The topic 'Emerging Talents in Sleep Disorders' is dedicated to highlighting students and early career researchers within the field of sleep disorders. They are bringing exciting new ideas to the field. However, many of these ideas are not communicated to a broader audience. We recognize that this is because many students and early career researchers may lack a platform to share their ideas. This topic gives an opportunity to succeed with their manuscripts.Chen Tien-Yu et al., reported the prevalence and effects of sleep-disordered breathing on middle-aged patients with sedative-free generalized anxiety disorder ( https://doi.org/10.3389/fpsyt.2022.1067437 ). Generalized anxiety disorder (GAD) and sleepdisordered breathing (SDB) share similar symptoms, such as poor sleep quality, irritability, and poor concentration during daily activities. This study investigates the proportion of undiagnosed SDB and its impacts on anxiety severity and autonomic function in newly diagnosed, sedativefree GAD patients. They found that an average age 55 years and mean BMI 23 kg/m2 patients with GAD and matched controls had an undiagnosed SDB prevalence of approximately 50%. Also noticed that SDB correlated with worsening anxiety severity and reduced cardiac autonomic function. Importantly, age and BMI were major risk factors for predicting undiagnosed SDB. Nakajima S et al described the transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders (https://doi.org/10.3389/fpsyt.2023.1114945). Comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. This study investigated whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders. In schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Their results suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders.Ding Q et al examined validation of a portable monitor compared with polysomnography for screening of obstructive sleep apnea in polio survivors (https://doi.org/10.3389/fneur.2023.1137535). Sleep-disordered breathing (SDB) is highly prevalent in polio survivors. Obstructive sleep apnea (OSA) is the most frequent type. Full polysomnography (PSG) is recommended for OSA diagnosis in patients with comorbidities by current practice guidelines, but it is not always accessible. They studied whether type 3 portable monitor (PM) or type 4 PM might be a viable alternative to PSG for the diagnosis of OSA in post-polio subjects. The insightful study showed Type 3 PM and Type 4 PM could be alternative ways to screen OSA for polio survivors, especially for moderate to severe OSA. Sun J et al reviewed Global research on cancer and sleep: a bibliometric and visual analysis of the last two decades (https://doi.org/10.3389/fneur.2023.1139746). This systemic review analyzed the research status, hotspots, and frontiers of global research on cancer and sleep through bibliometrics and provided references and guidance for future research. Cancer and sleep disruption and the influencing factors of sleep quality is an emerging topic. This study systematically analyzed the hotspots and frontiers in the field of cancer and sleep research. The authors named multiple foal topics for further research studies such as, intervention measures for the cancer symptom cluster, the bioavailability of exogenous melatonin, the relationship between OSA and cancer, the mechanism of tumor-induced sleep disruption, the dose-response relationship between sleep duration and cancer risk.Sleep problems are a growing public health concern worldwide. The 2023 Sleep in America poll conducted by the National Sleep Foundation showed that almost 65% of adults who are dissatisfied with their sleep have mild or severe depressive symptoms (1). The International Classification of Sleep Disorders by American Academy of Sleep Medicine lists 60 specific sleep disorders, the most common of which are insomnia, sleep apnea, restless legs syndrome, and narcolepsy (2).The close association between altered sleep pattern and diseases makes sleep a valuable diagnostic biomarker for non-invasive early diagnosis of some diseases. As sleep disorders increase with age and age is considered one of the major predictors of morbidity and mortality. Despite the diverse nature of sleep disorders, they have far-reaching, detrimental effects on population health and increase both morbidity and mortality of various chronic diseases (3). The chronic effects of sleep disorders deserve more attention from doctors, researchers, and society. As well as a better understanding of the mechanisms of sleep, new approaches to diagnose and treat sleep disorders are urgently needed. The editorial team thanks reviewers for their constructive criticism.
1266Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients
Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients
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6Sleep Problems in Parkinson's Disease.
In his famous monograph “An Essay in Shaking Palsy,” James Parkinson provided astute descriptions of impaired sleep in his case series of patients with Parkinson's disease (PD) two centuries ago. It is only three decades ago that sleep dysfunction started to attract attention of medical and scientific communities involved in the clinical care and research of PD. Tremendous advancements in our understanding of impaired sleep and alertness associated with PD have developed since then. Sleep problems are one of the major, challenging issues in patients with PD, affecting a significant number of patients. The etiology of sleep problems is multifactorial, including disease-related nocturnal symptoms, medication adverse effects, and primary sleep disorders including restless legs syndrome, rapid eye movement sleep behavior disorder, and sleep apnea syndrome. These causes of impaired sleep-wake cycles in the PD population often coexist or even overlap, rendering the management of sleep problems in PD patients difficult. Also, excessive daytime sleepiness is observed in a significant number of patients. In PD patients, therefore, appropriate assessment of disease-related nocturnal disturbances and primary sleep disorders is imperative. This special issue addresses unmet need for understanding PD-related sleep problems. PD sleep scale 2 (PDSS-2) is a recently developed tool for screening and managing sleep disturbance in PD patients, consisting of 15 items which are clinically relevant to nocturnal problems including nonmotor and motor problems in PD [1]. The original PDSS-2 (German and English) has been translated into several languages, including Japanese [2] and Italian [3]. The PDSS-2 has been used to observe treatment response. In a double-blind, placebo-controlled trial, including 287 PD patients, mean PDSS-2 total score decreased by −5.9 points with rotigotine and by −1.9 points with placebo [4]. In this special issue, K. Horvath et al. estimated the threshold representing minimal clinically important difference of the PDSS-2 total score: the study results showed −3.44 points for detecting improvement or the threshold of 2.07 points for observing worsening. This finding is important when planning studies using the PDSS-2 as outcome measures. Full-night polysomnography (PSG) is a gold standard for diagnosing sleep apnea syndrome; however, applying PSG is often difficult in patients with PD, who have severe parkinsonism or psychiatric comorbidity. P. Gros et al. evaluated the usefulness of unattended portable monitoring (PM) for diagnosis of obstructive sleep apnea (OSA) in patients with PD. Although discrepancy between portable monitoring and PSG was greater in PD patients with more motor dysfunction, the authors confirmed the usefulness of portable monitoring in diagnosing moderate to severe OSA in PD patients. These results provide the rationale for the use of portable sleep monitoring in PD and are very relevant for circumstances where a complete PSG in a sleep laboratory is not available and/or feasible. M. Kaminska et al. performed a review on the relationship between OSA and PD. Although the clinical significance of OSA in PD has been controversial [5, 6], the authors suggest the possibility that treatment of OSA could delay cognitive decline or motor dysfunction in patients with PD. This area of research is of high significance as it is important to assess the prevalence of OSA and the impact of its treatment in the PD population. D. Martinez-Ramirez et al. correlated PSG findings and sleep disorders with clinical characteristics in PD patients and found that sleep disorders and sleep architecture were poorly predictable by clinical characteristic of PD patients. This comprehensive study demonstrates the complexity of sleep dysfunction associated with PD and its complex associations with metrics of PD. In a fine and thoughtful study K. Suzuki et al. provided an interesting insight into the complex relationship between PD and restless legs syndrome (RLS) and leg motor restlessness (LMR). A significant relationship between RLS and PD is suggested by observing a favorable response to dopaminergic treatment in both disorders. However, RLS prevalence in PD patients varies according to different studies. Recently, LMR, characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported more frequently in patients untreated with PD than healthy controls. This review article may provide a new insight into the relationship between RLS, LMR, and PD. Finally, the complex and still only partially understood interaction of impulse control disorders in PD and sleep is discussed in a review from the clinic of one of the guest editors. In summary, sleep problems are common but underreported by PD patients and underdiagnosed by health professionals. Further understanding of mechanisms that underlie impaired sleep and alertness in PD will allow for development of much needed treatment approaches for this nonmotor manifestation of PD. Koichi Hirata Birgit Hogl Eng King Tan Aleksandar Videnovic
Read more79Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis
The purpose of this study is to conduct a systematic review and meta-analysis evaluating the effects of respiratory muscle therapy (ie, oropharyngeal exercises, speech therapy, breathing exercises, wind musical instruments) compared with control therapy or no treatment in improving apnea-hypopnea index ([AHI] primary outcome), sleepiness, and other polysomnographic outcomes for patients diagnosed with obstructive sleep apnea (OSA). Only randomized controlled trials with a placebo therapy or no treatment searched using PubMed, EMBASE, Cochrane, and Web of Science up to November 2018 were included, and assessment of risk of bias was completed using the Cochrane Handbook. Nine studies with 394 adults and children diagnosed with mild to severe OSA were included, all assessed at high risk of bias. Eight of the 9 studies measured AHI and showed a weighted average overall AHI improvement of 39.5% versus baselines after respiratory muscle therapy. Based on our meta-analyses in adult studies, respiratory muscle therapy yielded an improvement in AHI of -7.6 events/h (95% confidence interval [CI] = -11.7 to -3.5; P ≤ .001), apnea index of -4.2 events/h (95% CI = -7.7 to -0.8; P ≤ .016), Epworth Sleepiness Scale of -2.5 of 24 (95% CI= -5.1 to -0.1; P ≤ .066), Pittsburgh Sleep Quality Index of -1.3 of 21 (95% CI= -2.4 to -0.2; P ≤ .026), snoring frequency (P = .044) in intervention groups compared with controls. This systematic review highlights respiratory muscle therapy as an adjunct management for OSA but further studies are needed due to limitations including the nature and small number of studies, heterogeneity of the interventions, and high risk of bias with low quality of evidence.
Read more12Respiratory-Related Leg Movements of Sleep Are Associated With Serotonergic Antidepressants But Not Bupropion.
Respiratory-related leg movements (RRLMs) may contribute to the cardiovascular risk associated with obstructive sleep apnea (OSA). Selective serotonin reuptake inhibitors (SSRIs), but not bupropion, increase periodic leg movements in sleep. This study examines whether patients with OSA using SSRIs have more RRLMs than those taking bupropion or no antidepressant. Patients with an apnea-hypopnea index (AHI) of at least 10 events/h during a full-night diagnostic study or split-night study, who were taking bupropion (n = 32), an SSRI (n = 31), or no antidepressant (n = 31), were selected from a database of prestudy questionnaires. RRLMs were scored according to World Association of Sleep Medicine 2016 standards. Patients using SSRIs had significantly greater overall RRLM% (defined as the percentage of respiratory events associated with a leg movement, including apneas, hypopneas, and respiratory effort-related arousals), RRLM index, and periodic limb movement index relative to patients using bupropion and control patients. The difference between the RRLM% in the SSRI and bupropion groups was limited to patients undergoing split-night studies, and that of the SSRI and control groups was limited to patients undergoing full-night diagnostic studies. The greater number of RRLMs and PLMs in the SSRI group may contribute to treatment-emergent insomnia often seen with SSRI use. Fragmented sleep and elevated autonomic nervous system activation associated with increased RRLMs in patients with OSA taking SSRIs might also limit the tolerability of antidepressant treatment, as well as increase the risk for cardiovascular disease.
Read more48Relationship of Heart Rate Variability to Sleepiness in Patients with Obstructive Sleep Apnea with and without Heart Failure
Many patients with severe obstructive sleep apnea (OSA) do not complain of excessive daytime sleepiness (EDS), possibly due to increased sympathetic nervous activity (SNA) and accompanying heightened alertness. We hypothesized that in patients with OSA, those without subjective EDS (Epworth Sleepiness Scale, ESS score < 11) would have higher very low frequency (VLF) heart rate variability (HRV) during sleep, reflecting greater sympathetic heart rate modulation than patients with an ESS score ≥ 11. Patients with severe OSA (AHI ≥ 30: 26 with and 65 without heart failure) were divided into those with and without EDS. Heart rate (HR) signals were acquired in stage 2 sleep during periods of recurrent apneas and hypopneas and submitted to coarse graining spectral analysis, which extracts harmonic, neurally mediated contributions to HRV from total spectral power. Because the apnea-hyperpnea cycle entrains muscle SNA at VLF (0 to 0.04 Hz), VLF power was our principal between-group comparison. Subjects without EDS had higher harmonic VLF power (944 ± 839 vs 447 ± 461 msec(2), p = 0.003) than those with EDS, irrespective of the presence or absence of heart failure (1218 ± 944 vs 426 ± 299 msec(2), p = 0.043, and 1029 ± 873 vs 503 ± 533 msec(2), p = 0.003, respectively). ESS scores correlated inversely with VLF power in all (r = -0.294, p = 0.005) and in heart failure subjects (r = -0.468, p = 0.016). Patients with severe OSA but without EDS have higher VLF-HRV than those with EDS. This finding suggests that patients with severe OSA but without EDS have greater sympathetic modulation of HRV than those with EDS that may reflect elevated adrenergically mediated alertness. Taranto Montemurro L; Floras JS; Picton P; Kasai T; Alshaer H; Gabriel JM; Bradley TD. Relationship of heart rate variability to sleepiness in patients with obstructive sleep apnea with and without heart failure.
Read more3Pathogenesis and Rehabilitation Therapy of Sleep Disorder after Stroke
Sleep disorder after stroke are classified into sleep-disordered breathing (SDB), insomnia, excessive daytime sleepiness (EDS) and restless legs syndrome (RLS), which have a great impact on the prognosis of cognitive and motor functions and the quality of life of stroke patients. Rehabilitation treatment for sleep disorder in stroke patients should be initiated as early as possible. This study provides an overview of the pathogenesis and rehabilitation treatment of sleep disorder after stroke. The pathogenesis research of post-stroke sleep disorder mainly includes the pathogenesis of SDB [obstructive sleep apnea syndrome (OSAS), central sleep apnea syndrome (CSAS) and mixed sleep apnea syndrome (MSAS)], insomnia, EDS and RLS. Research on rehabilitation treatments for post-stroke sleep disorder mainly includes rehabilitation treatments for SDB [continuous positive airway pressure (CPAP), body positioning therapy, and oropharyngeal muscle training], insomnia [cognitive behavioral therapy (CBT), acupuncture, non-invasive transcranial neuromodulation techniques (low-frequency repetitive transcranial magnetic stimulation and transcranial direct current stimulation), and light therapy], EDS (CPAP and light therapy) and RLS (acupuncture). However, the pathogenesis of post-stroke sleep disorder is not yet fully clarified, and its basic research is still at the phenotypic determination stage. Issues such as treatment compliance, safety, and accuracy remain in rehabilitation treatment, and there is limited research on the rehabilitation of post-stroke EDS and RLS. Future explorations are needed on experimental animal models suitable for the basic research on post-stroke sleep disorder. In addition, more high-quality, large-sample, multicenter clinical randomized controlled trials are needed to provide references for the rehabilitation treatment of post-stroke sleep disorder.
Read more40Restless legs syndrome: Impact on sleep‐related breathing disorders
Restless legs syndrome (RLS) is a common chronic sensory-motor neurological disorder that remains a clinical diagnosis. Most RLS patients present with sleep complaints in the form of initiation and/or maintenance insomnia as RLS has a circadian rhythmicity. An increased number of periodic leg movements during sleep (PLMS) is a supportive criterion in the diagnosis of RLS. Abnormalities in the central dopaminergic and iron systems are involved in the physiopathology of RLS. There is a higher prevalence of RLS and PLMS in sleep-disordered breathing patients, particularly those with obstructive sleep apnoea (OSA), the most common sleep disorder in western societies. The complex mechanisms underlying the association between OSA, RLS and PLMS remain unclear. Untreated OSA can lead to adverse cardiovascular consequences due to cardio-metabolic dysfunction. It remains controversial whether RLS could further adversely impact the cardiovascular consequences of OSA. The PLMS do not have an additive effect on the hypersomnia experienced by some sleep-disordered breathing patients. Continuous positive airway pressure (CPAP) therapy is the most effective therapy for OSA. The presence of PLMS during CPAP treatment could be a marker of an incomplete resolution of sleep-disordered breathing in the form of increased upper airway resistance syndrome, despite treatment. Dopaminergic agonists are the preferred agent for the treatment of RLS, and are indicated when RLS symptoms are frequent and affect quality of life. PLMS and RLS do not seem to contribute to the residual hypersomnia that can be observed in some sleep-disordered breathing patients despite adequate compliance and effective CPAP therapy.
Read more2SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT
SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT
Sleep disorders in patients with medication-overuse headache
To analyze complaints about sleep disorders and assess the incidence of various sleep disorders, using relevant scales, in patients with medication-overuse headache (MOH) in comparison with patients without MOH. The prospective case-control study included 171 patients, aged 18 years and older, with MOH (main group), and173 patients with primary headaches without MOH (control group). A neurologist conducted an initial examination and professional interview before the start of treatment. To diagnose sleep disorders, the International Classification of Sleep Disorders (3rd edition, 2014) was used. Additionally, an assessment was made using the Insomnia Severity Index Scale, the Epworth Sleepiness Scale (ESS) and the Lausanne Obstructive Sleep Apnea Syndrome Scale (NoSAS). Statistically significant differences were revealed in the prevalence of the following complaints about sleep disorders in patients with MOH: lack of sleep (51.5%), frequent awakenings during sleep (43.3%), discomfort in legs before falling asleep or at rest in the evening (37.4%). Difficulties falling asleep occurred equally often in both patients with MOH (43.9%) and without MOH (37.0%), as well as daytime sleepiness (40.4% vs 36.4%) and the presence of snoring (13% of patients in each group). Patients with MOH were significantly more likely to suffer from chronic insomnia (60.2% and 47.4%, respectively, p=0.02; OR 1.7; 95% CI 1.1-2.6) and restless legs syndrome (37.4% and 22.0%, respectively, p=0.002; OR 2.1; 95% CI 1.3-3.4). The incidence of hypersomnia and obstructive sleep apnea syndrome did not have statistically significant differences. Patients with MOH compared to patients without MOH have a significantly higher incidence of main complaints of sleep disorders, chronic insomnia and restless legs syndrome, which indicates the importance of sleep disorders in the pathogenesis of medication-overuse headaches and requires timely diagnosis and treatment to prevent the progression of both headaches and sleep disorders.
Read more34Differences and associations between nocturnal voiding/nocturia and sleep disorders
To determine the differences and associations between nocturnal voiding (NV)/nocturia and sleep disorders. Using an epidemiological survey, we compared residents with non-bothersome NV (NNV) and bothersome NV (BNV) to those with sleep disorders, including insomnia, obstructive sleep apnoea syndrome (OSAS), restless leg syndrome (RLS), and periodic limb movement disorder (PLMD), for patient background, lower urinary tract symptoms (LUTS), sleep status, and general health-related quality of life (HRQL). Furthermore, we investigated associations between BNV and sleep disorders using multivariate analyses. In all 2271 (38%) answers were available, of which 729 (32%), 966 (43%) and 546 (24%) subjects had no NV, NNV and BNV, respectively, and 348 (15%), 52 (2%), 172 (8%) and 62 (3%) were determined as having insomnia, OSAS, RLS and PLMD, respectively. For LUTS, subjects with BNV were significantly worse than those with OSAS, but better than those with RLS and PLMD. Total sleep status in the BNV group was better than that in the insomnia group, but worse than that in the OSAS and RLS groups. General HRQL in the BNV group was worse than that in the OSAS group, and better than that in the RLS and PLMD groups for physical aspects. In mental aspects, subjects with BNV were better than those with insomnia. Insomnia and OSAS had a close correlation with NNV/BNV (P < 0.001-0.022), and PLMD had a significant correlation with BNV (P = 0.031). However, RLS was not associated with NV (P = 0.42) nor with BNV (P = 0.09). NV/nocturia is closely related to sleep disorders, but obviously different from them in several aspects.
Read more32Sleep time and efficiency in patients undergoing laboratory-based polysomnography.
Sleep quality in patients studied with laboratory-based polysomnography may differ from sleep quality in patients studied at home but remains clinically relevant and important to describe. We assessed objective sleep quality and explored factors associated with poor sleep in patients undergoing laboratory-based polysomnography. We reviewed diagnostic polysomnography studies from a 10-year period at a single sleep center. Total sleep time (TST) and sleep efficiency (SE) were assessed as markers of sleep quality. Poor sleep was defined as TST ≤ 4 hours or SE ≤ 50%. Multivariable analysis was performed to determine associations between objective sleep quality as an outcome and multiple candidate predictors including age, sex, race, body mass index, comorbidities, severity of obstructive sleep apnea, and central nervous system medications. Among 4957 patients (age 53 ± 15 years), average TST and median SE were 5.8 hours and 79%, respectively. There were 556 (11%) and 406 (8%) patients who had poor sleep based on TST and SE, respectively. In multivariable analysis, those who were older (per 10 years: 1.48 [1.34, 1.63]), male (1.38 [1.14,1.68]), and had severe obstructive sleep apnea (1.76 [1.28, 2.43]) were more likely to have short sleep. Antidepressant use was associated with lower odds of short sleep (0.77 [0.59,1.00]). Older age (per 10 years: 1.48 [1.34, 1.62]), male sex (1.34 [1.07,1.68]), and severe obstructive sleep apnea (2.16 [1.47, 3.21]) were associated with higher odds of poor SE. We describe TST and SE from a single sleep center cohort. Multiple demographic characteristics were associated with poor objective sleep in patients during laboratory-based polysomnography. Harrison EI, Roth RH, Lobo JM, et al. Sleep time and efficiency in patients undergoing laboratory-based polysomnography. J Clin Sleep Med. 2021;17(8):1591-1598.
Read more141Obstructive sleep apnea is associated with fatigue in multiple sclerosis
Background: Multiple sclerosis (MS) patients often suffer from fatigue. Objective: We evaluated the relationship of obstructive sleep apnea (OSA) to fatigue and sleepiness in MS patients. Methods: Ambulatory MS patients without known sleep disorders and healthy controls underwent diagnostic polysomnography and a multiple sleep latency test (objective sleepiness measure). Fatigue was measured with the Fatigue Severity Scale (FSS) and the Multidimensional Fatigue Inventory (MFI), and subjective sleepiness by Epworth Sleepiness Scale. Covariates included age, sex, body mass index, Expanded Disability Status Scale (EDSS), depression, pain, nocturia, restless legs syndrome, and medication. Results: OSA (apnea–hypopnea index ≥15) was found in 36 of 62 MS subjects and 15 of 32 controls. After adjusting for confounders, severe fatigue (FSS ≥5) and MFI-mental fatigue (>group median) were associated with OSA and respiratory-related arousals in MS, but not control subjects. Subjective and objective sleepiness were not related to OSA in either group. In a multivariate model, variables independently associated with severe fatigue in MS were severe OSA [OR 17.33, 95% CI 2.53–199.84], EDSS [OR 1.88, 95% CI 1.21–3.25], and immunomodulating treatment [OR 0.14, 95% CI 0.023–0.65]. Conclusions: OSA was frequent in MS and was associated with fatigue but not sleepiness, independent of MS-related disability and other covariates.
Read more35Stridor combined with other sleep breathing disorders in multiple system atrophy: a tailored treatment?
Stridor combined with other sleep breathing disorders in multiple system atrophy: a tailored treatment?
23Treatment of Obstructive Sleep Apnea Syndrome with Nasal Positive Airway Pressure Improves Golf Performance
Obstructive sleep apnea syndrome (OSAS) is associated with impairment of cognitive function, and improvement is often noted with treatment. Golf is a sport that requires a range of cognitive skills. We evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS. Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). Twelve subjects with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry. After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated. The control subjects demonstrated no significant change in HI, ESS, or SQ during this study, while the OSAS group demonstrated a significant drop in average HI (11.3%, p = 0.01), ESS, (p = 0.01), and SQ (p = 0.003). Among the more skilled golfers (defined as HI ≤ 12), the average HI dropped by an even greater degree (31.5%). Average utilization of PAP was 91.4% based on data card reporting. Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence.
Read more0955 Correlation Between CPAP Use and Symptoms of Depression, Anxiety, and Sleepiness in Patients with OSA
Introduction Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder associated with poor health outcomes, including sleepiness, anxiety, and depression. This study aimed to further explore this relationship by looking at outcomes after treatment of OSA with continuous positive airway pressure (CPAP) therapy, using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and Epworth Sleepiness Scale (ESS) questionnaires respectively. Methods An observational longitudinal study in which the PHQ-9, GAD7, and ESS questionnaires were administered to adult patients diagnosed with OSA during the initial consultation and after three months of CPAP use. All patients had a diagnosis of OSA by a sleep study. Data collected included demographics, PSG data, and questionnaire results. Patients without follow-up or incomplete data were not included. Results One hundred patients were initially recruited. Thirty-five patients have completed data after three months. The mean±SD age was 50.9±15.4, BMI 36.5±8.9, 54% male and 46% female. Women were older 61.1±14 than men 46.5±14.9, p&lt; 0.001. The percent of CPAP adherence was 68.7±36.7, and hours used per day were 5.5±1.8. The PHQ-9 initially was 10.4±5.6 decreased to 5.32±5.3 p&lt; 0.001. GAD-7 initially 6.4±6.2 decreased to 4.29±4.8 p&lt; 0.001, ESS initially 11.1±5.5 decreased to 5.8±4.3 p&lt; 0.001. Neither age, BMI, or AHI correlated with compliance or hours used. The strongest negative correlation was between post-treatment GAD-7 and compliance (r= -0.45), followed by a mild negative correlation between PHQ-9 and compliance (r = -0.345). A mild positive correlation existed between the initial ESS and the AHI (r = 0.288). There were no statistical differences in questionnaire results between men and women. Conclusion The study demonstrates that daytime symptoms of sleepiness, depression, and anxiety improved in a cohort of patients with OSA and CPAP. The post-CPAP GAD-7 was moderately and negatively correlated with CPAP compliance percent use, while PHQ-9 was mildly negatively correlated. Initial ESS was mildly correlated with AHI, and although it improved, it was not correlated with compliance. Support (if any)
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