The authors acknowledge some limitations of this study. The reliance on the self-reported questionnaire in data collection made our data more subjective. The number of women enrolled in our sample was higher than men; this is due to the high proportion of women in our faculty. Also, in order to reduce the duration of the interview and maintain a high response rate, we did not include questions regarding socioeconomic dimension of students and the existence of specific sleep disorder as obstructive sleep apnea or periodic limb movement in our survey. Larger multicenter and lon- gitudinal studies are needed to examine the causes of sleep disorders and to implement preventive measures to enhance the university students’ academicperformance.
a self-administered questionnaire with 8 questions. Respondents are asked to rate, on a 4-point scale (0-3), their usual chances of dozing off or falling asleep while engaged in eight different activities. The ESS score (the sum of 8 item scores, 0-3) can range from 0 to 24. The higher the ESS score, the higher that person’s average sleep propensity in daily life (ASP), or their ‘daytimesleepiness’. The reference range of ‘normal’ ESS scores is zero to 10. That is the same as the range defined by the 2.5 and 97.5 percentiles. While ESS scores of 11-24 represent increasing levels of ‘excessivedaytimesleepiness’ (EDS)  . A total of 157 students returned
A questionnaire was designed based on previously pub- lished survey instruments to assess demographics, sleep/ wake schedule, sleep habits, self-perceived sleep, sleep complaints, caffeine intake, smoking, and time allocated for daily activities and habits [4,7-9]. Caffeine intake was measured in drinks per day (8 oz. serving of coffee, espresso, tea, soft drinks, hot chocolate, or 1.5 oz. of chocolate). In addition, the students recorded their em- ployment time outside of school. Daytimesleepiness was evaluated using the Epworth Sleepiness Scale (ESS) . The ESS is a standardized validated questionnaire that assesses the likelihood that the subject will fall asleep during certain activities . It consists of eight items describing different situations and activities of daily liv- ing. ESS scores range from 0–24, and based on previous studies, the upper limit of a normal score is estimated to be 10 . ESS scores >10 indicate increased daytimesleepiness. Sleep/wake patterns were assessed using sleep diaries. A sleep diary is a daily log that is used to record sleep-wake pattern of individuals. Students were asked to fill out the diary each morning when they wake up, each night when they go to bed or when they nap. They were instructed to keep the diary beside their beds in order not to forget filling it. A two-week diary was com- pleted each morning and evening by students to get esti- mates of bedtime, wake-up time and nap-time.
Nearly 16% of the students in our sample classified their sleepquality bad, however Corrêa et al found that 40% of the study subjects reported their life. 26 Poorsleepquality is associated with excessivedaytimesleepiness. 27,28 In the present study, daytime dysfunction was reported by 70% of the participants, who had difficulty staying awake during the day at least once a week. This is consistent with the literature, although there are variations across studies in the proportion of medicalstudents reporting daytimesleepiness: 31%; 42.1% ; and 63%. 27,29,30 Therefore, medicalstudents experienced greater deleterious effects on subjective sleepquality and daytime dysfunction than non-medicalstudents. This can be explained by the fact that attending a medical course requires a high level of dedication and selflessness, signifying harmful lifestyle changes, such as sleep deprivation and poorsleep hygiene habits. 31-34
In PSQI-J component scores in the present study, overall sleepquality (C1), duration of sleep (C3), sleep disturbance (C5), and day dysfunction due to sleepiness (C7) were significantly higher in the EDS(+) group than in the EDS(–) group. It was obvious that day dysfunction due to sleepiness (C7) were more severe in the patients with EDS compared to those without EDS. It was sug- gested that EDS was associated with low subjective sleepquality, short sleep duration and more sleep disturbed in the patients of EDS(+) group. EDS in OSAS is not al- ways caused by sleep apnea alone, although causative relations should further be evaluated. It should be pointed out that sleepiness is a common symptom in the general population, and often results from sleep deprivation. This type of sleepiness will not improve with CPAP if they do not have sleep disorders breathing. EDS in OSAS under good CPAP compliance may be caused clinically, by 1) development of new conditions associated with OSAS/ CPAP, such as increase in weight, rhinitis or other medical illness; or 2) an undiagnosed associated condition such as poorsleep hygiene, treatment with sedating drugs, de- pression, or other sleep disorders; or 3) loss of placebo (honeymoon) effect revealing the conditions not previ- ously diagnosed . It was suggested that the subjective sleep evaluation, chiefly EDS, in the OSAS patients under CPAP treatment may have involved many factors sur- rounding the sleep habits, chiefly behaviorally induced insufficient sleep.
EDS is found to be associated with increased inflammatory markers such as TNF α and IL-6 . If these cytokines remain chronically it will predispose an early onset of systemic disorders like Diabetes Mellitus, Hypertension etc., Also individuals with EDS were reported to have psychological problems like irritability and decreased quality of interpersonal relationships . All these factors can ultimately impair the quality of life and reduce the lifespan of the affected individual. This can be prevented by early lifestyle modifications with the complete understanding and co-operation of the affected individuals
In another study, the author believes stress from lack of sleep causes poor school performance. 17 On the other hand, in a systematic review, the authors could not estab- lish a cause and effect relationshipbetweensleepquality and academicperformance. 2 In their meta-analysis study, Dewald and colleagues (2010) emphasized that because of the diversity of the methodology of studies, it is impossi- ble to de ﬁ nitely derive a relationshipbetweensleepquality and academicperformance, and thus more longitudinal intervention studies are warranted. 1 According to different conclusions in this respect, the researchers decided to determine the relationshipbetweensleepquality and aca- demic performance among students at Kermanshah University of Medical Sciences.
(16 - 85 years) and dialysed since >6 months in three dialysis centres. For each patient, we as- sessed insomnia according to international definition, obstructive sleep apnea syndrome (OSAS) with the Berlin questionnaire, restless leg syndrome (RLS) using abridged version of Cambridge- Hopkins RLS questionnaire, and excessivedaytimesleepiness (EDS) with Epworth sleepiness scale. Logistic multivariate regression was used to identify factors associated with different SD. Results: Overall prevalence of SD was 88% comprising: insomnia (64.3%), OSAS (49.1%), RLS (24.1%) and EDS (20.5%). Forty-two patients presented at least two disorders. No difference was noticed in prevalence of SD between genders (p = 0.14). Level of blood pressure were not different across patients with and without SD. Insomnia correlated with anemia, inflammation and EDS. OSAS was associated with age ≥50 years, EDS and neck circumference ≥25 cm. RLS correlated with anemia and EDS. Other parameters such as gender, dialysis vintage, KT/V, obesity, diabetes status and hypoalbuminemia were not associated with the different SD. The majority of patients had not been diagnosed before the survey and none of them was under treatment. Conclusions: Our findings are
Data on airflow, air pressure and SpO 2 were used to determine respiratory disturbance index (RDI), snoring index (SI) and the nadir SpO 2 level, respec- tively. A reduction of airflow by 50% or more for at least 10 s and noises of 8–160 Hz were counted as a snoring event. The numbers of these events per one ‘sleep’ hour are represented as RDI and SI, respec- tively. SDB was defined as RDI ≥5. Data were analysed by well-trained sleep technicians, under the supervision of sleep specialists (RS, TaT). The device employed is well established and RDI values derived identified indi- viduals with SDB, 17 as well as showed a good correlation
The results of this study suggest that there are qualitative and quantitative differences in both sleep-associated and daytime behaviors in children, depending on the primary and comorbid sleep dis- order diagnoses. First, as expected, the OSAS group had a significantly greater frequency of symptoms of sleep disordered breathing than did the BSD group, although the BSD group did exhibit some degree of snoring. When the OSAS group was divided into pure (OSAS-P) and comorbid (OSAS-BSD) groups, these two groups were found to be clinically similar to one another in terms of sleep disordered breath- ing. However, when severity of OSAS was defined by polysomnographic variables (number of apneas and hypopneas/hour and the nadir O 2 saturation),
spavanja tako što će razviti vlastite svakodnevne strategije kako se nositi s tim problemom. Program također obuhvaća rad na snu i tehnike opuštanja. Cilj je ovoga istraživanja bio utvrditi djelotvornost dvodnevnoga seminara iz spavanja na poboljšanje kvalitete spavanja, dnevnu pospanost te na kvalitetu rada i života smjenskih radnika jedne austrijske željezničke tvrtke (Österreichische Bundesbahnen, ÖBB). Istraživanje je obuhvatilo 30 radnika (28 muškaraca i dvije žene, srednja dob 24±45,90 godina, u dobnom rasponu od 24 do 56 godina) koji su odgovorili na upitnik prije seminara te šest mjeseci nakon njega da bi se utvrdile početne vrijednosti i promjene. Upitnik je sadržavao pitanja iz Pittsburgh indeksa kvalitete spavanja (izv. Pittsburgh SleepQuality Index, krat. PSQI) i iz Epworthove ljestvice pospanosti (izv. Epworth Sleepiness Scale, krat. ESS), zatim kronotip ispitanika, čimbenike osobnosti i rizične čimbenike za izgaranje na poslu (engl. burn- out). Početne su vrijednosti u ovoj skupini uspoređene s početnim vrijednostima u skupini koja nije ispunila upitnik nakon seminara (N=154) kako bi se utvrdilo razlikuju li se te dvije skupine dovoljno da se može pretpostaviti otklon (engl. bias) u skupini koja je ispunila upitnik nakon seminara. Dvije su se skupine razlikovale samo razinom izgaranja na poslu i trajanjem spavanja, ali ne i distribucijom vrijednosti iz PSQI i ESS upitnika. Dvodnevni je seminar iz vođenja spavanja u skupini koja je ispunila upitnik nakon seminara doveo do značajnoga poboljšanja u ukupnim bodovima iz PSQI upitnika te do značajnoga smanjenja dnevnoga umora, odgode spavanja i dnevne pospanosti. S obzirom na mali uzorak, potrebno je provesti veće longitudinalno istraživanje s većim uzorkom kako bi se utvrdili dugotrajni učinci vođenja spavanja. KLJUČNE RIJEČI: dnevna pospanost; Holzinger & Klösch™; kvaliteta spavanja; tegobe sa spavanjem
Almost all students were found to have day sleepiness which means that they do not get enough sleep during the night. Groningen scale showed that almost all students were experiencing poorqualitysleep at the time of survey which was independent of academicperformance. However sleep quantity was an important factor related with academicperformance which showed less sleep was associated with pooracademicperformance. Although there were few students with less sleep and good academicperformance so there may be other factors and behaviours relating to academic performance.Bulk of the students had decreased amount of sleep in exam days and its reason was found to be
Results: Our results showed that 39.5% of participants were found to have a high risk of sleep apnea and 9.9% of the participants were found to have abnormal daytimesleepiness. The risk of developing OSA was associated with a higher body mass index (BMI) (P=0.02), and depression severity (patient health questionnaire 9 score) (P=0.01). Increasing severity of depressive symptoms was associated with a higher risk of sleep apnea (P=0.01). BMI (odds ratio [OR] =5.97, 95% confidence interval [CI] 1.89–18.82) and depression severity (OR =4.04, 95% CI 1.80–9.07) were also found to be predictors of OSA. The psychiatric diagnoses of the participants were not found to have a significant association with the risk of sleep apnea. Conclusion: The risk of OSA is increased among hospitalized psychiatric patients, and this condition can have detrimental effects on psychiatric patients. OSA appears to be under- recognized in this population, psychiatrists should screen for OSA in hospitalized psychiatric patients and refer them for diagnostic testing or treatment when indicated.
cell damage that occurred during the day and refreshes the immune system which in turn helps to prevent disease. Many physician consider sleep to be a barometer of a persons health like taking the temperature. Elderly who don’t sleep well are more likely to suffer from depression, attention memory problems and excessive day time sleepiness. They are also likely to suffer more night time falls, have increased sensitivity to pain, and use more prescription or over the counter sleep aids. Insufficient sleep can also lead to many serious health in older adults, including an increased cardio vascular diseases, diabetes, weight problems and breast cancer in women.(Robinson, kemp & Segal, 2011)
interviews using a questionnaire to diagnose headache type, sleep duration, sleepiness, anxiety, and depression door-to-door using a face-to-face interview. The interview included questions on headache symptoms and sleep sta- tus. All interviewers were employed by Gallup Korea and had previous social survey interviewing experience. The study was conducted from November 2011 to January 2012. It was approved by the institutional review board/ ethics committee of Hallym University Sacred Heart Hos- pital and was performed in accordance with the ethical standards described in the 1964 Declaration of Helsinki and its subsequent amendments . Written informed consent was obtained from all participants.
mild, moderate, and severe OSAS. Similarly, one-way analysis of variance was used to test the difference in Conners scores between patients with mild, moderate, and severe OSAS. As the Conners score has been studied only in children 3 to 17 years of age, data were reanalyzed with subjects younger than 3 years excluded. The Spearman correlation coefficient was used to describe the relation- ship between the ESS score and PSG variables, as well as between the Conners score and PSG variables. PSG variables evaluated include sleep efficiency, arousal index, apnea-hypopnea index, apnea-hypopnea index during rapid eye movement (REM) sleep, Sao 2 nadir, duration of Sao 2 ⱕ92%, mean ETco 2 , mean ETco 2
1. Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, Bogels SM. The influence of sleepquality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews 2010; 14 (3): 179-89. doi : 10.1016/j.smrv.2009.10.004 2. Vidyashree HM, Patil PP, Moodnur V, Singh D. Evaluation and comparison of sleepquality among medical and yogic students- A questionnaire based study. National Journal of Physiology, Pharmacy and Pharmacology 2013; 3 (1): 71-4. doi: 10.5455/njppp.2013.3.71-74 3. Lemma S, Gelaye B, Berhane Y, Worku
Clomipramine is a serotonergic reuptake inhibitor often results in substantial REM suppression. Declining severity and frequency of cataplexy at doses of 25-75mg and at low dose of 10-20mg daily are more effective. Adverse effects exist of anticholinergic effects including dry mouth, sweating, constipation, tachycardia, weight increase, hypotension, difficulty in urinating, and impotence. Rebound cataplexy may occur on withdrawal of TCAs causes increased in number and severity of cataleptic attacks. 
impairment of studied cognitive function, quality of life, mood disturbance as depressed or anxious mood, and more affection of SDQ and ESS in patients with OSA than control group. These results could be attributed to multiple mechanisms, thought to contribute to sleepiness in patients with OSA. These include sleep fragmentation , hypoxia , partial chronic sleep deprivation from sleep time lost due to arousals , cytokine dysregulation , and interactions with individual adaptations . Other studies had proposed the hypothesis that both daytime somnolence and hypoxemia may contribute to cognitive dysfunction in OSA patients. In particular, the impairment of executive functions, motor and visuo-constructive abilities (such as language, fluency, drawing) may be related to severity of hypoxemia. Also, attention and memory deficits may be due to excessivedaytime somnolence associated with sleep fragmentation [27-29]. Other studies suggested the importance of REM sleep for memory consolidation [30,31], particularly for those individuals with insomnia .