Key pointsContinuous positive airway pressure (CPAP) adherence is low among individuals with obstructive sleep apnoea.Type D personality and high scores on the depression and hypochondriasis scales on the Minnesota Multiphasic Personality Inventory (MMPI) have been identified as factors contributing to non-compliance with CPAP.Further research into personality type may assist in understanding why some people adhere to CPAP, while others fail.Obstructive sleep apnoea (OSA) is a condition characterised by repetitive, intermittent partial or complete collapse/obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is highly efficacious in treating OSA but its effectiveness is limited due to suboptimal acceptance and adherence rates, with as many as 50% of OSA patients discontinuing CPAP treatment within the first year. Until recently, research has focused on examining mechanistic and demographic factors that could explain nonadherence (e.g. age, sex, race and education level) with limited applicability in a prospective or clinical manner.More recent research has focused on personality factors or types of patients with OSA who comply and do not comply with CPAP adherence in an attempt to enhance the accuracy of predicting treatment compliance. Type D personality has been found to be prevalent in one third of patients with OSA. The presence of Type D personality increases noncompliance and poor treatment outcomes due to negative affectivity, social inhibition, unhealthy lifestyle, and a reluctance to consult and/or follow medical advice. Conversely, individuals who are more likely to adhere to CPAP treatment tend to have a high internal locus of control and high self-efficacy, self-refer for treatment, and have active coping skills. By assessing personality and coping skills, the clinician may gain insight into the likelihood of a patient’s adherence to treatment. If the patient displays potential risk factors for CPAP noncompliance, the clinician can offer the patient education, refer them to a support group, engage in behavioural/motivational therapy and undertake regular follow-up visits or phone calls incorporating troubleshooting to increase CPAP adherence, especially in individuals with Type D personality.

Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.

No abstract

No abstract

Abstract Small studies in Western populations report a high prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome. To date, ethnic differences have not been explored. A questionnaire sent to 2,752 adults with Down syndrome aged ≥16 years in Scotland and Japan (789 valid responses) estimated OSA prevalence based on reported symptoms. Symptoms were common in both countries, with snoring (p = 0.001) and arousals (p = 0.04) more prevalent in Japan. Estimated OSA prevalence in adults with Down syndrome was similar in the two countries, and raised in comparison with the general adult population (19.6% in Scotland and 14.3% in Japan; p = 0.08), though BMI was a confounder. Identification and treatment of OSA is recommended in adults with Down syndrome, regardless of ethnicity.

Slow wave sleep disorders (SWSD) are unwanted nocturnal behaviors that affect 2% to 5% of adults. 1 The role of alcohol in the pathogenesis of SWSD is controversial, 2 and it has recently been removed as a trigger for these behaviors in the International Classification of Sleep Disorders, Third Edition (ICSD-3). 3 We undertook an audit in our patients with SWSD (n = 126) to examine for association between alcohol and SWSD. A questionnaire reviewing lifestyle factors and triggers that might affect symptom frequency and severity was mailed to patients meeting ICSD-3 3 criteria for non-rapid eye movement parasomnia, identified through a clinical database at our tertiary referral sleep center. Formal ethical approval was deemed unnecessary because this was an audit and questionnaire-return implied consent.The overall response rate was 31% (n = 39). The mean age of responders (40.7 ± 12.7 years) compared to that of nonresponders (36.3 ± 11.1 years) did not differ significantly (P = .39), nor did the sex of the responders (56.4% male, 41.0% female, and 2.6% other) versus nonresponders (48.3% male and 51.7% female) (P = .2).Responders reported the following types of SWSD: 59.0% sleepwalking, 28.2% sleep talking, 23.1% sexsomnia, 20.5% night terrors, 23.1% other (eg, sleep eating). Almost half (46.2%) suffered from more than one type of SWSD.Twelve individuals reported consuming alcohol regularly and 11 (91.7%) of these individuals reported that alcohol increased the frequency of their SWSD (P < .001). Two responders reported that an increase in alcohol intake increased their behaviors, two responders reported that decreasing their alcohol intake decreased their behaviors, and one reported that a decrease in alcohol intake increased the behaviors.Alcohol has been shown to influence both sleep quality and symptoms in patients with SWSD. 4,5 Consuming alcohol increases the amount of slow wave sleep in the first half of the night while increasing arousals in the second half of the night. Chronic alcohol use can lead to significant sleep fragmentation that can persist in the long term, resulting in chronic sleep deprivation.We believe alcohol intoxication can act as a trigger for SWSD because of its effects on sleep architecture, whereas low doses of alcohol could have the opposite effect. Our survey provides support that alcohol can influence symptom expression in patients LETTERS TO THE EDITOR