We diagnosed migraine using a questionnaire. The ques- tionnaire established a headache profile which was de- signed to align with the second edition of the International Classification of Headache Disorders (ICHD-2) . We investigated the severity of headache based on its effects on daily activity (mild, moderate, or severe) and using a visual analogue scale (VAS). Further- more, we surveyed the headache frequency as following question. “How many days do you experience the head- ache every month?” Migraine was diagnosed based on the ICHD-2 criteria for migraine without aura (code 1.1) . We did not attempt to separately diagnose mi- graine with and without aura. As such, both were in- cluded in the present study. The questions used to diagnose migraine have 75.0 % sensitivity and 88.2 % specificity, verified by comparing the diagnoses from the survey with those of doctors obtained from an additional telephone interview. This validation process has been previously described in detail .
In our study, place of residence, Sudanese ethnicity and obesity were associated with EDS in hypertensive subjects. In the series of Stater et al. including 173 apneic and non- apneic patients recruited from a London sleep study center, obesity was associated with EDS regardless of other sleep disorders and hypertension . After adjusting for confounding factors, our obese subjects were 63% more likely to have EDS compared to subjects with normal BMI. This risk was 175% in the study including 411 hypertensive subjects recruited from a hospital center in Douala, Cameroon . Other studies have also reported an association between obesity and EDS [9, 26].
Methods: This cross-sectional study conducted among medical students in the Medical College, University of Tabuk, Saudi Arabia during the period from February to May 2017. Two hundred and seventy-seven medical students were invited to sign a written informed consent then responded to a structured questionnaire based on the Epworth Sleepiness Scale, demographic factors, Technology use, Cumulative Academic Grade (GPA), coffee consumption and sleeping pill use. The Chi-square and t-test were used to compare the students with excessivedaytimesleepiness and those without the disorder and test the associated factors. The ethical committee of the Medical College approved the research. Results: They were 277 medical students (men 49.5%), mean age (21.78±1.59) years, excessivedaytimesleepiness was evident in 52.3% of students, the average technology use/day was 5.25± 2.84 hours, the coffee intake was 1.98±1.36 cups/day, while 14.3% were using sleeping pills. No significant statistical associations were evident between the daytime
Diabetes mellitus is a major public health problem, causing significant morbidity and mortality. Across different populations, several studies have found sleep disturbances in patients with diabetes mellitus in relation with their quality of life. However, the relationship between sleep disorders and diabetes mellitus is less understood and less studied.The current study is a study using the Epworth sleepiness scale (ESS) and Pittsburgh sleep quality index (PSQI) to examine the sleep quality and excessive day-time sleepiness (EDS) in the diabetic population. Recent literature suggests that it may also be associated with the metabolic syndrome, for example: obesity, diabetes, insulin resistance. Even in the present study, the data revealed that there is a strong association between EDS and diabetes. This finding suggests that diabetes should be considered whenever a complaint of EDS is present in individuals . 71-73
When considering the mechanistic pathways which may drive an association between sleepiness and falls, it is feasible to assume that diurnal disruptions characteristic of the aging process, such as a reduction in total sleep time, reduced sleep efficiency and increased sleep fragmentation may contribute to impairments in behavioural and cognitive functions similarly implicated in falls . Coupled with increased rates of polypharmacy often observed among these age groups, it is also likely that these factors interact to contribute to and compound impaired levels of cognition; which is directly associated with increased falls occurrence and future falls risk. Indeed, reduced executive function capabilities, which can be impaired as a result of sleepiness  and often are associated with increased or excessive poly-medication use (such as sedatives, painkillers, cardiac medications etc.) ; have also been shown to contribute to falls among older men and women , and measures of these variables have demonstrated efficacy in predicting later falls . Differences in mechanistic properties driving an association between EDS and falls between men and women may, in part, be due to differing sex-specific characteristic sleep and medical profiles. Among men, it is possible that both indirect (weight, neck circumference,
unusually high sleep efficacy and/or reports about 2 hours more sleep on each weekend day than each weekday, chronic sleep restriction is suspected . Sleeping with the CPAP more hours will presumably result in improvements of sleepiness. According to the 2010 Nippon Hoso Kyokai (NHK) Japanese Time Use Survey , average sleep time per day in adult employed Japanese were 6 hours 55 minutes on weekdays, 7 hours 29 minutes on Saturday, and 7 hours 51 minutes on Sunday. Consequently, each day of the week marked the shortest sleeping hours since 1970. In a cross-sectional self-administered questionnaire survey , the 1-month point prevalence of poor sleep quality in Japanese white-collar daytime employees was significantly higher than in the general population of Japanese adults. Most of the OSAS patients treated by CPAP are daytime employee. The present study esti- mated 19.4% of the OSAS patients with EDS showed actual sleep time to be less than 5 hours/day. This dura- tion might be equivalent to that of subjects with behave- ioral induced insufficient sleep syndrome in ICSD-2 . For behavioral induced insufficient sleep patients, regu- larizing bedtime and increasing time in bed produces a resolution of their symptoms, but no other manipulations help significantly [7,20].
headaches are poorly understood, thus, further research is warranted . Studies suggest that CEH can be explained by local factors in the neck with dysfunction of the neck muscles and mechanical cervical spine pathology leading to limited cervical movements and projection of the pain . Headaches attributed to head trauma and whiplash trauma have instead been sug- gested to represent an interplay between the physical in- jury, neuroinflammation, psychological disturbances and emotional stress of the accident [25, 26]. Finally, long- standing oedema of the nasal mucosa and rhinosinal in- flammation result in chronic rhinosinusitis which may give chronic headache . The present study reported that CPTH/CEH and HACRS had similar prevalence of EDS despite these different headache forms probably be- ing caused by different pathophysiological mechanisms. Therefore, it may be the complex burden of pain, more than the specific condition that is associated with EDS. Furthermore, the prevalence was comparable to that of two other different headache entities; chronic migraine and chronic tension-type headache .
Methods: The study was a postal survey of a random age and gender-stratified sample of 40,000 persons aged 20 to 80 years old drawn by the National Population Register in Norway. The questionnaire included questions about migraine, headache, the Epworth sleepiness scale (ESS) and various comorbidities. EDS was defined as ESS > 10. The association of EDS and migraine/headache were analysed by bivariate and multivariable logistic regression analyses. Results: A total of 21,177 persons responded to the ESS and were included in the analyses. The odds ratio (OR) for EDS was increased for migraineurs (1.42 (95% CI 1.31 ─ 1.54), p < 0.001) compared to non-migraineurs; however, this finding was not significant after adjustment for a number of possible confounders. EDS increased with increasing headache frequency, with an OR of 2.74 (95% CI 2.05 ─ 3.65), p < 0.001) for those with headache on >179 days per year compared to those without headache in multivariable analysis.
Narcolepsy is a chronic neurological disorder specifying the abnormal sleep manifestations which mainly impact the quality of life of narcolepsy patients. The exact cause is unclear but found significant evidences that orexin/hypocretin deficiency causes narcolepsy which regulates sleep. Treatment focuses on symptomatic relief throughout medication, education, and behavioral therapy. Stimulants are the first line treatment for the excessivedaytimesleepiness. Modafinil, sodium oxybate, amphetamine, methylphenidate, and selegiline are effectual treatments for somnolence associated with narcolepsy. Tricyclic antidepressants and SSRIs are one of the best treatments for cataplexy, sleep paralysis, and hypnagogic hallucinations. Benzodiazepines are the best regimen for disturbed nocturnal sleep.
This may suggest that some of the psycho- physiological consequences of OSA do not reflect a general psychological and mood effect but rather the specific consequences of sleepiness and impaired alertness. This could suggest that the sleepiness reported by OSA patients translates both the inability to stay awake, as measured by sleepiness questionnaires, as well as a subjective feeling of "loss of energy" . In addition, the impairment of quality of life among OSA is correlated with cognitive impairments and increased risk for depression and anxiety, it also correlated with AHI, minimum Sao2% and disturbed sleep architecture. However, the pathways producing alterations in behavioral outcomes are complex and may involve both chronic and acute insults acting on cerebral structure or function . Experimental evidence suggests that mild to moderate hypoxia can reduce turnover of acetylcholine , potentially producing global and diffuse cortical slowing. In more severe hypoxemia, loci of cerebral anoxic damage could be produced. One speculative mechanism involves both sleep fragmentation and hypoxemia acting synergistically to produce irreversible neuronal damage. Such cerebral damage in OSA might be mediated by abnormalities in ventilatory drive, potentiated by sleep disruption, leading to alterations to intracranial haemodynamic. These path physiological changes might potentially act in a positive feedback loop to produce cerebral ischemia, an agent of irreversible damage to neuronal structure and function.
Participants with SDB and/or those with notice- able sleep apnoea-related symptoms were invited to the second part of the study, in which they saw sleep specialists (RS, TaT) for a diagnosis and underwent CPAP, using a DreamStar Auto (Sefam Healthc’Air, Nancy, France) for at least 1 month. After 3–6 weeks, their conditions were assessed, using the type 3 sleep monitor, as well as ESS and SF-8. CPAP prescription was made by a sleep specialist (SR), who took both the data in the present study and sleep-related symptoms and other clinical information into consideration. In some participants, despite their overall RDI being lower than 5, they were witnessed to have severe sleep-related symptoms, such as heavy snoring, disrupted breathing, EDS, morning headache and polyuria, together with hypertension, 21 or high RDI values linked to certain
lence of sleep apnea in this sample was found to be higher in males, which is consistent with the literature (Table 1). The prevalence of sleep apnea was not found to be higher in older patients, which is unusual per the literature. Being in the younger age range was found to be a predictor of OSA (Table 3). Despite having a low odds ratio (OR), this finding was still significant. This underscores the importance of not overlooking OSA symptoms and their risks in the young psychiatric patient population. This could also be explained by the small sample size when compared to larger general population studies. The prevalence of OSA in this study, was found to be higher than available prevalence data from our region regarding OSA which showed a prevalence ranging up to 21% in special populations, such as end-stage renal failure patients. 8,9,28 The high prevalence in this study, may be due to
A repeat overnight PSG was completed at five years three months of age due to ongoing concerns of EDS and cataplectic episodes. The goals for treatment were to optimize school performance and ensure our pa- tient’s safety. At that time, episodes of cataplexy were still occurring, mainly in the mornings upon awaken- ing. The results of the second PSG study (Table 1) were abnormal and suggestive of narcolepsy. Spikes were noted on electroencephalography without any seizure activity and a shortened REM sleep latency was observed. The overall degree of SDB was improved compared to the previous measurement. Abnormal respiratory events were limited to one obstructive apnea and two obstructive hypopneas with an AHI of 0.4 events per hour. The average EtCO 2 was
control children demonstrated differences between them that were consistently statistically significant, with the worse scores of the narcolepsy group covering many aspects of behavior, emotional state, quality of life, ed- ucational progress, and impact on the children’s families. There have been several essentially anecdotal or im- pressionistic accounts suggesting that children with nar- colepsy are particularly subject to psychosocial problems. However, apparently the only published investigation comparable to the present study, in using standardized measures (although narrower in scope), was confined to 18 cases of children with onset of narcolepsy symptoms before 14 years of age. 14 The study was published in
polygraph (SomnoStarPro; VIASYS, Yorba Linda, CA, USA), and the PSG records were evaluated by clinical technologists who were certified by the Japanese Society of Sleep Research and blinded to the patients’ clinical status. The scoring of sleep stages, arousals, and respira- tory events was done manually from the PSG records according to the 1999 recommendations of the American Academy of Sleep Medicine Task Force . SDB was defined as an apnea-hypopnea index (AHI) of 5 or more apnea or hypopnea episodes/h, and severe SDB was defined as an AHI of 30 or more apnea or hypopnea episodes/h. The periodic leg movement (PLM) index was calculated on the basis of the number of PLMs/h in sleep. A PLM index greater than 15 was defined as an abnormal PLMS according to Version 2 of the Inter- national Classification of Sleep Disorders. The PLM arousal index was defined as the number of PLM-related electroencephalographic arousals/h of sleep. RLS was diagnosed when patients met the 4 minimal criteria of the syndrome as defined by an international study group . In the event of an inability to fall asleep, subjects were administered a nonbenzodiazepine sedative/hypnotic (zolpidem, 5 mg) at the beginning of polysomnography. The calculation of the L-3,4-dihydroxyphenylalanine (L-dopa)-equivalent dose (LED) was based on its the- oretical equivalence to L-dopa, as described in previ- ous reports [23-25] as follows: 100 mg L-dopa with dopa-decarboxylase inhibitor = 1 mg pergolide = 1.5 mg of cabergoline = 1 mg of pramipexole. Fiberoptic laryn- goscopy was performed during wakefulness as well as under sedation by intravenously injecting propofol .
Based on her sleep habits, and the sleep study findings, she also has DSPS, the most common type of circadian rhythm sleep disorder seen in adoles- cents. This is characterized by sleep and wake times that are later than desired, often resulting in daytimesleepiness when conventional waking times are enforced. 4
Background: Perceived Health Related Quality of Life (HRQoL) is impaired in obstructive sleep apnea (OSA). This study examines changes in HRQoL aspects occurring immediately after CPAP titration. Furthermore, we analyzed variations in each gender and in patients undergoing home or laboratory-based CPAP titration pathways. Methods: Twohundredfive outpatients (151 M) (56.7 ± 10.3 years) were evaluated, before first visit and nocturnal diagnostic examination (T0), and the morning after CPAP titration (T1). Two self-reported HRQoL questionnaires were administered: Psychological General Well-Being Index (PGWBI), composed by six subscales, and 12-Item Short- Form Health Survey (SF-12), including Physical (PCS) and Mental Component Summaries (MCS). CPAP titration was performed using auto-adjusting CPAP units at patients ’ home or in the sleep laboratory.
Methods: Five hundred and seventy-nine children aged 3–6 years were randomly recruited from 15 kindergartens in the city of Qazvin in Iran. The Iranian version of BEARS (Bedtime problems, Excessivedaytimesleepiness, Awakenings during the night, Regularity and duration of sleep and Snoring) and the Children’s Sleep Habits questionnaire (CSHQ) were completed by interviewers. Data analysis was performed using SPSS version 19. The data were analysed with a Student’s t-test, chi-square and Fisher’s exact tests. A P value < 0.05 was considered significant.
We have done a descriptive study using data obtained from two Spanish National Health Surveys (NHS) correspond- ing to years 2006 and 2011/2012 and one European Health Interview Surveys for Spain (EHSS) for year 2014. These surveys are designed to obtain representative data of the Spanish population aged $15 years and noninstitutionalized. Interviewers go the households and conduct face-to-face interviews. Collection periods were June 2006–June 2007 for the NHS 2006, July 2011–June 2012 for NHS 2011/2012, and January–December 2014 for the EHSS 2014. More detailed methods are describe elsewhere. 8,9 We selected participants
The results of our study have a number of clinical implications that must be addressed. First, they suggest that health care providers should screen hypertensive patients for sleep-related disorders, particularly EDS. One such screening tool is the Epworth Sleepiness Scale, which is a relatively easy survey that can be self-administered. Other validated self-administered tools are available as well. If necessary, health care providers should organize referral for a sleep study to ascertain the presence of obstructive sleep apnea, a well known independent risk factor for hypertension. 17–19 In