The characteristics of residual excessive sleepiness (RES), defined by an Epworth score .10 in adequately treated apnoeic patients, are unknown.40 apnoeic patients, with (n520) and without (n520) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring.The marked subjective sleepiness in the RES group (mean¡SD score 16.4¡3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies .8 min). Compared with patients without RES, the patients with RES had more fatigue, lower stage N3 percentages, more periodic leg movements (without arousals), lower mean sleep latencies and longer daytime sleep periods. Most neuropsychological dimensions (morning headaches, memory complaints, spatial memory, inattention, apathy, depression, anxiety and lack of self-confidence) were not different between patients with and without RES, but gradually altered from controls to apnoeic patients without and then with RES.RES in apnoeic patients differs markedly from sleepiness in central hypersomnia. The association between RES, periodic leg movements, apathy and depressive mood parallels the post-hypoxic lesions in noradrenaline, dopamine and serotonin systems in animals exposed to intermittent hypoxia.
Cyamemazine showed similar efficacy and tolerability to diazepam for the treatment of alcohol withdrawal symptoms at therapeutic doses in the range 100-300 mg.
Strongly linked to the presence of obesity, the obstructive sleep apnea syndrome is an independent risk factor for abnormalities of glucose metabolism ranging from simple impaired glucose tolerance to type 2 diabetes. It is also a risk factor for dyslipidemia, metabolic syndrome and non-alcoholic fatty liver disease. The pathological mechanisms underlying these associations remain to be precisely discovered, but intermittent hypoxia is probably one of the major factors. The place of obstructive apnea treatment in the management of metabolic conditions remains unclear.
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