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Can We Use Home Sleep Testing for the Evaluation of Sleep Apnea in Obese Pregnant Women?
Objective. To evaluate the performance of a type III home sleep testing (HST) monitor including its autoscoring algorithm, in a population of obese pregnant women. Methods. This was an ancillary study of an ongoing prospective study of obese (BMI of ≥30) pregnant women. For the primary study, women undergo serial in-lab polysomnograms (PSG) during pregnancy. Sleep apnea was defined as an apnea hypopnea index (AHI) of ≥ 5 events/hour. A subgroup of women were asked to wear an ApneaLink HST device for 1 night, within 2 weeks of a late pregnancy PSG (≥ 28 weeks’ gestation). The AHI obtained from PSG was compared to the AHI from the HST via autoscoring (HST-auto) as well as the AHI via technician scoring (HST-tech). We calculated Shrout Fleiss Fixed correlation coefficients (ICC) and looked at positive-positive and negative-negative agreement. Results. 43 women were recruited and we obtained 30 valid HST. The mean PSH AHI was 3.3 (±3.2, range 0.5-16.6). Six (20%) women had a positive PSG study. ICCs were 0.78 for HST-auto versus HST-tech, 0.76 for HST-auto versus PSG, and 0.70 for HST-tech versus PSG. Categorical agreement was also strong, with 24/30 (80.0%) for HST-auto versus HST-tech, 25/30 (83.3%) for HST-auto versus PSG, and 23/30 (76.7%) for HST-tech versus PSG. Conclusion. In obese women evaluated in late pregnancy, we found relatively high intraclass correlation and categorical agreement among HST-auto scores, HST-tech scores, and in-lab PSG results obtained within a two-week window. These results suggest that HST may be used to screen pregnant women for OSA.
Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus
Aims. Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA. Methods. Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing. Results. Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity. Conclusions. This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of “Neck grasp as a predictor of Sleep Apnea,” https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.
Evaluation of Sleep Patterns and Self-Reported Academic Performance among Medical Students at the University of Ghana School of Medicine and Dentistry
Background. Sleep habits and problems play a vital role in determining sleep quality. We describe sleep habits and problems among medical students and assess their possible effect on self-reported academic performance. Methods. We conducted a cross-sectional study among medical students at the University of Ghana during the 2014/2015 academic year. Data was collected using the Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire that assesses sleep quality over a 1-month time interval. Results. 153 medical students were recruited comprising 83 (54.2%) females and 70 (45.8%) males with a mean age of 23.1 ± 2.4 years. The mean duration of night sleep was 5.7 ± 1.2 hours; 88 (57.5%) students had sleep latency of 10-30 minutes while 18 (11.8%) woke up nightly. 23 (15%) students experienced nightmares, 13 (8.5%) snored at night, and only one student reported coffee intake of 2-3 times daily. Sleep quality was poor in 86 (56.2%) and was significantly associated with sleep latency, morning tiredness, daytime sleepiness during lectures, academic performance, living conditions, leisure time, frequency of nocturnal awakenings, waking up due to noise, sleep walking, and nocturnal awakening to use washroom. There was also a significant positive relation between sleep quality and academic performance (X2 = 10.004 p = 0.019). Conclusion. Poor sleep quality and daytime dysfunction are widespread among medical students in Ghana. There was a significant positive relation between sleep quality and self-reported academic performance.
Insomnia among Town Residents in Ethiopia: A Community-Based Cross-Sectional Survey
Background. Insomnia is one of the most common sleep problems throughout the world and a major public health concern among adults in the general population. The aim of this study was to assess the prevalence of insomnia and its associated factors among town adult residents in Ethiopia. Methods. Community-based cross-sectional study was done among 840 randomly selected adult participants by using standardized and pretested Athens insomnia scale (AIS) to assess insomnia. Systematic random sampling technique was used to get samples of the study participants. Data were entered into Epi-Info and analyzed using SPSS version 20. Descriptive, bivariate, and multivariate logistic regression models were used for analysis. Adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was used to show the odds, and P value < 0.05 was considered as statistically significant. Results. The prevalence of insomnia was found to be 42.9%. Sleep problems were associated with female sex [AOR =2.74, 95% CI; (1.77, 4.24)], age above 48 years [AOR=4.67, 95% CI: (2.32, 9.40)], being single [AOR=2.81, 95% CI (1.59, 4.95)] and widowed [AOR=4.20, 95% CI; (1.60, 11.01)], khat chewing [AOR=1.76,95% CI; (1.19, 2.60)], current tobacco smoking [AOR=3.13, 95% CI; (1.64, 5.95)], caffeinated beverage use [AOR=1.67, 95% CI; (1.12, 2.49)], comorbid medical-surgical disorders [AOR=2.03, 95% CI; (1.18, 3.48)], common mental disorders [AOR=8.92, 95% CI; (5.93,13.44)], and noise at bed time [AOR=2.13 95% CI; (1.20, 3.78)]. Conclusion. The prevalence of insomnia has to be found high and associated with many area related factors. It is important to pay attention in urban settings and large scale studies recommended.
Determinants of Insomnia among Mothers during Postpartum Period in Northwest Ethiopia
Objective. Postpartum period is a state of instability that may be accompanied by mood liability, anxiety, insomnia, and neuropsychiatric disturbance in women. This neuropsychiatric disturbance has a negative influence on the child’s psychological and physical development. Our aim was to see the level of sleep difficulties among postpartum mothers in three obstetric care settings in Ethiopia. Method. Institutional based cross-sectional study was conducted at one referral hospital and two health centers. A total of 988 postpartum mothers had been interviewed for sleep difficulties by using Athens Insomnia Scale (AIS). Adjusted Odd Ratio (AOR) and 95% Confidence Interval (CI) were used and P-value <0.05 was used for indicating significant variables. Result. The prevalence of sleep difficulty between four to six weeks of postpartum period was 21.8% (215/988). Marital status of divorced/widowed/separated [AOR= 2.29, 95% CI (1.40, 6.08)], no educational opportunity [AOR= 2.35, 95% CI (1.57, 3.51)], having poor social support [AOR=2.82, 95% CI (1.63, 4.88)], alcohol use [AOR=1.58, 95% CI (1.13, 2.22)], history of depression [AOR=1.93, 95% CI (1.13, 3.31)], and who has poor support from husband [AOR=1.94, 95% CI (1.18, 3.18)] had association with sleep difficulty. Conclusion. There is a high magnitude of sleep difficulties during four to six weeks of postpartum period in postpartum mothers and they are associated with many preventable risk factors.
Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration
Objectives. To compare interfaces performance during home-based automatic titration (APAP). Methods. Retrospective study based on APAP titration from Obstructive Sleep Apnea Syndrome (OSA) patients. Results. 707 patients, 513 men (70.6%), were titrated. Masks were 104 pillows (14.7%), group I (GI); 532 nasal (75.2%), group II (GII); and 71 oronasal masks (10%), group III (GIII). We found differences in effective pressure to the device (P90/P95) (GI: 7.13±1.9 vs. GII: 8.3±2.1 vs. GIII: 9.3±2.6 cmH2O, p <0.001) but not in final pressure titrated manually (GI: 7.9±1.4 vs. GII: 8.6±1.6 vs. GIII: 9.2±1.9 cm of H2O, p >0.5), where lower residual AHI for pillows was p <0.001 and leaks for nasal were p <0.001. No differences were found in compliance (hours) (GI: 6.3±1.2 vs. GII: 6.2±1.1 vs. GIII: 6.1±1.0, p <0.4). Conclusion. During auto-adjusting titration by CPAP-naïve patients, nasal masks had lower leak rates and nasal pillows presented a similar performance.