Validity and reliability of the Persian version of the Insomnia Diurnal Impact Scale (IDIS).

BACKGROUND: Insomnia disorder is characterized by nighttime and daytime symptoms. The aim of this study was to assess the validity and reliability of a Persian version of the Insomnia Diurnal Impact Scale (IDIS) as a screening tool to evaluate diurnal effects of sleep fragmentation in Iranians. METHODS: Of 300 individuals recruited, 150 had insomnia disorder based on DSM-5 criteria and 150 were good sleepers based on research diagnostic criteria. All subjects completed the IDIS, Pittsburg Sleep Quality Index, Insomnia Severity Index, Depression-Anxiety-Stress Scale-21, and sleep diaries. RESULTS: The Persian version of the IDIS showed adequate psychometric properties for internal consistency and test-retest reliability. The result of principal component analysis confirmed a single component with six items as the final structure of the scale in the insomniac group. The total IDIS score significantly correlated with the Pittsburg Sleep Quality Index, Insomnia Severity Index, and subscales of Depression-Anxiety-Stress Scale-21 verifying the convergent validity of the scale. The Persian version of the IDIS significantly discriminated the insomniac group from the non-insomniac group. The result of the fit estimates for the one-factor unidimensional model met the previously specified fit criteria and adequately fit the data in the non-insomniac group. CONCLUSION: The Persian version of the IDIS was shown to be a valid and reliable clinical tool in evaluating the daytime consequences of insomnia in Iranians.

The Effectiveness of Transdiagnostic Cognitive Behavioral Therapy for Comorbid Insomnia: A Case Report.

Objective: Similar cognitive and behavioral factors underlie and perpetuate insomnia and emotional disorders. This brief case report aims to evaluate the effectiveness of the Unified Protocol (UP), a transdiagnostic treatment designed to target emotional disorders in treating comorbid insomnia. Method: The patient was a 32-year-old male, who met the DSM-IV-TR criteria for chronic insomnia, major depressive disorder, and generalized anxiety disorder. After 3 baseline weeks, the patient underwent 14 sessions of UP and was retested after 1-month follow-up. Consensus Sleep Diary (CSD), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI) were completed during baseline, treatment, and follow-up. Results: The treatment led to improvements in sleep onset latency, time awake after sleep onset, terminal awakenings, sleep quality, and insomnia severity. These gains were maintained at 1-month follow-up. Conclusion: UP is effective in improving different symptoms of chronic insomnia. Controlled clinical studies with more cases are required to investigate the effects of UP in the treatment of insomnia.

A Comparative study of four Persian versions of sleep questionnaires for screening obstructive sleep apnea syndrome (OSAS).

Background: Diagnosis of obstructive sleep apnea syndrome (OSAS) is valuable, but it is time-consuming and expensive. Appropriate screening instruments help clinicians select high-risk individuals for further investigations. In the present study, we compared 4 popular instruments used in screening OSAS including Berlin, STOP, STOP-BANG questionnaires, and Epworth Sleepiness Scale (ESS). Methods: A total of 250 individuals, who referred to Sleep Laboratory of Shoorideh Hospital (Tehran, Iran) for polysomnography during May 2015 to November 2015, were recruited for this cross-sectional study. In addition to taking history and physical examination, 4 screening instruments including Berlin, STOP, STOP-BANG questionnaires, and ESS were completed. Diagnosis of OSAS was established using apnea-hypopnea index (AHI) in 3 categories of mild, moderate, and severe. Results: Severe OSAS was diagnosed in 159 (63.6%), moderate OSAS in 43 (17.2%), and mild OSAS in 41 (16.4%) of the participants, moreover, AHI was within normal range in the other 7 (2.8%). To diagnose OSAS with any severity, Berlin questionnaire was a preferable instrument, with a sensitivity of 79.8% and specificity of 71.4%, considering the cut-point value of 3.5. In addition, in cases of severe OSAS, Berlin questionnaire showed superiority over other instruments, with a sensitivity of 80.5% and specificity of 61.5% using the cut-point value of 3.5. Conclusion: None of the 4 instruments are ideal to predict OSAS. However, considering the simplicity and availability of the instruments, Berlin and STOP-BANG questionnaires had maximum diagnostic values that helped us distinguish OSAS and severe OSAS, respectively.

Left Ventricular Mass Index and Pulmonary Artery Pressure in Patients with the Obstructive Sleep Apnea Syndrome.

BACKGROUND: Sleep apnea is accompanied by some cardiovascular complications. It has even been hypothesized that sleep apnea, itself, can induce some of these complications. Given such controversies, we assessed the left ventricular mass index (LVMI) and systolic pulmonary artery pressure in patients with sleep apnea. METHODS: Through convenience sampling, 56 patients with the obstructive sleep apnea syndrome (OSAS) were included in the present descriptive cross-sectional study. Patients with any past history of hypertension and diabetes mellitus were excluded. The apnea severity was assessed via the polysomnography-derived apnea-hypopnea index (AHI). All the patients underwent transthoracic echocardiography. In this cross-sectional study - data regarding age, gender, smoking, systolic and diastolic blood pressures, polysomnographic parameters (AHI, severity of disease, mean heart rate, mean oxygen saturation [SaO2], lowest SaO2, and duration of SaO2 below 90% [d.SaO2 < 90%]), and echocardiographic parameters (systolic pulmonary artery pressure and LVMI) were accumulated and processed. RESULTS: Fifty-two men and 14 women at a mean age of 49.29 ± 11.79 years participated in this study. Systolic and was significantly high in the severe group compared with the mild group (128.21 ± 9.73 mmHg vs. 119.23 ± 12.5 mmHg; p value = 0.007). The LVMI was increased parallel to an increase in the severity of the OSAS, but that increase was not statistically significant (p value = 0.161). The d.SaO2 < 90% was positively correlated with the LVMI, and this relationship remained true after adjustment for the body mass index (r = 0.27; p value = 0.042). CONCLUSION: Severe OSAS was accompanied by a higher blood pressure. The LVMI did not differ significantly between the patients with the OSAS and those who did not suffer from other risk factors of cardiac diseases.

Obstructive sleep apnea syndrome and non-arteritic anterior ischemic optic neuropathy: a case control study.

BACKGROUND: Sleep apnea is temporary cessation or absence of breathing during sleep. Significant increase in blood pressure is clinically seen in apneic episodes. The aim of this study was to examine sleep apnea syndrome as a risk factor for non- arthritic anterior ischemic optic neuropathy (NAION) in a case control study. METHODS: Nineteen NAION patients (9 men and 10 women) and 31 age and sex matched control participants (18 men and 13 women) were evaluated for obstructive sleep apnea syndrome (OSAS). Full night polysomnography was performed and proportion of OSAS was compared between the NAION patients and the control group. Other risk factors for NAION such as hypertension, diabetes, hyperlipidemia, ischemic heart disease and tobacco consumption were also evaluated. Chi square test and independent samples t-test were used for statistical analysis. RESULTS: OF the 19 NAION patients, 18 (95%) had OSAS, and of the control group 13 (41.9%) had OSAS. The frequency of OSAS was significantly higher among NAION patients compared to the controls (p< 0.001). The Mean Respiratory Disturbance Index (RDI) was 37.65/h SD= 37.61/h in NAION patients and it was 15.05/h SD= 11.97/h (p= 0.018) in controls. The frequency of diabetes and hypertension was significantly higher in the NAION patients than in controls. CONCLUSION: based on the results of this study, it seems that there is an association between NAION and OSAS.