Potential immunological triggers for narcolepsy and idiopathic hypersomnia: Real-world insights on infections and influenza vaccinations.

OBJECTIVE: It is hypothesized that narcolepsy type 1 (NT1) develops in genetically susceptible people who encounter environmental triggers leading to immune-mediated hypocretin-1 deficiency. The pathophysiologies of narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) remain unknown. The main aim of this study was to collect all reported immunological events before onset of a central disorder of hypersomnolence. METHODS: Medical records of 290 people with NT1, and 115 with NT2 or IH were retrospectively reviewed to extract infection and influenza vaccination history. Prevalence, distribution of immunological events, and time until hypersomnolence onset were compared between NT1 and the combined group of NT2 and IH. RESULTS: Immunological events were frequently reported before hypersomnolence disorder onset across groups. Flu and H1N1 influenza vaccination were more common in NT1, and Epstein-Barr virus and other respiratory and non-respiratory infections in NT2 and IH. Distributions of events were comparable between NT2 and IH. Rapid symptom onset within one month of infection was frequent across groups, especially after flu infection in NT1. Hypersomnolence disorder progression after an immunological event was reported in ten individuals. CONCLUSIONS: Our findings suggest a variety of immunological triggers potentially related to NT1, including H1N1 influenza infection or vaccination, infection with other flu types, and other respiratory and non-respiratory infections. Frequent reports of immunological events (other than those reported in NT1) immediately prior to the development of NT2 and IH support the specificity of triggers for NT1, and open important new research avenues into possible underlying immunological mechanisms in NT2 and IH.

Supplement use and its impact on daily life of cancer patients: a cross-sectional study.

PURPOSE: This cross-sectional study aimed to investigate the prevalence and characteristics of supplement usage among cancer patients and explore its potential associations with anxiety, excessive daytime sleepiness, and overall quality of life. METHODS: Cancer patients receiving specific care at Hôtel Dieu de France University Hospital, Beirut, were enrolled between April and June 2023. In face-to-face interviews, participants were asked to complete a questionnaire consisting of sociodemographic information, supplement usage details, and cancer-related variables. Three validated surveys (Epworth Sleepiness Scale, GAD-7, and EORTC-QLQ-C15-PAL) were employed to assess excessive daytime sleepiness, anxiety, and overall quality of life. Statistical analyses, including chi-square tests, t-tests, and multiple regression models, were conducted to examine associations between supplement use and other variables. RESULTS: A total of 202 participants were interviewed. Fifty-two percent reported regular use of supplements following their cancer diagnosis, with vitamin D being the most commonly used supplement. Using multivariate logistic regression, supplement use was associated with being female, having lower educational levels, having a longer duration since cancer diagnosis, and having a poor overall quality of life. The multivariate logistic regression showed no significant correlation between supplement use and excessive daytime sleepiness and anxiety. CONCLUSION: This study highlights a high prevalence of supplement usage among cancer patients in Lebanon, indicating a rising interest in alternative therapies aimed at enhancing quality of life. Larger prospective studies are needed to assess the relation between supplement intake and excessive daytime sleepiness and anxiety and establish clear guidelines pertaining to supplement use in cancer patients.

Bidirectional associations between sleep problems and suicidal thought/attempt in adolescents: A 3-wave data path analysis.

PURPOSE: This longitudinal data analysis examined the bidirectional relationships between sleep problems and suicidal thought (ST)/attempt (SA) in a large sample of Chinese adolescents. METHODS: A total of 6995 adolescents (mean age = 14.86 years and 51.4% males) participated in a 3-wave longitudinal study of behavior and health in Shandong, China. A self-administered questionnaire and standardized scales were used to assess ST, SA, sleep duration, insomnia, daytime sleepiness, and behavioral/emotional problems in 2015 (T1), 1 year later (T2), and 2 years later (T3). Path analyses were performed without and with adjustment for covariates, including gender, grade level, chronic diseases, cigarette smoking, alcohol use, anxiety/depressive symptoms, paternal education, and family economic status. RESULTS: The prevalence rates of short sleep (<7 h/night), insomnia symptoms, and daytime sleepiness were 46.9-58.8%, 16.0-19.4%, and 25.1-25.3% at T1, T2, and T3, respectively. The rates of past-year ST and SA were 9.1-12.4% and 1.6-2.4% at T1, T2, and T3, respectively. Path analyses showed that short sleep, insomnia, and daytime sleepiness predicted subsequent ST, and vice versa. Daytime sleepiness and SA predicted each other 1 year later. Sleep problems and ST/SA in the previous year significantly predicted themselves in the follow-up year. STUDY LIMITATION: All data were based on self-report. CONCLUSION: Short sleep, insomnia, and daytime sleepiness all had bidirectional relationships with ST. Daytime sleepiness and SA were bidirectionally linked. Our findings suggest that interventions should be taken for both night sleep disturbances and daytime sleepiness to prevent suicide. Adverse sleep outcomes in suicidal adolescents should be assessed, which can in turn increase suicide risk.

Severity and determinants of psychosocial comorbidities in granulomatosis with polyangiitis and their impact on quality of life.

Depression, anxiety, sleep disturbances, and fatigue are inadequately addressed comorbidities in granulomatosis with polyangiitis (GPA). We determined the prevalence, severity, determinants, and the impact of these comorbidities on quality-of-life (QoL) in GPA. This observational study included adult GPA patients; patients with RA and lupus were included as comparators. Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder 7-item scale for anxiety, Epworth Sleepiness Scale for sleep disturbances, and Fatigue Severity Scale for fatigue were administered prospectively to estimate prevalence and severity. QoL and disability were estimated using PROMIS-HAQ, HAQ-health and HAQ-pain. Correlations among these parameters were assessed. Stepwise regression analyses were performed to identify determinants of depression, anxiety, excessive sleepiness, and fatigue. One hundred eighty-one patients-62 GPA [mean age 43 (13) years], 57 RA and 62 SLE- were included. The prevalence of depression (47%), excessive sleepiness (21%), and fatigue (39%) in GPA were comparable to RA and lupus; anxiety was less prevalent (29% versus 46% and 53%, p = 0.02). Severity was mostly mild-moderate. Younger age [OR = 0.93 (0.89-0.98)], higher BMI [OR = 1.2 (1.0-1.4)], and greater disease damage [OR = 2.0 (1.3-3.3)] independently predicted presence of depression. Higher BMI [OR = 1.3 (1.1-1.5)] and concomitant FMS [OR = 80.9 (5.1-1289.2)] were independently associated with excessive sleepiness. No association with disease activity, duration, or gender was seen. GPA patients with depression, anxiety, excessive sleepiness, and fatigue had worse PROMIS-HAQ, HAQ-pain, and HAQ-health. In conclusion, depression, anxiety, sleep disturbances, and fatigue are common in GPA. Although their severity is mostly mild-moderate, they impair QoL significantly. Potentially modifiable determinants that can form targets for future interventions have been identified.

Sleep problems during and after paediatric brain tumours.

Brain tumours are among the most common cancer diagnoses in paediatrics. Children with brain tumours are at risk of developing sleep problems because of direct and indirect effects of the tumour and its treatment, in addition to psychosocial and environmental factors. Sleep has an important role in physical and psychological wellbeing, and sleep problems are associated with many adverse outcomes. In this Review, we describe the state of the evidence regarding sleep in people with paediatric brain tumours, prevalence and types of sleep problems, risk factors, and effectiveness of interventions. Evidence shows that sleep problems, particularly excessive daytime sleepiness, are common in people with paediatric brain tumours, with high BMI emerging as a consistent predictor of sleep disruption. Further intervention studies are needed, and clinical evaluation of sleep is warranted for people with paediatric brain tumours.

Sleep Complaints Among Adults With Major Depressive Episode Are Associated With Increased Risk of Incident Psychiatric Disorders: Results From a Population-Based 3-Year Prospective Study.

Objective: Sleep alterations have been suggested as a cause and consequence of psychiatric disorders. In this context, we evaluated the incidence of psychiatric disorders following sleep complaints in adults with major depressive episode (MDE).Methods: In a large, nationally representative 3-year prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2001-2002 (Wave 1) and 2004-2005 (Wave 2), we used structural equation modeling to examine shared and specific effects of trouble falling asleep, early morning awakening, and hypersomnia on incidence of common comorbid DSM-IV disorders among patients with MDE. The analyses adjusted for sociodemographic and clinical characteristics, including sedative or tranquilizer use.Results: Among participants with MDE at Wave 1, 3-year incidence rates were dysthymia = 2.9%, general anxiety disorder = 8.2%, panic disorder = 3.4%, social anxiety disorder = 4.0%, specific phobia = 3.0%, alcohol use disorder = 8.1%, nicotine dependence = 6.2%, cannabis use disorder = 2.7%, and other drug use disorder = 4.9%. Participants with 3-year incident psychiatric disorders commonly had trouble falling asleep (67.6% for cannabis use disorder to 76.4% for panic disorder), early morning awakening (43.3% for cannabis use disorder to 55.6% for dysthymia), and hypersomnia (51.3% for nicotine use disorder to 72.1% for social anxiety disorder). The effects of the incident general psychopathology factor, representing mechanisms related to incidence of all psychiatric disorders, were exerted almost exclusively through a factor representing shared effect across all sleep complaints. Sleep complaints were associated with increased risk of incident psychiatric disorders, independent of sociodemographic and clinical characteristics.Conclusions: These findings suggest that sleep complaints should be clinically assessed in all psychiatric disorders, as these prodromal symptoms might constitute transdiagnostic biomarkers and therapeutic targets for prevention.

Impact of common diseases and habits on daytime sleepiness in adults.

We aimed to investigate the impact of common diseases and habits on daytime sleepiness in adults. We retrospectively collected the clinical and overnight polysomnographic data of 2829 adults. The impact of common diseases and habits on the Epworth Sleepiness Scale (ESS) score was analyzed by univariate and multivariate linear regression analyses. The mean ESS score was 6.2 (standard deviation = 4.3; range = 0-24) for all adults. Multivariate linear regression analysis showed that dyslipidemia, acute myocardial infarction (AMI), liver cirrhosis, alcohol drinking, and tea consumption had a significantly positive association with ESS score for all adults after adjusting for age, sex, body mass index, apnea-hypopnea index, sleep efficiency, percentage of sleep N3 stage, and depression. Subgroup analysis by sex showed that AMI, liver cirrhosis, alcohol drinking, and tea consumption had significantly positive association with ESS scores in males, whereas only dyslipidemia had significantly positive association with ESS scores in females. Subgroup analysis by age showed that alcohol drinking had a significantly positive association with ESS scores in young adults. AMI had a significantly positive association with ESS scores, but chronic kidney disease had a significantly negative association with ESS scores in middle-aged adults. Furthermore, dyslipidemia, chronic kidney disease, and cancers had a significantly positive association with ESS scores in older adults. Dyslipidemia, AMI, liver cirrhosis, alcohol drinking, and tea consumption had a significantly positive association with daytime sleepiness in adults but differed by sex and age.

Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer.

Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.

A Longitudinal Study of Insomnia, Daytime Sleepiness, and Academic Performance in Chinese Adolescents.

BACKGROUND: Longitudinal data on the associations between sleep disturbances, daytime sleepiness, and daily functioning are limited in the general adolescent population. This study examined the cross-sectional and longitudinal associations between insomnia, excessive daytime sleepiness (EDS), and subject-specific academic performance in a large sample of Chinese adolescents. METHOD: Data were derived from the Shandong Adolescent Behavior and Health Cohort (n = 7,072) study. A self-administered questionnaire was used to assess insomnia, EDS, academic performance (overall, Chinese, mathematics, and English), behavioral and emotional problems, and family demographics. The cross-sectional analysis was conducted with baseline data while the longitudinal analysis was conducted with both baseline and 1-year follow-up data. Logistic regression analyses and mediation models were performed to examine the associations between insomnia, EDS, and academic performance. RESULTS: Logistic regression analyses revealed that insomnia and EDS had significant cross-sectional associations with overall performance and mathematics performance after controlling for age, gender, ever smoking, ever alcohol drinking, frequent snore, sleep duration, chronic disease, anxious/depressive symptoms, parents' education, parents' occupation, and family economic status. Both insomnia (OR = 1.20, 95% CI: 1.00-1.45) and EDS (OR = 1.22, 95% CI: 1.03-1.45) at baseline were significantly associated with poor mathematics performance 1 year later. The effect of insomnia at baseline on poor academic performance 1 year later was mediated by EDS except for the Chinese subject after controlling for the covariates. CONCLUSIONS: Insomnia and daytime sleepiness are significantly associated with poor academic performance, particularly in mathematics. EDS mediates the association between insomnia and poor academic performance. Further research is warranted to investigate the effects of sleep disturbance and daytime sleepiness on the learning process and performance across academic subjects.

Predictive Factors for Obstructive Sleep Apnea Diagnosis in Bariatric Surgery Candidates with or Without Chronic Insomnia Complaints.

OBJECTIVE: This study aims to evaluate the frequency of insomnia complaints in bariatric patients and to assess obstructive sleep apnea (OSA) predictors according to the presence or absence of chronic insomnia. METHODS: Insomnia was defined as the presence of at least one specific symptom: difficulty falling asleep, difficulty maintaining sleep, and/or waking up earlier than expected. Diagnosis of OSA was objectively obtained from in-laboratory polysomnography. Multivariate logistic regression analysis was used to assess OSA predictors. RESULTS: This cross-sectional study contains 1,737 bariatric surgery candidates: 59.6% without insomnia and 40.4% with insomnia. OSA prevalence was similar among participants with or without insomnia either for any OSA (p = 0.168) or for moderate-to-severe OSA (p = 0.185). Patients without insomnia showed a higher prevalence of severe OSA than those with insomnia (p = 0.005). In both cohorts, five parameters were independent OSA predictors: sex, age, body mass index (BMI), neck circumference (NC), and excessive daytime sleepiness (EDS). Male sex was the most important predictor, whether in individuals without insomnia (adjusted odds ratio [OR] ranging from 4.874 to 8.369) or in those with insomnia (adjusted OR ranging from 5.672 to 12.441). CONCLUSIONS: A considerable proportion of bariatric patients report insomnia complaints. The probability of suffering from OSA was similar among bariatric candidates with or without insomnia, except for severe OSA diagnosis. Sex, age, BMI, NC, and EDS were independent predictors for OSA diagnosis irrespective of insomnia symptoms, and male sex was the main predictor for OSA in bariatric individuals with or without insomnia.

Investigation of the relationships between sleep behaviors and risk of healthspan termination: a prospective cohort study based on 323,373 UK-Biobank participants.

OBJECTIVES: To examine the associations between four sleep behaviors and the risk of healthspan termination. METHODS: This study included 323,373 participants, free of terminated healthspan at baseline, from the UK-Biobank (UKB). We applied multivariable-adjusted Cox regression models to estimate the risk of terminated healthspan based on four sleep behaviors (insomnia/sleeplessness, napping, daytime sleepiness, and difficulty getting up from bed), which were self-reported and measured on Likert scales from "usually" to "never/rarely" experiences. In this study, healthspan was defined based on eight events that are strongly associated with longevity (congestive heart failure, myocardial infarction, chronic obstructive pulmonary disease, stroke, dementia, diabetes, cancer, and death). RESULTS: Participants who reported the following unhealthy sleep behaviors had a significantly higher risk of terminated healthspan: "usually experience sleeplessness/insomnia" (HR = 1.05, 95% CI: 1.03-1.07; P < 0.001); "usually nap" (HR = 1.22, 95% CI: 1.18-1.26; P < 0.01); "excessive daytime sleepiness" (HR = 1.25, 95% CI: 1.19-1.32; P < 0.001); and "difficult getting up from bed" (HR = 1.08, 95% CI: 1.05-1.10; P < 0.001). The corresponding population attributable risk percentage (PAR%) indicated that about 7% of healthspan termination in this cohort would have been eliminated if all participants had healthy sleep behaviors. CONCLUSION: Participants who reported "usually experience sleeplessness/insomnia," "usually nap," "excessive daytime sleepiness," and "difficult getting up from bed" had increased risk of shortened healthspan. Therefore, adherence to healthy sleep behavior is significant for the extension of healthspan.

Risco de Morte em Idosos com Sonolência Excessiva Diurna, Insônia e Depressão: Estudo de Coorte Prospectiva em População Urbana no Nordeste Brasileiro / Risk of Death in the Elderly with Excessive Daytime Sleepiness, Insomnia and Depression: Prospective Cohort Study in an Urban Population in Northeast Brazil

Resumo Fundamento A íntima relação entre a regulação do sono e os eventos cardiovasculares é um dos principais focos de investigação na medicina contemporânea. Hábitos e características do sono interferem na ritmicidade cardíaca e também na expectativa de vida, principalmente em idosos. Objetivo Estimar o risco de óbito e de eventos cardiovasculares em idosos comunitários que apresentam queixa de insônia e sonolência excessiva diurna ao longo de oito anos de seguimento. Método Foi desenhada uma coorte prospectiva com 160 idosos, a primeira onda em 2009 e a segunda em 2017. Os grupos de seguimento foram determinados pela exposição ou não às queixas de insônia primária e a sonolência excessiva diurna, com ou sem ronco. As covariáveis sexo, estado conjugal, depressão, hipertensão e diabetes foram controladas. O desfecho primário foi o óbito e o secundário, os eventos cardiocerebrovasculares (ECV). As probabilidades dos desfechos foram estimadas pelo risco relativo (RR), através da regressão de Poisson, adotando-se α ≤ 0,05. Resultados Registraram-se 40 mortes no período (25,97%:19,04-32,89) e 48 ECVs (30,76%:23,52-38,01). Os homens apresentaram maior risco (RR = 1,88;1,01-3,50) de óbito. A depressão (RR = 2,04;1,06-3,89), a gravidade da insônia (RR = 2,39;1,52-4,56) e a latência do sono entre 16-30 minutos (RR = 3,54;1,26-9,94) e 31-60 minutos (RR = 2,23;1,12-4,47) aumentaram independentemente o risco de óbito em idosos comunitários. Os ECVs foram preditos apenas por idosos hipertensos e/ou diabéticos (RR = 8,30; 1,98-34,82). Conclusão A mortalidade em idosos é influenciada pelo estado emocional e pela dificuldade de dormir, diferentemente dos ECVs, condicionados apenas pelas condições pressóricas arteriais e metabólicas.

Abstract Background The close relationship between sleep regulation and cardiovascular events is one of the main focuses of research in contemporary medicine. Sleep habits and characteristics interfere with the cardiac rhythm and also with life expectancy, especially in the elderly. Objective To estimate the risk of death and cardiovascular events in community-dwelling elderly individuals complaining of insomnia and excessive daytime sleepiness over eight years of follow-up. Method A prospective cohort was designed with 160 elderly, with the first wave occurring in 2009 and the second in 2017. Follow-up groups were determined by exposure or not to complaints of primary insomnia and excessive daytime sleepiness with or without snoring. The covariates gender, marital status, depression, hypertension and diabetes were controlled. The primary outcome was death and the secondary outcome was cardio-cerebrovascular events (CCV). Outcome risks were estimated by relative risk (RR) through Poisson regression, adopting α≤0.05. Results There were 40 (25.97%: 19.04-32.89) deaths over the period and 48 (30.76%: 23.52-38.01) CCV. Men had a higher risk (RR = 1.88; 1.01-3.50) of death. Depression (RR = 2.04; 1.06-3.89), insomnia severity (RR = 2.39; 1.52-4.56) and sleep latency between 16-30 minutes (RR = 3, 54; 1.26-9.94) and 31-60 minutes (RR = 2.23; 1.12-4.47) increased the risk of death independently in community-dwelling elderly. CCV were predicted only in the hypertensive and / or diabetic elderly (RR = 8.30; 1.98-34.82). Conclusion Mortality in the elderly is influenced by the emotional state and difficulty in falling asleep, unlike CCVs, which are conditioned only by arterial and metabolic blood pressure conditions.

Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia.

BACKGROUND: This cross-sectional study aimed to examine associations between excessive daytime sleepiness (EDS) with falls and falls related conditions in older adults. METHODS: To assess EDS, the Epworth Sleepiness Scale was used, with a score of ≥11/24 points indicating EDS. Number of falls and fall history (at least one) in the last year were recorded. Timed Up and Go test (TUG) was used to assess fall risk. Sarcopenia was defined by SARC-F tool. A grip strength score of the dominant hand, measured with a hand-grip dynamometer, less than 16 kg in females and 27 kg in males was accepted as dynapenia. Frailty status was defined by five dimensions including shrinking, exhaustion, low levels of activity, weakness, and slowness with those scoring positive on ≥3 dimensions being categorized as frail. The relationship between EDS with outcomes including fall, number of falls, falls risk, dynapenia, sarcopenia and frailty was investigated. RESULTS: Of the 575 outpatients (mean age 78.7 ± 7.5 years, female:70.4%), the prevalence of EDS was 19.8%. In the multivariable model adjusted for age, sex, living status, marital status, polypharmacy, osteoarthritis, Parkinson disease, depression and dementia; EDS was significantly associated with the number of falls last year (IRR = 1.94, 95% CI: 1.42-2.65) and sarcopenia (OR = 2.41, 95% CI: 1.41-4.12). EDS was not significantly associated with TUG based fall risk, frailty and dynapenia. CONCLUSIONS: EDS was observed in approximately one in every five older adults. EDS should be evaluated as part of geriatric assessment. Moreover, older patients with EDS should be further assessed for falls and sarcopenia.

Anthropometry, dietetic habits and sleepiness in Ecuadorian adults

The reduction of hours of sleep affects the physical and mental health of people. Having unhealthy sleep habits are associated with a greater occurrence of daytime sleepiness, which in turn has been related to poorer nutritional status. The objective of this study was to relate food intake, anthropometric measurements, and daytime sleepiness in Ecuadorian adults. Non-experimental, cross-sectional study, the sample included 400 men and women between 18 and 65 years of age, who attended an outpatient consultation of general medicine, family medicine, and traumatology services of a public hospital in Quito-Ecuador. Anthropometric and body composition measurements were measured using tetrapolar bio-impedance, following the recommendations of the International Society for the Advancement of Anthropometry (ISAK). Caloric intake was measured using a 24-hour recall and for daytime sleepiness (DS) the Epworth questionnaire was used. Statistical analyzes were performed using R. From the sample 56.5% presented DS, which affected women more frequently compared to men (p < 0.05). Differences were found between body measurements and dietary intake between groups of people with and without DS. Caloric intake, waist circumference, percentage of fat mass were higher in people with DS (p < 0.05), while muscle mass was higher in subjects without DS (p <0.05). No differences were found concerning visceral fat. We conclude that SD is related to less healthy values in terms of dietary intake and anthropometric measures(AU)

La reducción de las horas de sueño afecta la salud física y mental de las personas. Tener hábitos de sueño poco saludables se asocia a una mayor ocurrencia de somnolencia diurna, lo que a su vez se ha relacionado con un peor Estado Nutricional. El objetivo de este estudio fue relacionar la ingesta de alimentos, las medidas antropométricas y la somnolencia diurna en adultos ecuatorianos. Estudio no experimental, transversal n=400 hombres y mujeres entre 18 y 65 años, que acudieron a consulta externa de los servicios de medicina general, medicina familiar y traumatología de un hospital público de Quito, Ecuador tomado como referencia. Se tomaron medidas antropométricas siguiendo las recomendaciones de la Sociedad Internacional para el Avance de la Antropometría (ISAK) y de composición corporal a través de la bioimpedancia tetrapolar. La ingesta calórica se midió mediante un recordatorio de 24 horas y para somnolencia diurna (SD)se utilizó el cuestionario de Epworth. Los análisis estadísticos se realizaron utilizando el software R. 56,5% de la muestra presenta SD, que afectó con mayor frecuencia a las mujeres en comparación con los hombres (p <0,05). Se encontraron diferencias entre las medidas corporales y la ingesta dietética entre grupos de personas con SD y sin ella. La ingesta calórica, la circunferencia de la cintura, el porcentaje de masa grasa fue mayor en personas con SD (p <0.05), mientras que la masa muscular fue mayor en sujetos sin SD (p <0.05). No se encontraron diferencias en relación con la grasa visceral. Concluimos que SD está relacionada con valores menos saludables en cuanto a ingesta dietética y medidas antropométricas(AU)

Clinical use of STOP-BANG and ESS questionnaires in the evaluation of obstructive sleep apnoea-related risk factors for motor vehicle accidents among public transport drivers in Delhi, India.

PURPOSE: To assess the clinical use of Epworth Sleepiness Score (ESS) and STOP-BANG questionnaires in the evaluation of sleep apnoea-related risk factors for motor vehicle accident (MVA) among public transport drivers in Delhi, India. METHODS: The present cross-sectional study is based on data collected between April 2018 and March 2019 from public transport drivers in Delhi. All drivers coming for gas filling to 43 compressed natural gas (CNG) stations in Delhi were included in the study. The evaluation of sleep apnoea-related risk factors for motor vehicle accident was done using ESS and STOP-BANG Score. RESULTS: A total of 4094 drivers participated in this study, and 299 drivers (7%) gave a history of motor vehicle accidents during the preceding 3 years. Drivers with STOP-BANG score ≥ 3 had a higher risk for MVA (OR 1.59; 95% CI 1.26-2.02; p value < 0.0001). Score of ESS ≥ 10 carried a very high risk for MVA (OR 26.95; 95% CI 16.18-44.87; p value < 0.0001). The other risk factor of significance was alcoholism (OR 1.37; 95% CI 1.04-1.80; p value < 0.0248). CONCLUSION: Among public transport drivers in Delhi, daytime sleepiness is the major contributing factor to motor vehicle accidents. ESS and STOP-BANG questionnaires may be good screening tools for the clinical evaluation of OSA. Community-based screening of OSA is required for identification of public transport drivers at high risk of MVA.

Association between physical activity, screen time activities, diet patterns and daytime sleepiness in a sample of Brazilian adolescents.

OBJECTIVE: To examine the association between physical activity, screen time, eating habits and daytime sleepiness among Brazilian adolescents. METHODS: Adolescents from three high schools (n = 876, 49.8% female, 16.4 ± 1.2 years) participated in this cross-sectional survey. Variables related to lifestyle behaviors (ie, physical activity, screen time, eating habits, sleep duration) were collected through an online questionnaire. Daytime sleepiness was assessed using the Pediatric Daytime Sleepiness Scale (PDSS). Excessive daytime sleepiness was defined as a PDSS score ≥20. RESULTS: The average PDSS score was 18.9 (SD ± 4.8) points and 46.8% of adolescents were classified as having excessive daytime sleepiness. Physical activity was inversely associated with PDSS score (ß = -0.29, 95% CI -0.47; -0.11). Consuming processed foods frequently (ß = 1.16, 95% CI 0.85; 1.47) and using social media (ß = 0.22, 95% CI 0.14; 0.30) were positively associated with PDSS score. Similar findings were observed for the odds of excessive daytime sleepiness. Physical activity was inversely associated (OR = 0.91, 95% CI 0.84; 0.99), while frequent consumption of processed foods (OR = 1.55, 95% CI 1.33; 1.82) and using social media (OR = 1.13, 95% CI 1.02; 1.24) were positively associated with excessive daytime sleepiness. CONCLUSIONS: Lower physical activity level, a higher consumption processed foods, and higher social media use were associated with daytime sleepiness in this sample of Brazilian adolescents.

Smoking and sleep apnea duration mediated the sex difference in daytime sleepiness in OSA patients.

PURPOSE: Daytime sleepiness is a common symptom of obstructive sleep apnea (OSA) and is more common in men, but the underlying mechanism remains unclear. The aim of this study was to assess whether or not sex differences in daytime sleepiness persisted after controlling for age and OSA severity and to explore the factors contributing to daytime sleepiness in patients with OSA. METHODS: A total of 104 pairs of patients with OSA, matched by age and apnea-hypopnea index (AHI), were enrolled in this retrospective study. Demographic data were collected; daytime sleepiness was measured by the Epworth Sleepiness Scale (ESS); and polysomnography (PSG) was performed on each participant. These measurements were compared between sexes, and the factors affecting daytime sleepiness were explored with correlation and multivariate linear regression analyses. RESULTS: Men had significantly higher ESS scores (p = 0.021) than women. Regarding demographics, BMI, neck/height ratio, and proportion of habitual smoking and alcohol intake were significantly higher in men. Regarding PSG findings, men had more rapid eye movement sleep, a longer mean apnea-hypopnea duration, and a longer mean apnea duration (MAD). Regression analysis showed that two sex-associated variables, habitual smoking (ß = 0.189, p = 0.006) and MAD (ß = 0.154, p = 0.024), had the strongest association with ESS scores. Further analysis revealed that MAD was significantly influenced by apnea index (ß = 0.306, p < 0.001) and sex (ß = - 0.193, p = 0.003). CONCLUSION: The sex difference in daytime sleepiness persists in patients with OSA, even after matching AHI and age. The difference is mediated by sex-specific smoking habits and sex differences in apnea duration.

Excessive daytime sleepiness in cancer patients.

PURPOSE: Excessive daytime sleepiness (EDS) is commonly reported in patients with cancer, and it is also a cardinal feature of central disorders of hypersomnolence. Multiple sleep latency testing (MSLT) is used for objective assessment. METHODS: A retrospective review of patients with cancer history who underwent formal sleep evaluation and MSLT from 2006 to 2019 was performed. Clinical characteristics, sleep-related history, and polysomnographic data were reviewed. RESULTS: Of 16 patients with cancer history, 9 were women (56%) and median age was 49. Cancer diagnoses included 4 central nervous system, 3 breast, 1 lymphoma, and 9 other solid malignancies, and 31% were undergoing active treatment. Comorbid conditions included depression, obstructive sleep apnea, and cancer-related fatigue. Daytime fatigue (94%), daily naps (81%), and EDS (69%) were the most common symptoms. Hypnopompic and hypnogogic hallucinations, sleep paralysis, sleep attacks, and cataplexy were present in a few. Epworth Sleepiness Scale scores were consistent with EDS in 88%, and mean sleep latency was less than 8 min in 69%. Only 31% had more than 2 sleep-onset REM periods. MSLT supported diagnoses of central disorders of hypersomnolence in 5 patients (4 narcolepsy, 1 idiopathic hypersomnia); 5 hypersomnia due to a medical disorder, psychiatric condition, or medication; and 6 with normal results. Pharmacotherapy was prescribed in 5 patients. CONCLUSIONS: EDS in patients with cancer may be multifactorial, but persistent symptoms may indicate an underlying disorder of hypersomnolence. Sleep referral and polysomnography to exclude other sleep disorders may be indicated. MSLT can help confirm the diagnosis. In those with normal MSLT, further evaluation for mood disorder should be considered.

Excessive Daytime Sleepiness and Associated Factors in Military Search and Rescue Personnel.

BACKGROUND: Abnormal excessive daytime sleepiness (EDS) has been reported worldwide, but too little is known about EDS and its determinants in Search and Rescue (SAR) populations. We aimed to determine the prevalence of abnormal EDS and contributing factors among Royal Norwegian Air Force (RNoAF) SAR helicopter personnel.METHODS: In this cross-sectional study, a total of N = 175 RNoAF SAR personnel completed an electronic survey including socio-demographic and lifestyle questions. The Epworth Sleepiness Scale (ESS) was used as both a continuous and categorical outcome variable to measure EDS.RESULTS: Abnormal EDS defined by ESS was found in 41% of the participants in this study. We observed no associations between socio-demographic and lifestyle factors and abnormal EDS in this study. DISCUSSION: There is a high prevalence of abnormal EDS in the current RNoAF SAR population. Despite this elevated level of fatigue, we did not find that the socio-demographic and lifestyle factors assessed in this study were associated with abnormal EDS in RNoAF SAR helicopter personnel. Also unusually, the study cohort did not demonstrate higher scores in factors found to change ESS scores in similar study populations (e.g., caffeine use, tobacco use, exercise level). Further research is required to investigate other factors (organizational, operational) that may be associated with abnormal EDS in this and other SAR populations.Akter R, Larose TL, Sandvik J, Fonne V, Meland A, Wagstaff AS. Excessive daytime sleepiness and associated factors in military search and rescue personnel. Aerosp Med Hum Perform. 2021; 92(12):975-979.

Chronotype change in university students in the health area with excessive daytime sleepiness / Alteração do cronotipo em universitários da área da saúde com sonolência diurna excessiva

Abstract: Introduction: Excessive daytime sleepiness (EDS) is characterized by an increased likelihood of initiating sleep at inappropriate times through involuntary naps and it negatively impacts performance in studies, work, family, and social relationships and increases the risk of accidents. Objective: This study evaluated the schedule and prevalence of EDS and its associated factors in medical students (using the PBL method), comparing it with students from other health courses (using the Traditional method). Methods: A cross-sectional study was carried out with 1152 university students who were attending courses in the health area. The presence of EDS was defined when scores >10 in the Epworth Sleepiness Scale (ESS) and the chronotype was assessed by means of the Morningness-Eveningness Questionnaire (MEQ). Using Stata 13.0 software, descriptive statistics, bivariate and multivariate analyses were performed, including interactions to fit the model. Results: The prevalence of EDS was 56.5% (95% CI, 53.6-59.4), and the mean ESS score was 11.1 (95% CI, 10.8-11.3). This value was lower among those who had morning chronotypes and was higher among medical students. 10.3% (n=119) of the students had a chronotype that was incompatible with the period of the course. The associated and independent factors for EDS were: female gender (PR, 1.14, 95% CI, 1.01-1.29), age between 16 and 19 years (PR, 1.20, 95% CI, 1.04-1.39), studying late at night and using cell phones before falling asleep (PR, 1.56, 95% CI, 1.02-2.38), not doing weekly physical activity (PR, 1.13, 95% CI, 1.02-1.25), and morning chronotype (PR, 0.87, 95% CI, 0.76-0.99). Not using cell phones before bedtime reduced the prevalence of EDS by 14%. Conclusions: This study demonstrated that the morning chronotype behaved as an independent protective factor for disorders of the circadian cycle. Performing weekly physical activity reduces EDS among students with intermediate and evening chronotypes.

Resumo: Introdução: A sonolência diurna excessiva (SDE) é caracterizada por uma maior probabilidade de o indivíduo iniciar o sono em horários inadequados por meio de cochilos involuntários, afeta negativamente o desempenho nos estudos, no trabalho e nas relações familiares e sociais, e aumenta o risco de acidentes. Objetivo: Este estudo teve como objetivo avaliar o cronotipo e a prevalência de SDE e seus fatores associados em estudantes de Medicina (método PBL). Para tanto, compararam-se os discentes de Medicina com os de outros cursos da área da saúde (método tradicional). Métodos: Trata-se de estudo transversal com 1.152 estudantes universitários matriculados em cursos de graduação da área da saúde. Definiu-se a presença de SDE quando se observaram escores > 10 na Epworth Sleepiness Scale (ESE), e o cronótipo foi avaliado por meio do instrumento Morningness-eveningness Questionnaire (MEQ). Por meio do software Stata 13.0, realizaram-se estatística descritiva e análises bivariadas e multivariadas, além de interações para que o estudo pudesse se ajustar ao modelo. Resultados: A prevalência de SDE foi de 56,5% (IC 95%, 53,6-59,4), e a pontuação média na ESE foi de 11,1 (IC 95%, 10,8-11,3). Esse valor foi menor entre os que apresentaram cronotipo matutino e maior entre os estudantes de Medicina. Dos alunos que participaram do estudo, 10,3% (n = 119) apresentaram um cronotipo incompatível com o período do curso. Os fatores associados e independentes para a SDE foram: sexo feminino (RP, 1,14, IC 95%, 1,01-1,29), idade entre 16 e 19 anos (RP, 1,20, IC 95%, 1,04-1,39), hábito de estudar de madrugada, uso de celular antes de dormir (RP, 1,56, IC 95%, 1,02-2,38), não praticar atividade física semanal (RP, 1,13, IC 95%, 1,02-1,25) e cronótipo matutino (RP, 0,87, IC 95%, 0,76-0,99). Não usar telefones celulares antes de dormir reduziu a prevalência de SDE em 14%. Conclusões: Este estudo demonstrou que o cronotipo matutino se comportou como um fator protetor independente para distúrbios do ciclo circadiano. A prática de atividade física semanal reduziu a prevalência SDE entre universitários com cronotipos intermediário e noturno.