Siniestralidad y apnea obstructiva del sueño. Revisión de la literatura y evaluación de la situación en 3 países latinoamericanos / Accident Rate and Obstructive Sleep Apnea: Literature Review and Assessment of the Situation in Three Latin American Countries

La apnea obstructiva del sueño (AOS) es una condición común en adultos en edad laboral. Incluso, en la actualidad, vemos cómo la edad de retiro se ha ido prolongando de tal manera que adultos mayores, quienes tienen mayor prevalencia de AOS, continúan trabajando incluso en situaciones de alto riesgo de siniestralidad. Uno de los principales síntomas de la AOS es la somnolencia diurna que puede contri- buir de manera directa al riesgo de accidentabilidad, compromiso cognitivo y desem- peño laboral. También se ha demostrado cómo la reducción de la materia gris a nivel cerebral y cerebelar provoca alteraciones en coordinación y capacidad de conducción. El tratamiento con dispositivos de presión positiva mejora el desempeño laboral y redu- ce la incidencia de accidentes de tránsito, pero algunos déficits cognitivos pueden per- sistir incluso después de meses de tratamiento. La evaluación del riesgo de accidentabilidad en conductores es un desafío y los cues- tionarios actuales no son adecuados para el cribado. Los simuladores de conducción y las pruebas de alerta son más prometedores. El futuro de la investigación se centra en estandarizar los resultados de los simulado- res, determinar los mejores predictores de eventos reales y utilizar la inteligencia arti- ficial y los automóviles autónomos para reducir los riesgos relacionados con la somno - lencia al volante. Es necesario que la posición de los entes gubernamentales de nuestros países latinoa- mericanos sea proactiva y orientada a la protección de la salud y la seguridad de la po- blación.

Obstructive sleep apnea (OSA) is a common condition among working-age adults. In today's context, we observe that the retirement age has been extended, with older adults, who have a higher prevalence of OSA, continuing to work even in high-risk situations. One of the main symptoms of OSA is daytime sleepiness, which can directly contribu- te to the risk of accidents, cognitive impairment and reduced work performance. It has also been demonstrated that the reduction of gray matter in the brain, especially in the cerebellum, can lead to coordination and driving capacity impairments. Treatment with positive pressure devices improves work performance and reduces the incidence of traffic accidents, but some cognitive deficits may persist even after months of treatment. Assessing the risk of accidents in drivers is a challenge, and current questionnaires are not suitable for screening. Driving simulators and alertness tests show more promise. The future of research is focused on standardizing simulator outcomes, identifying the best predictors of real-world events, and utilizing artificial intelligence and autonomous vehicles to mitigate risks associated with driver drowsiness. It is imperative that the stance of government entities in our Latin American countries is proactive and aimed at safeguarding the health and safety of the population.

Risk stratification for frailty, impairment and assessment of sleep disorders in community-dwelling older adults.

BACKGROUND: Frailty is associated with an increased susceptibility to functional decline, impairment, hospitalization, and mortality among the older adults. However, the potential reversibility of frailty lies in identifying modifiable factors that could prevent, mitigate, or interrupt its progression. While there is a suggestion that sleep disorders may increase the risk of frailty and impairment, the risk stratification of this relationship remains inconclusive. OBJECTIVE: Stratify the risk of frailty and impairment and investigate potential connections with sleep quality, excessive daytime sleepiness, and the risk of obstructive sleep apnea in older adults dwelling in the community. METHODS: This was a quantitative cross-sectional investigation. Frailty risk and impairment were stratified using the Frail Non-disabled Questionnaire (for impairment) and the FRAIL Scale (for Frailty). The assessment of excessive daytime sleepiness, sleep quality, and the risk of obstructive sleep apnea involved the employment of the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and the STOP-BANG questionnaire, respectively. RESULTS: A total of 109 older adults living in the urban area (86 %, p = 0.010), females (61 %; p = 0.030), median age 68 (64-75) years, with overweight (36 %, p < 0.010) and self-identified as belonging to other racial or ethnic categories (71 %, p < 0.010). According to the impairment assessment, 32 % of participants were classified as disable (p < 0.01). Conversely, as per the frailty evaluation, 33 % were pre-frail and 25 % were identified as frail. Additionally, a substantial proportion experienced poor sleep quality (80 %, p = 0.010), exhibited a moderate risk of obstructive sleep apnea (49 %, p < 0.010), and showed no signs of excessive daytime sleepiness (62 %, p < 0.010). There was a modest correlation between frailty and impairment with poor sleep quality (rho = 0.39; p < 0.001) and the risk of obstructive sleep apnea (rho = 0.26; p = 0.000). However, the was no significant relationship was observed between frailty and impairment and excessive daytime sleepiness (rho = 0.04; p = 0.660). Similarly, a modest correlation was observed between sleep quality (rho = 0.33; p < 0.001), the risk of obstructive sleep apnea (rho = 0.27; p = 0.001), and frailty. Conversely, no correlation was found with excessive daytime sleepiness (rho = 0.05; p = 0.590). Also, the poor sleep quality and the risk of obstructive sleep apnea explain 14 % of the risk of frailty in the population of community-dwelling older adults (r2 = 0.14; p = 0.04). CONCLUSION: This study reveals a modest risk of frailty and impairment with sleep quality and the risk of obstructive sleep apnea, but not with excessive daytime sleepiness in community-dwelling older adults.

Assessment of the Relationship between Non-motor features and Severity of Parkinson's Disease Patients in Bangladesh.

Parkinson's disease (PD) is second most common neurodegenerative disorder after Alzheimer's disease that may present with both motor and non-motor symptoms (NMSs). Many of the ignored NMSs may potentiate further deterioration of the patient's quality of life (QoL). But there is scarcity of data regarding NMSs of PD patients and their relationship with the disease severity in Bangladesh. This study was aimed to investigate the frequency of NMSs and assess their debatable impact on the severity of PD patients in Bangladesh. This cross-sectional type of observational study was conducted in neurology department of Dhaka Medical College Hospital, Bangladesh from January 2012 to June 2013 which recruited 60 eligible PD patients. The PD patients and disease severity was demonstrated by UK Parkinson's Disease Society Brain Bank criteria for idiopathic PD and the Hoehn and Yahr scale respectively. Whereas, NMSs were demonstrated by the self-structured questionnaire which had encountered 30 common symptoms of PD. The mean age of our study cohort was found 57.88±10.56 years with male female ration 2:1. According to the Hoehn and Yahr (H & Y) severity scale 38.3%, 38.3%, 20.1% and 3.3% patients had been suffering from stage ?, stage II, stage III and stage ?V Parkinson's disease respectively. Irrespective of the severity of the PD the frequency of NMSs was nocturia (66.7%), sadness or blues (65.0%), memory disturbance (61.7%), anxiety (58.3%), insomnia (56.7%), orthostatic hypotension (55.0%), erectile dysfunction (50.0%), urinary urgency (46.7%), anhedonia (45.0%), olfactory disturbance (38.3%), constipation (38.3%), hyper or hypo sexuality (31.7%) and restless leg syndrome (31.7%). However, after head-to-head NMSs analysis, daytime dribbling of saliva (p=0.024), urinary urgency (p=0.036), nocturia (p=0.001), weight loss (p=0.001), anhedonia (p=0.027), excessive daytime sleepiness (p=0.024), insomnia (p=0.007), vivid dream (p=0.024), REM behavior disorder (p=0.010), restless leg syndrome/ periodic leg movements (p=0.043) had significantly been reported higher among the stage II PD patients than that of stage I patients. Whereas fall (p=0.001), dysphagia or choking (p=0.002), constipation (p=0.003), fecal incontinence (p=0.033), excessive daytime sleepiness (p=0.033), anxiety (p=0.036) and anhedonia (p=0.044) were significantly more prevalent among the advanced stage (III) than stage (II) PD patients. Mean total NMS increased significantly with PD severity based on H and Y staging with a mean NMSQ-T (Non-Motor Symptoms Questionnaire Test) of 5.43 in stage 1, 9.22 in stage 2, 13.75 in stage 3 and 17.0 in stage 4 (p=0.0001). This study revealed that there was high frequency of NMSs among the PD patients and most common symptoms were nocturia, sadness, memory impairment, anxiety, insomnia, orthostatic hypotension, erectile dysfunction, anhedonia, urinary urgency and constipation. Finally, the more advanced disease as indicated by a higher H&Y stage was associated with significantly higher number of reported NMSs.

Exploring the impact of excessive daytime sleepiness caused by obstructive sleep apnea on patient and partner quality of life: a time trade-off utility study in the UK general public.

STUDY OBJECTIVES: This study aimed to quantify the impact of excessive daytime sleepiness (EDS) on patient and patient's partner health-related quality of life in the form of utility values typically used in health economic evaluations. METHODS: A time trade-off study was conducted in a UK general population sample (representing a societal perspective) to elicit utility values, measured on a 0 to 1 scale, for health states with varying obstructive sleep apnea-associated EDS severity. In a time trade-off study, health states are described, and participants "trade off" time in a specific higher severity state for a shorter amount of time in full health. RESULTS: Overall, the sample consisted of 104 participants, who were interviewed and took part in the time trade-off exercise to elicit utility values for patient and partner residual EDS health states. The average utility score declined with increasing obstructive sleep apnea-associated EDS severity for both patient (no EDS, 0.926; mild EDS, 0.794; moderate EDS, 0.614; severe EDS, 0.546) and partner (no EDS, 0.955; mild EDS, 0.882; moderate EDS, 0.751; severe EDS, 0.670) health states. CONCLUSIONS: These results demonstrate the high impact that EDS in obstructive sleep apnea is estimated to have on patient and partner health-related quality of life. CITATION: Tolley K, Noble-Longster J, Mettam S, et al. Exploring the impact of excessive daytime sleepiness caused by obstructive sleep apnea on patient and partner quality of life: a time trade-off utility study in the UK general public. J Clin Sleep Med. 2022;18(9):2237-2246.

Multidimensional assessment and cluster analysis for OSA phenotyping.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a heterogeneous disease with varying phenotype. A cluster analysis based on multidimensional disease characteristics, including symptoms, anthropometry, polysomnography, and craniofacial morphology, in combination with auto-continuous positive airway pressure titration response and comorbidity profiles, was conducted within a well-characterized cohort of patients with OSA, with the aim to refine the current phenotypic expressions of OSA with clinical implications. METHODS: Two hundred ninety-one patients with a new diagnosis of moderate to severe OSA referred for auto-continuous positive airway pressure titration to the sleep center were included for analysis. In-laboratory polysomnography and craniofacial computed tomography scanning were performed, followed by an auto-continuous positive airway pressure titration. The symptom of excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. RESULTS: Three patient phenotypes-normal weight, nonsleepy, moderate OSA; obese, nonsleepy, severe OSA; and obese, sleepy, very severe OSA with craniofacial limitation-were identified. Among the polysomnography parameters, only percentage of N3 time of total sleep time (N3%) and mean pulse oxygen saturation were found to be associated with the Epworth Sleepiness Scale score, and they only explained a small fraction of the variation (R2 = .136). Neck circumference and craniofacial limitation were associated with the more severe phenotype, which had a higher prevalence of hypertension and metabolic syndrome, greater diurnal blood gas abnormalities, and worse positive airway pressure titration response. CONCLUSIONS: Three OSA phenotypes were identified according to multiple aspects of clinical features in patients with moderate to severe OSA, who differed in their prevalence of hypertension, metabolic syndrome, diurnal blood gas parameters, and continuous positive airway pressure titration response. Self-reported excessive daytime sleepiness was not related with the severity of sleep breathing disturbance, and craniofacial limitation was associated with the more severe phenotype. These findings highlight the necessity of integrating multiple disease characteristics into phenotyping to achieve a better understanding of the clinical features of OSA. CITATION: Zhang XL, Zhang L, Li YM, et al. Multidimensional assessment and cluster analysis for OSA phenotyping. J Clin Sleep Med. 2022;18(7):1779-1788.

Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample.

BACKGROUND: Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. METHODS: This study assessed 367 women aged 60-93 years (median 72, interquartile range 65-79) and 451 men aged 60-92 years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. RESULTS: Among women, 50 (13.6%) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR = 2.54, 95% CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p < .001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR = 2.63, 95% CI 1.31-5.30). Among men, 72 (16.0%) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p = 0.06), however, age explained this relationship (age adjusted OR = 2.20, 95% CI 1.03-1.10). CONCLUSIONS: For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.

Validation of the Thai SCOPA-sleep scale for assessment of sleep and sleepiness in patients with Parkinson's disease.

OBJECTIVE: To validate the Thai version of the Scale for Outcomes in Parkinson 's disease-Sleep Scale (SCOPA-Sleep scale)for assessment of nighttime sleep problems (NSP) and daytime sleepiness (DS). MATERIAL AND METHOD: A Thai version of SCOPA-Sleep scale has been developed with the permission of the originator. Fifty-one patients with Parkinson's disease were asked to complete the Thai SCOPA-Sleep scale (consisting of NSP and DS sections), plus the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). A second group of twenty patients completed the Thai SCOPA-Sleep scale, twice, two weeks apart. The reliability and validity were subsequently analyzed. RESULTS: The Thai SCOPA-Sleep scale showed a Cronbach 's alpha coefficient of 0.87 and 0.74 for SCOPA-NSP and SCOPA-DS, respectively with no significant difference between initial and follow-up scores. The content validity of SCOPA-NSP and SCOPA-DS were 0.9 and 0.9, respectively. There was a strong correlation between the Thai SCOPA-NSP and PSQI as well as the Thai SCOPA-DS and ESS (p < 0.01 and p < 0.01, respectively). CONCLUSION: The Thai SCOPA-Sleep scale is a reliable, valid instrument for assessing NSP and DS

Insomnia and long sleep duration are risk factors for later work disability. The Hordaland Health Study.

Both insomnia and sleep duration have previously been linked with a range of adverse outcomes, but no studies have explored their relative effect on subsequent work disability. The aim of the present study was to investigate the contribution of insomnia versus sleep duration to later long-term work disability. Using a historical cohort design with 4-year follow-up, data on insomnia, sleep duration and potential confounders were gathered from 6599 working persons (40-45 years). The outcome was award of disability pension, as registered in the National Insurance Administration. After controlling for baseline exposure to disability and sick leave, insomnia was a strong predictor of permanent work disability [odds ratio (OR) = 4.56], and this effect remained significant after controlling for sleep duration, as well as for other possible confounders (OR = 1.88). Short sleep duration was not significantly associated with subsequent work disability, while long sleep duration (>8.5 h) did predict work disability (OR = 2.96), also in the fully adjusted model (OR = 2.14).The present study demonstrates that both insomnia and long sleep duration are strong and independent risk factors for subsequent work disability.

Driving in Europe: the need of a common policy for drivers with obstructive sleep apnoea syndrome.

Obstructive sleep apnoea syndrome (OSA) increases the risk of motor vehicle crashes, and of all medical disorders, has greatest risk in this respect. There is no consistency in the way OSA is considered by the national 'Physical Fitness to Drive' legislations within the 27 member countries of the European Union (EU), and most ignore OSA. This is further reflected by the absence of any reference to OSA in Annex III of the Directive 91/439/EEC, harmonizing Driving License regulations in the EU. A recent meeting brought together experts from several European and other countries, together with a representative of the European Commission. They discussed the best way to design and implement a uniform policy within Europe, for OSA and driving. It was agreed that: (i) other forms of pathological sleepiness be included, (ii) it covers both private and professional drivers, (iii) police accident report forms should explicitly consider sleepiness as a potential cause, (iv) sleep-wake education should be incorporated into the mandatory program of continuous education for professional drivers, ideally from 2010, (v) driver screening methods should contain questions on sleepiness at the wheel, habitual snoring and witnessed apneas during sleep, as well as the Epworth Sleepiness Score and Body Mass Index and (vi) following effective and efficient treatment, patients should be permitted to drive. In the light of medical, scientific and technical progress, EU procedures exist to enable the rapid modification of existing legislation. If such a procedure could be enacted for these aspects of driver sleepiness, then roads would be safer for 400 million people.

[Factors determining the decision to initiate nCPAP therapy in patients with obstructive sleep apnea (OSA)]. / Analiza czynników determinujacych akceptacje leczenia obturacyjnego bezdechu podczas snu metoda nCPAP.

UNLABELLED: The aim of the study was to determine the factors which influence the decision to initiate nCPAP therapy in patients with OSA. 184 patients with OSA were enrolled to the study. They were divided into two groups: group "T" ("treated") which consisted of 112 patients who were being treated with nCPAP and group "R" (resigned") which consisted of 68 patients who refused nCPAP therapy. The main causes of their refusal were: the possibility of surgical treatment, nCPAP intolerance and high costs associated with the purchase of a nCPAP device. The mean age of the patients was comparable in both groups (49.2 +/- 8.7 vs 50.5 +/- 10.6 yrs). Patients from group T had a significantly higher body weight and BMI than the patients from group R (106.6 +/- 2.1 kg vs 94.1 +/- 20.9 kg, p < 0.0001 and 35.0 +/- 6.3 kg/m2 vs 31.1 +/- 6.3 kg/m2, p < 0.00005 respectively). The patient evaluation included physical examination, a questionnaire concerning symptoms related with OSA and OSA assessment by poly-MESAM, polysomnography (PSG) before and with nCPAP trial therapy. RESULTS: the following parameters obtained in the poly-MESAM recording differed significantly (p < 0.001) between group T and group R: RDI (54.6 vs 41.7), HRV index (24 vs 11), SaO2 min (67.0 vs 75% and SaO2 mean (84 vs 88%). Analysis of the baseline PSG did not reveal differences in sleep structure in both groups. We found a significantly higher AHI in group T (63.6 vs 44.9, p < 0.00005). PSG confirmed a significantly lower SaO2 min and SaO2 mean in group T (67.0 vs 75.0%, p < 0.001 and 89.0 vs 92%, p < 0.00002 respectively) and also revealed a significantly longer total sleep time with SaO2 < 90% in this group (183.0 vs 55.0 min, p < 0.0005). We did not find any differences between both study groups in the parameters obtained in PSG with nCPAP trial therapy. CONCLUSIONS: OSA patients who decide to be treated with nCPAP are more obese, have a higher BMI and demonstrate a more severe disease assessed by PSG.

Assessment of sleep and sleepiness in Parkinson disease.

STUDY OBJECTIVES: To develop a short and practical scale (SCOPA-SLEEP) that evaluates nighttime sleep and daytime sleepiness. The scale is developed for research in Parkinson disease but may be of value for other somatic diseases. DESIGN: Postal survey including 4 instruments, the SCOPA-SLEEP nighttime sleep (5 items) and daytime sleepiness (6 items), the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. SETTING: Movement Disorders Center, Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. PARTICIPANTS: 143 patients with Parkinson disease and 104 controls. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Reliability of the scale was high: internal consistency of the nighttime sleep and daytime sleepiness scales were 0.88 and 0.91, respectively (Cronbach alpha), and test-retest reliabilities were 0.94 and 0.89, respectively (intraclass correlation coefficient). Scale scores differed significantly between patients and controls (P < .001). Construct validity was assessed by correlations with scales that addressed similar constructs. Correlation between the nighttime sleep scale and the Pittsburgh Sleep Quality Index was 0.83 (P < .001), and the correlation between the daytime sleepiness scale and the Epworth Sleepiness Scale was 0.81 (P < .001). Factor analysis revealed 1 factor each for both scales, indicating that the scales measure 1 construct, which justifies the calculation of sumscores. The coefficient of variation of both the nighttime sleep and the daytime sleepiness scale was higher than that of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, indicating a better ability to detect differences between individuals. CONCLUSIONS: The SCOPA-SLEEP is a reliable and valid instrument for assessing nighttime sleep and daytime sleepiness in patients with Parkinson disease.

Sleep disorders in patients with Parkinson's disease: epidemiology and management.

Patients with Parkinson's disease can experience a number of sleep disorders, including insomnia, parasomnias and daytime somnolence [specifically, excessive daytime sleepiness (EDS) and sleep attacks]. Insomnia is a frequent and important complaint of patients with the disease. Both the pathology of Parkinson's disease and dopaminergic drugs may contribute to the much higher than expected frequency of sleep fragmentation and disrupted sleep among these patients. In addition, coexisting depression seems to be a major and frequent risk factor for insomnia in Parkinson's disease. After recognising a sleep problem, the first step in management is to examine and diagnose the type of insomnia and possible medical or psychological factors that may disturb nocturnal sleep. The next step is to give the patient appropriate advice on sleep hygiene. Increasing the dosage of dopaminergic drug treatment will often increase sleep disruption and should be avoided unless the patient's sleep is primarily disturbed by the motor manifestations of parkinsonism during the night. Depression should be looked for and if appropriate be treated in any patients with insomnia. If it becomes necessary to treat the patient with an hypnosedative agent, it is important to use a drug with a short half-life and that manifests as few adverse effects as possible the next morning. Up-to-date guidelines for the use of hypnosedatives should be followed. Patients with Parkinson's disease experience a wide range of parasomnias. The majority of behaviours may be related to rapid eye movement (REM) sleep behaviour disorder (RBD) or to a spectrum of symptoms ranging from vivid dreaming to psychosis. RBD is effectively treated with clonazepam. In addition, the atypical antipsychotics have given physicians new and better treatment options for psychotic symptoms in individuals with Parkinson's disease. EDS is common in Parkinson's disease, while sleep attacks seem to be rare manifestations of the disease or its treatment. Significant EDS is found in 15% of patients with Parkinson's disease compared with in 1% of healthy elderly people. Sleep attacks are observed in patients treated with all dopaminergic medications but have recently been brought to prominence because of their association with the newer dopamine agonists ropinirole and pramipexole. Patients with Parkinson's disease should be informed about the possibility of developing sleep problems during the day when prescribed new drugs. Appropriate actions with regard to driving must be taken if significant and persistent daytime somnolence or sleep attacks appear.