aAHI to was 94%, with a Kappa coefficient of 0.83 () and a CCI of 0.83. The AUC-ROC, sensitivity, and specificity were 0.99 (CI 95%: 0.98-0.99, ), 86% (CI 95%: 78.7–91.4), and 97% (CI 95%: 96–98.3), respectively. Conclusions. We observed good agreement between automatic scoring and sequential manual scoring to identify subjects with  eV/h. Glenda Ernst, Martín Bosio, Alejandro Salvado, Facundo Nogueira, Carlos Nigro, and Eduardo Borsini Copyright © 2015 Glenda Ernst et al. All rights reserved. Factors Associated with Successful Treatment by Radiofrequency Treatment of the Soft Palate in Obstructive Sleep Apnea as the First-Line Treatment Mon, 03 Aug 2015 13:50:18 +0000 Background. Radiofrequency ablation (RFA) is recommended as the second-line treatment for obstructive sleep apnea (OSA). This study aims to study the factors associated with successful treatment by RFA in OSA patients as the first-line treatment. Methods. All patients diagnosed as mild to moderate OSA were enrolled prospectively and treated with RFA. Three points of soft palate were ablated: midline, left, and right paramedian sites. Baseline characteristics and clinical factors including snoring score (SS), Epworth Sleepiness Scale (ESS), and apnea-hypopnea index (AHI), with minimal oxygen saturation, were recorded at baseline and three months after treatment. Results. During the study period, there were 51 patients who met the study criteria and received RFA treatment. At three months, the SS, ESS, and AHI were significantly lower than baseline values, while the minimal oxygenation was significantly increased from the baseline values. There were 16 patients (31.37%) who had an AHI of < 5 times/h. Only baseline AHI was significantly associated with an AHI of < 5 times/h at three months after RFA treatment. The adjusted odds ratio was 0.804 (95% CI: 0.699, 0.924). Conclusion. Transoral RFA treatment may be effective in mild to moderate OSA as the first-line treatment. Baseline AHI is associated with preferable outcome by RFA treatment. Nuntigar Sonsuwan, Kongsak Rujimethabhas, and Kittisak Sawanyawisuth Copyright © 2015 Nuntigar Sonsuwan et al. All rights reserved. Physiological Sleep Propensity Might Be Unaffected by Significant Variations in Self-Reported Well-Being, Activity, and Mood Thu, 30 Jul 2015 13:21:03 +0000 Background and Objective. Depressive state is often associated with such physical symptoms as general weakness, fatigue, tiredness, slowness, reduced activity, low energy, and sleepiness. The involvement of the sleep-wake regulating mechanisms has been proposed as one of the plausible explanations of this association. Both physical depressive symptoms and increased physiological sleep propensity can result from disordered and insufficient sleep. In order to avoid the influence of disordered and insufficient sleep, daytime and nighttime sleepiness were tested in winter depression characterized by normal night sleep duration and architecture. Materials and Methods. A total sample consisted of 6 healthy controls and 9 patients suffered from depression in the previous winter season. Sleep latency was determined across 5 daytime and 4 nighttime 20-min attempts to nap in summer as well as in winter before and after a week of 2-hour evening treatment with bright light. Results and Conclusions. Patients self-reported abnormally lowered well-being, activity, and mood only in winter before the treatment. Physiological sleep propensity was neither abnormal nor linked to significant changes in well-being, activity, and mood following the treatment and change in season. It seems unlikely that the mechanisms regulating the sleep-wake cycle contributed to the development of the physical depressive symptoms. Arcady A. Putilov Copyright © 2015 Arcady A. Putilov. All rights reserved. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review Thu, 30 Jul 2015 09:49:21 +0000 Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP) devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s) development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI) and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies), apnea-hypopnea index (seventeen studies), and neck circumference (eleven studies) were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted. Macario Camacho, Muhammad Riaz, Armin Tahoori, Victor Certal, and Clete A. Kushida Copyright © 2015 Macario Camacho et al. All rights reserved. Computer-Assisted Diagnosis of the Sleep Apnea-Hypopnea Syndrome: A Review Tue, 21 Jul 2015 10:38:13 +0000 Automatic diagnosis of the Sleep Apnea-Hypopnea Syndrome (SAHS) has become an important area of research due to the growing interest in the field of sleep medicine and the costs associated with its manual diagnosis. The increment and heterogeneity of the different techniques, however, make it somewhat difficult to adequately follow the recent developments. A literature review within the area of computer-assisted diagnosis of SAHS has been performed comprising the last 15 years of research in the field. Screening approaches, methods for the detection and classification of respiratory events, comprehensive diagnostic systems, and an outline of current commercial approaches are reviewed. An overview of the different methods is presented together with validation analysis and critical discussion of the current state of the art. Diego Alvarez-Estevez and Vicente Moret-Bonillo Copyright © 2015 Diego Alvarez-Estevez and Vicente Moret-Bonillo. All rights reserved. Continuous Positive Airway Pressure Device Time to Procurement in a Disadvantaged Population Tue, 02 Jun 2015 11:31:45 +0000 Introduction. The management of obstructive sleep apnea (OSA) in patients who cannot afford a continuous positive airway pressure (CPAP) device is challenging. In this study we compare time to CPAP procurement in three groups of patients diagnosed with OSA: uninsured subsidized by a humanitarian grant (Group 1), uninsured unsubsidized (Group 2), and those with Medicare or Medicaid (Group 3). We evaluate follow-up and adherence in Group 1. We hypothesize that additional factors, rather than just the ability to obtain CPAP, may uniquely affect follow-up and adherence in uninsured patients. Methods. 30 patients were in Groups 1 and 2, respectively. 12 patients were in Group 3. Time of CPAP procurement from OSA diagnosis to CPAP initiation was assessed in all groups. CPAP adherence data was collected for Group 1 patients at 1, 3, 6, and 9 months. Results. There were no significant differences between groups in gender, age, body mass index, or apnea hypopnea index. The mean time to procurement in Group 1 was shorter compared to Group 2 but not significant. Compared to both Group 1 and Group 2, Group 3 patients had significantly shorter times to device procurement. Conclusion. Time to procurement of CPAP was significantly shorter in those with Medicaid/Medicare insurance compared to the uninsured. Lourdes M. DelRosso, Romy Hoque, and Andrew L. Chesson Jr. Copyright © 2015 Lourdes M. DelRosso et al. All rights reserved. Nitric Oxide Bioavailability in Obstructive Sleep Apnea: Interplay of Asymmetric Dimethylarginine and Free Radicals Wed, 06 May 2015 07:25:10 +0000 Obstructive sleep apnea (OSA) occurs in 2% of middle-aged women and 4% of middle-aged men and is considered an independent risk factor for cerebrovascular and cardiovascular diseases. Nitric oxide (NO) is an important endothelium derived vasodilating substance that plays a critical role in maintaining vascular homeostasis. Low levels of NO are associated with impaired endothelial function. Asymmetric dimethylarginine (ADMA), an analogue of L-arginine, is a naturally occurring product of metabolism found in the human circulation. Elevated levels of ADMA inhibit NO synthesis while oxidative stress decreases its bioavailability, so impairing endothelial function and promoting atherosclerosis. Several clinical trials report increased oxidative stress and ADMA levels in patients with OSA. This review discusses the role of oxidative stress and increased ADMA levels in cardiovascular disease resulting from OSA. Mohammad Badran, Saeid Golbidi, Najib Ayas, and Ismail Laher Copyright © 2015 Mohammad Badran et al. All rights reserved. The Relationship between Sleep-Disordered Breathing and Hypertension in a Nationally Representative Sample Wed, 29 Apr 2015 13:46:23 +0000 Sleep-disordered breathing (SDB), characterized by abnormal respiratory patterns or inadequate quantity of ventilation, is common in adults. A positive association between SDB and hypertension has been established, in both cross-sectional and longitudinal studies. One void in the literature concerns the role of race/ethnicity in the association between SDB and hypertension. In this context, a cross-sectional study was performed on 6,783 participants in the National Health and Nutrition Examination Survey 2005–2008. Participants were ≥age 20 and free from cardiovascular disease. The outcome of interest was hypertension, defined as ≥140 mmHg systolic blood pressure (BP), and/or ≥90 mmHg diastolic BP or antihypertensive medication use. Self-reported SDB was positively associated with hypertension, independent of confounders such as depression, diabetes, cholesterol levels, and body mass index, among others. The association persisted in subgroup analyses by gender, with a stronger association among males than females, as well as by race/ethnicity, with non-Hispanic blacks displaying the strongest association. In the multivariable-adjusted model, compared to a sleep summary score of zero (referent), the OR (95% CI) of hypertension for non-Hispanic blacks was 1.34 (0.98–1.83) for a sleep summary score of 1, 1.44 (1.06–1.97) for a score of 2 and 3.72 (1.98–7.00) for a score of >3; p-trend < 0.0001. SDB was positively associated with hypertension in a large, nationally representative sample of US adults. Along with being prevalent, SDB is also treatable. Therefore, our results are important for minority race/ethnic groups who typically experience a higher baseline for negative health outcomes. Sarah Dee Geiger and Anoop Shankar Copyright © 2015 Sarah Dee Geiger and Anoop Shankar. All rights reserved. Daytime Sleepiness and Parkinson’s Disease: The Contribution of the Multiple Sleep Latency Test Thu, 10 Jul 2014 11:42:27 +0000 Background. Sleep disorders are major nonmotor manifestations of patients with Parkinson’s disease (PD), and excessive daytime sleepiness (EDS) is one of the most common symptoms. Objective. We reviewed a current literature concerning major factors that influence EDS in PD patients, using Multiple Sleep Latency Test (MSLT). Methods. A Medline search found 23 studies. Results. The presence of EDS was observed in 12.7% to 47% in patients without complaints of daytime sleepiness and 47% to 66.7% with complaints of daytime sleepiness. Despite being recognized by several authors, major factors that influence EDS, such as severity of motor symptoms, use of dopaminergic medications, and associated sleep disturbances, presented contradictory data. Conclusions. Available data suggest that the variability of the results may be related to the fact that it was conducted with a small sample size, not counting the neuropathological heterogeneity of the disease. Thus, before carrying out longitudinal studies with significant samples, careful analysis should be done by assigning a specific agent on the responsibility of EDS in PD patients. Marcelo Ataide, Clélia Maria Ribeiro Franco, and Otavio Gomes Lins Copyright © 2014 Marcelo Ataide et al. All rights reserved. Screening Sleep Disordered Breathing in Stroke Unit Tue, 27 May 2014 08:11:52 +0000 In acute stroke, OSA has been found to impair rehabilitation and increase mortality but the effect of central apnea is more unclear. The aim of the present study was to evaluate the feasibility of using limited ambulatory recording system (sleep mattress to evaluate nocturnal breathing and EOG-electrodes for sleep staging) in sleep disordered breathing (SDB) diagnostics in mild acute cerebral ischemia patients and to discover the prevalence of various SDB-patterns among these patients. 42 patients with mild ischemic stroke or transient ischemic attack were studied. OSA was found in 22 patients (52.4%). Central apnea was found in two patients (4.8%) and sustained partial obstruction in only one patient (2.4%). Sleep staging with EOG-electrodes only yielded a similar outcome as scoring with standard rules. OSA was found to be common even after mild stroke. Its early diagnosis and treatment would be favourable in order to improve recovery and reduce mortality. Our results suggest that OSA can be assessed by a limited recording setting with EOG-electrodes, sleep mattress, and pulse oximetry. Kirsi Väyrynen, Kati Kortelainen, Heikki Numminen, Katja Miettinen, Anna Keso, Mirja Tenhunen, Heini Huhtala, and Sari-Leena Himanen Copyright © 2014 Kirsi Väyrynen et al. All rights reserved. Prevalence of Sleep Disorders and Their Impacts on Occupational Performance: A Comparison between Shift Workers and Nonshift Workers Tue, 20 May 2014 06:46:17 +0000 The consequences of sleep deprivation and sleepiness have been noted as the most important health problem in our modern society among shift workers. The objective of this study was to investigate the prevalence of sleep disorders and their possible effects on work performance in two groups of Iranian shift workers and nonshift workers. This study was designed as a cross-sectional study. The data were collected by PSQI, Berlin questionnaire, Epworth Sleepiness Scale, Insomnia Severity Index, and RLS Questionnaire. Occupational impact of different sleep disorders was detected by Occupational Impact of Sleep Disorder questionnaire. These questionnaires were filled in by 210 shift workers and 204 nonshift workers. There was no significant difference in the age, BMI, marital status, and years of employment in the two groups. Shift workers scored significantly higher in the OISD. The prevalence of insomnia, poor sleep quality, and daytime sleepiness was significantly higher in shift workers. Correlations between OISD scores and insomnia, sleep quality, and daytime sleepiness were significant. We concluded that sleep disorders should receive more attention as a robust indicator of work limitation. Zohreh Yazdi, Khosro Sadeghniiat-Haghighi, Ziba Loukzadeh, Khadijeh Elmizadeh, and Mahnaz Abbasi Copyright © 2014 Zohreh Yazdi et al. All rights reserved. Insomnia in Sweden: A Population-Based Survey Mon, 12 May 2014 07:51:25 +0000 Aims. Estimate the prevalence of insomnia and examine effects of sex, age, health problems, sleep duration, need for treatment, and usage of sleep medication. Methods. A sample of 1,550 subjects aged 18–84 years was selected for a telephone interview. The interview was completed by 1,128 subjects (72.8%). Results. 24.6% reported insomnia symptoms. Insomnia disorder, that is, insomnia symptoms and daytime consequences, was reported by 10.5%. The prevalence was similar among all age groups, with the exception of women aged 40–49 years who demonstrated a significantly higher prevalence, 21.6%. Having at least one physical or psychiatric disorder was reported by 82.8% of subjects with insomnia disorder. Mean sleep duration for subjects with insomnia disorder was 5.77 hours on weeknights and 7.03 hours on days off/weekends. The corresponding figures for subjects without insomnia disorder were 7.04 hours and 7.86 hours, respectively. Among those with insomnia disorder 62.5% expressed a need for treatment, and 20.0% used prescribed sleep medication regularly. Conclusions. Insomnia disorder is highly prevalent in the population. There are significant associations between insomnia disorder and physical and psychiatric disorders. A majority of subjects with insomnia disorder expressed a need for treatment, indicating a public health problem. Lena Mallon, Jan-Erik Broman, Torbjörn Åkerstedt, and Jerker Hetta Copyright © 2014 Lena Mallon et al. All rights reserved. Restless Leg Syndrome in Diabetics Compared with Normal Controls Wed, 07 May 2014 06:18:52 +0000 Introduction. Restless leg syndrome (RLS) is a common sleep disorder which is characterized by urge to move the legs accompanied by disturbing and uncomfortable leg sensation during night and rest. This common condition affects 7–10% of general population and is frequently unrecognized, misdiagnosed, and poorly managed. Several clinical conditions like diabetes have been associated with secondary form of RLS. This study analyzed the frequency and possible risk factor for RLS development in diabetic patient. Material and Methods. This descriptive case-control study was done on 140 consecutive outpatient diabetics and age, sex, and body mass index matched control group. RLS was diagnosed by criteria of the International RLS Study Group. Results. Prevalence of RLS was 28.6% in diabetes and 7.1% in control group (). Sex difference was not significant and with rising duration of diabetes prevalence of RLS was not increased. Discussion. With regarding significant association between RLS and diabetes and its negative impact on quality of life/health outcome/sleep/daytime activity/cognitive function/ and mental state of diabetic patient/higher awareness of RLS among physicians and related health worker suggested. Mehdi Zobeiri and Azita Shokoohi Copyright © 2014 Mehdi Zobeiri and Azita Shokoohi. All rights reserved. Relationships between Obstructive Sleep Apnea Syndrome, Continuous Positive Airway Pressure Treatment, and Inflammatory Cytokines Tue, 06 May 2014 07:39:29 +0000 The cardiovascular complications that frequently accompany obstructive sleep apnea syndrome (OSAS) are thought to develop as a result of inflammatory stress associated with cytokines such as IL-6 and TNF-α. We conducted the current study to compare levels of these cytokines in OSAS patients and nonapneic controls . Furthermore, we investigated the impact of a three-month regime of continuous positive airway pressure (CPAP) on serum levels of IL-6 and TNF-α only in the OSAS patients. There were no significant differences in serum levels of either IL-6 () or TNF- α () or TNF-α () between OSAS patients and nonapneic controls. Serum IL-6 levels correlated significantly with neck circumference in OSAS patients (). In OSAS patients, reduced levels of TNF-α and IL-6 correlated with increases in mean SaO2 after CPAP treatment ( and , resp.). However, neither of cytokine levels was significantly impacted by CPAP therapy (both ). We have demonstrated that plasma cytokine levels are similar in both otherwise healthy subjects with OSAS and in nonapneic control, and we conclude that OSAS-related parameters and CPAP treatment do not play a significant role in altering cytokine levels. Filiz Ünüvar Doğan, Şebnem Yosunkaya, Hacer Kuzu Okur, and Ümmügülsüm Can Copyright © 2014 Filiz Ünüvar Doğan et al. All rights reserved. Sleep and Emotional and Behavioral Symptoms in Adolescents with Inflammatory Bowel Disease Sun, 04 May 2014 10:09:07 +0000 The current study assessed the associations between sleep and psychosocial symptoms in 157 Finnish adolescents with inflammatory bowel disease (IBD). Sleep trouble was self-rated in Sleep Self-Report (SSR) and in Youth Self-Report (YSR). Psychosocial symptoms of the adolescents were assessed by the YSR and Child Behavior Checklist (CBCL). Patients reporting sleep trouble had significantly more psychosocial symptoms than their counterparts without sleep trouble. This was shown in the CBCL and YSR scales of total problems (), anxious/depressed mood (), and aggressive behavior (). Additionally, SSR sleep problem subscale scores indicating lower sleep quality (bedtime, sleep behavior) associated significantly with attention problems (). These results point out that sleep trouble should be recognized and treated in adolescents with IBD to possibly avoid the emerging of psychosocial symptoms. Teija Pirinen, Kaija-Leena Kolho, Merja Ashorn, and Eeva T. Aronen Copyright © 2014 Teija Pirinen et al. All rights reserved. Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea Sun, 27 Apr 2014 06:51:46 +0000 Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of “habit” in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42–0.93), item-total correlations (0.58–0.91), and reliability (α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice. Anders Broström, Per Nilsen, Benjamin Gardner, Peter Johansson, Martin Ulander, Bengt Fridlund, and Kristofer Årestedt Copyright © 2014 Anders Broström et al. All rights reserved. The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients’ Satisfaction, and Outcome in a Large Health Provider System Thu, 24 Apr 2014 13:46:52 +0000 During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomnography (PSG) to home studies for the diagnosis of obstructive sleep apnea (OSA). We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients’ satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs) and 2010 and 2011 (when most studies were ambulatory). Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (). 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients’ satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0–10; ). Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients’ satisfaction remained similarly high. The total direct cost of OSA management was reduced. Ahmad Safadi, Tamar Etzioni, Dan Fliss, Giora Pillar, and Chen Shapira Copyright © 2014 Ahmad Safadi et al. All rights reserved. Secondhand Smoke Exposure, Restless Sleep, and Sleep Duration in Adolescents Mon, 07 Apr 2014 00:00:00 +0000 Purpose. To examine whether secondhand smoke (SHS) exposure is associated with restless sleep and/or nighttime sleep duration among adolescents. Methods. Data were analyzed from 1,592 adolescents who completed an internet-delivered survey as part of the British Columbia Adolescent Substance Use Survey cohort study. Ordinal logistic and linear regression models were used to examine associations between frequency of SHS exposure in the past month and frequency of restless sleep and nighttime sleep duration, respectively. Results. SHS exposure was significantly positively associated with restless sleep and significantly negatively associated with sleep duration. In fully adjusted models, compared with students who reported never being exposed to SHS in the past month, students who reported a low, medium, or high frequency of SHS exposure were 1.53, 1.76, and 2.51 times as likely, respectively, to report more frequent restless sleep (, 95% CI 1.08–2.16; , 95% CI 1.22–2.53; , 95% CI 1.59–3.98). With regard to sleep duration, as frequency of SHS exposure increased by one category, nighttime sleep duration during the week and weekend decreased by 4 minutes (, 95% ) and 6 minutes (, 95% ), respectively. Conclusions. This study suggests that frequency of SHS exposure has a significant dose-response relationship with restless sleep and sleep duration in adolescents. Jennifer Schwartz, Joan L. Bottorff, and Chris G. Richardson Copyright © 2014 Jennifer Schwartz et al. All rights reserved. Manual Characterization of Sleep Spindle Index in Patients with Narcolepsy and Idiopathic Hypersomnia Tue, 01 Apr 2014 08:51:19 +0000 This is a retrospective review of PSG data from 8 narcolepsy patients and 8 idiopathic hypersomnia (IH) patients, evaluating electrophysiologic differences between these two central hypersomnias. Spindles were identified according to the AASM Manual for the Scoring of Sleep and Associated Events; and counted per epoch in the first 50 epochs of N2 sleep and the last 50 epochs of N2 sleep in each patient’s PSG. Spindle count data (mean ± standard deviation) per 30 second-epoch (spindle index) in the 8 narcolepsy patients was as follows: 0.37 ± 0.73 for the first 50 epochs of N2; 0.65 ± 1.09 for the last 50 epochs of N2; and 0.51 ± 0.93 for all 100 epochs of N2. Spindle index data in the 8 IH patients was as follows: 2.31 ± 2.23 for the first 50 epochs of N2; 2.84 ± 2.43 for the last 50 epochs of N2; and 2.57 ± 2.35 for all 100 epochs of N2. Intergroup differences in spindle count in the first 50 N2 epochs, the last 50 N2 epochs, and all 100 epochs of scored N2 were significant () as were the intragroup differences between the first 50 N2 epochs and the last 50 N2 epochs. Lourdes M. DelRosso, Andrew L. Chesson, and Romy Hoque Copyright © 2014 Lourdes M. DelRosso et al. All rights reserved. Healthcare Providers’ Knowledge of Disordered Sleep, Sleep Assessment Tools, and Nonpharmacological Sleep Interventions for Persons Living with Dementia: A National Survey Mon, 17 Mar 2014 12:10:53 +0000 A large proportion of persons with dementia will also experience disordered sleep. Disordered sleep in dementia is a common reason for institutionalization and affects cognition, fall risk, agitation, self-care ability, and overall health and quality of life. This report presents findings of a survey of healthcare providers’ awareness of sleep issues, assessment practices, and nonpharmacological sleep interventions for persons with dementia. There were 1846 participants, with the majority being from nursing and rehabilitation. One-third worked in long-term care settings and one-third in acute care. Few reported working in the community. Findings revealed that participants understated the incidence of sleep deficiencies in persons with dementia and generally lacked awareness of the relationship between disordered sleep and dementia. Their knowledge of sleep assessment tools was limited to caregiver reports, self-reports, and sleep diaries, with few using standardized tools or other assessment methods. The relationship between disordered sleep and comorbid conditions was not well understood. The three most common nonpharmacological sleep interventions participants identified using were a regular bedtime routine, increased daytime activity, and restricted caffeine. Awareness of other evidence-based interventions was low. These findings will guide evidence-informed research to develop and test more targeted and contextualized sleep and dementia knowledge translation strategies. Cary A. Brown, Patricia Wielandt, Donna Wilson, Allyson Jones, and Katelyn Crick Copyright © 2014 Cary A. Brown et al. All rights reserved. The Negative Effect of Carpal Tunnel Syndrome on Sleep Quality Mon, 17 Feb 2014 14:04:29 +0000 Objective. Sleep disturbances are common in patients with carpal tunnel syndrome (CTS). This study investigates the impact of CTS on sleep quality and clarifies the magnitude of this relationship. Methods. This is a prospective investigation of patients with CTS. Patients responded to the Levine-Katz Carpal Tunnel and the Pittsburgh Sleep Quality Index (PSQI) questionnaires to assess symptom severity and quality, respectively. Descriptive and bivariate analyses summarized the findings and assessed the correlations between CTS severity and sleep quality parameters. Results. 66 patients (53F, 13M) were enrolled. Patients reported a sleep latency of 30.0 () minutes, with a total sleep time of 5.5 () hours nightly. Global PSQI score was 9.0 (); 80% of patients demonstrated a significant reduction in sleep quality (global PSQI score ). Increased CTS symptom and functional severity both resulted in a significant reduction in quality and time asleep. Both significantly correlated with subjective sleep latency, sleep disturbance, use of sleep promoting medications, daytime dysfunction, and overall global PSQI score. Conclusions. The findings confirm the correlation of sleep disturbances to CTS, that is, significant reduction of sleep duration and a correlation to sleep quality. Patients sleep 2.5 hours less than recommended and are at risk for comorbid conditions. Ashish Patel, Maya Deza Culbertson, Archit Patel, Jenifer Hashem, Jinny Jacob, David Edelstein, and Jack Choueka Copyright © 2014 Ashish Patel et al. All rights reserved. Complex Sleep Apnea Syndrome Sun, 16 Feb 2014 13:54:57 +0000 Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour) persist or emerge when obstructive events are extinguished with positive airway pressure (PAP) and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous cositive airway pressure (CPAP) related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therap, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs. Muhammad Talha Khan and Rose Amy Franco Copyright © 2014 Muhammad Talha Khan and Rose Amy Franco. All rights reserved. The Relationship between Nocturnal Hypoxemia and Left Ventricular Ejection Fraction in Congestive Heart Failure Patients Thu, 13 Feb 2014 12:59:18 +0000 Congestive heart failure (CHF) is a major cause of mortality and morbidity. Among patients with heart failure, sleep disordered breathing (SDB) is a common problem. Current evidence suggests that SDB, particularly central SDB, is more prevalent in patients with CHF than in the general population, but it is underdiagnosed as SDB symptoms that are less prevalent in CHF. The main aims of this study were to determine the relationship between nocturnal hypoxemia and left ventricular ejection fraction in patients with chronic heart failure. By means of echocardiography, 108 patients with left ventricular ejection fraction ≤45% were divided into mild, moderate, and severe CHF. Hypoxemia was recorded overnight in the hospital and was measured by portable pulse oximetry. In the 108 patients with CHF, 44 (40.7%) were severe, 17 (15.7%) moderate, and 47 (43.6%) mild CHF. 95 (88%) of patients with CHF had abnormal patterns of nocturnal hypoxemia suggestive of Cheyne-Stokes respiration. Ejection fraction correlated negatively with dip frequency. There was no correlation between nocturnal hypoxemia with BMI and snoring. This study confirms strong associations between sleep apnea and heart disease in patients with CHF. Overnight oximetry is a useful screening test for Cheyne-Stokes respiration in patients with known heart failure. Mohammad Mirzaaghazadeh, Mehrzad Bahtouee, Fariba Mehdiniya, Nasrollah Maleki, and Zahra Tavosi Copyright © 2014 Mohammad Mirzaaghazadeh et al. All rights reserved. Effects of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea on Cognitive Functions: Evidence for a Common Nature Thu, 06 Feb 2014 07:32:00 +0000 Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS. Georgia Andreou, Filippos Vlachos, and Konstantinos Makanikas Copyright © 2014 Georgia Andreou et al. All rights reserved. Fast-Acting Sublingual Zolpidem for Middle-of-the-Night Wakefulness Wed, 05 Feb 2014 13:03:15 +0000 Sleep disorders (somnipathies) are conditions characterized by disruptions of sleep quality or of sleep pattern. They can involve difficulty falling asleep (prolonged sleep onset latency), difficulty staying asleep (disturbance of sleep maintenance), sleep of poor quality (unrefreshing), or combinations of these and can lead to poor health and quality of life problems. A subtype of sleep-maintenance insomnia is middle-of-the-night wakefulness, a relatively common occurrence. Zolpidem, a nonbenzodiazepine benzodiazepine receptor agonist, allosterically modulates an ion channel and increases the influx of Cl−, thereby dampening the effect of excitatory (sleep disrupting) input. Recently, product label changes to some zolpidem containing products have been implemented by the FDA in order to reduce the risk associated with their morning after residual side effects. A new formulation of zolpidem tartrate (Intermezzo) sublingual tablet, an approved product indicated exclusively for the treatment of middle-of-the-night wakefulness and difficulty returning to sleep, did not have its label changed. We present a short summary of its basic science and clinical attributes in light of the recent regulatory changes for zolpidem products. Joseph V. Pergolizzi Jr., Robert Taylor Jr., Robert B. Raffa, Srinivas Nalamachu, and Maninder Chopra Copyright © 2014 Joseph V. Pergolizzi Jr. et al. All rights reserved. Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea Wed, 05 Feb 2014 09:27:00 +0000 Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA). Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males;  yrs; body mass index  kg/m2) with apnea-hypopnea index (AHI) events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (), income level (), and employment status () between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (, , and , resp.), as well as in Hispanics (, , , resp.). Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence. Montserrat Diaz-Abad, Wissam Chatila, Matthew R. Lammi, Irene Swift, Gilbert E. D’Alonzo, and Samuel L. Krachman Copyright © 2014 Montserrat Diaz-Abad et al. All rights reserved. Daytime Sleepiness: Associations with Alcohol Use and Sleep Duration in Americans Wed, 29 Jan 2014 00:00:00 +0000 The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES) 2007-2008 () using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use). A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58–0.95)], a decreased log drinking frequency [0.90 (95% CI, 0.83–0.98)], and lower sleep duration [OR = 0.75 (95% CI, 0.67–0.84)]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (). Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking. Subhajit Chakravorty, Nicholas Jackson, Ninad Chaudhary, Philip J. Kozak, Michael L. Perlis, Holly R. Shue, and Michael A. Grandner Copyright © 2014 Subhajit Chakravorty et al. All rights reserved.