Comparing MSLT and ESS in the measurement of excessive daytime sleepiness in obstructive sleep apnoea syndrome

Fong, SW; Ho, Crover Kwok Wah; Wing, Yun Kwok

doi:10.1016/j.jpsychores.2004.05.004

Cited by 123 publications

(93 citation statements)

References 23 publications

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“…Others have also demonstrated that the ESS is a poor predictor of the severity of sleep disorders and that the ESS may not reflect sleepiness measured objectively. 33 It is possible that sympathetic hyperstimulation, or anxiety could induce a "hyperalert" state, thereby diminishing the extent of perceived sleepiness. In their study of sleep quality in patients with COPD, Scharf et al 34 found that in spite of a high incidence of selfreported poor sleep quality and insufficient sleep, few patients had excessive sleepiness as measured by ESS.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea in Patients with End-Stage Lung Disease

Romem

Iacono²,

McIlmoyle³

et al. 2013

Journal of Clinical Sleep Medicine

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Objectives:Little is known about the rate of obstructive sleep apnea (OSA) in patients with end stage lung disease (ESLD). Given the potential deleterious effect of OSA in these patients, we assessed the case-rate and severity of OSA and described associated patient characteristics. Methods: Retrospective survey of 60 patients with ESLD referred for lung transplantation evaluation. Demographic, polysomnographic, spirometric, and medication utilization data were extracted and analyzed. Results: As demographic and polysomnographic data did not differ between obstructive and restrictive patients, we present analysis of pooled data. Demographics/physiology: median age was 58.5 years, 52% males, mean BMI 32.3 kg/m 2 , 52% obstructive. Sleep variables (all medians): total sleep time (TST) 312 min, sleep effi ciency 77%, minimal oxygen saturation 84%, apnea hypopnea (AHI) 9.7, respiratory disturbance index (RDI) 12.7 events/h of sleep. Sixty-seven percent had RDI > 5; 21% had RDI between 15 and 30; and 21% had RDI > 30. Periodic limb movement index ≥ 15/h sleep was present in 21.7%. An independent positive correlation between DLCO% and RDI was noted (r = 0.41, p < 0.01). The minimal oxygen saturation was negatively correlated with the RDI (r = -0.34, p < 0.01). The use of ACE inhibitors was associated with moderate-to-severe OSA (odd ratio of 4.67, CI 1.45-15.03; p = 0.017). Conclusions:In patients with ESLD, organic sleep disorders are common. Greater severity of OSA was associated with the higher DLCO% and lower oxygen saturation. keywords: End-stage lung disease, sleep apnea, obstructive lung disease, restrictive lung disease, diffusion capacity, lung transplantation, sleep disorders, oxygen saturation Citation: Romem A; Iacono A; McIlmoyle E; Patel KP; Reed RM; Verceles AC; Scharf SM. Obstructive sleep apnea in patients with end-stage lung disease. J Clin Sleep Med 2013;9(7):687-693.

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Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea in Patients with End-Stage Lung Disease

Romem

Iacono²,

McIlmoyle³

et al. 2013

Journal of Clinical Sleep Medicine

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“…All the subjects completed Beck Depression Inventory (BDI), 17 Ullanlinna Narcolepsy Scale (UNS), 18 Epworth Sleepiness Scale (ESS), 19 and a one-week sleep log. The usage of medications and continuous positive airway pressure (CPAP) were also recorded.…”

Section: Questionnaire Assessment and Hla Typingmentioning

confidence: 99%

Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy

Liu

Lam

et al. 2015

Journal of Clinical Sleep Medicine

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EDS, such as obstructive sleep apnea syndrome (OSAS), 5,6 behaviorally induced insuffi cient sleep syndrome (BIISS), 7 and sleep interruption, 8 can also show similar diagnostic features of narcolepsy on MSLT. It was found that 3.9% to 17% of the general population had multiple SOREMPs, 9,10 and 3.6% could meet the MSLT diagnostic criteria of narcolepsy.11 In other words, the MSLT criteria of ICSD-3 would likely give rise to a high false positive rate in diagnosing narcolepsy. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Recent data suggested that altered sleep stage transition of REM sleep might be able to differentiate narcolepsy from other hypersomnias, but its longitudinal stability and association with HLA typing are unclear. Study Impact: Altered sleep stage transition from stage non-N2/N3 to stage R has good sensitivity and specifi city in diagnosing narcolepsy especially with the help of additional sleep variables in the decision tree analysis, which suggests its clinical utility in the differential diagnosis of hypersomnias. The longitudinal stability and association with HLA DBQ1*0602 further demonstrates that altered sleep stage transition is a trait marker of the instability of NREM-REM sleep regulation in narcolepsy.Objectives: To determine the diagnostic values, longitudinal stability, and HLA association of the sleep stage transitions in narcolepsy. Methods: To compare the baseline differences in the sleep stage transition to REM sleep among 35 patients with type 1 narcolepsy, 39 patients with type 2 narcolepsy, 26 unaffected relatives, and 159 non-narcoleptic sleep patient controls, followed by a reassessment at a mean duration of 37.4 months. Results:The highest prevalence of altered transition from stage non-N2/N3 to stage R in multiple sleep latency test (MSLT) and nocturnal polysomnography (NPSG) was found in patients with type 1 narcolepsy (92.0% and 57.1%), followed by patients with type 2 narcolepsy (69.4% and 12.8%), unaffected relatives (46.2% and 0%), and controls (39.3% and 1.3%). Individual sleep variables had varied sensitivity and specifi city in diagnosing narcolepsy. By incorporating a combination of sleep variables, the decision tree analysis improved the sensitivity to 94.3% and 82.1% and enhanced specifi city to 82.4% and 83% for the diagnosis of type 1 and type 2 narcolepsy, respectively. There was a signifi cant association of DBQ1*0602 with the altered sleep stage transition (OR = 16.0, 95% CI: 1.7-149.8, p = 0.015).

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“…Estudos desenvolvidos têm relatado discrepâncias entre os resultados obtidos com o TMLS e a escala de Epworth (7,19) . Os métodos objetivos são melhores do que a escala de Epworth na avaliação da sonolência diurna em pacientes com síndrome da apnéia obstrutiva do sono (12) . Investigando a hiperssonia em indivíduos com narcolepsia, observou-se que a escala de Epworth não media tão bem os níveis de sonolência como o TMV (20) .…”

Section: Discussionunclassified

“…A sonolência diurna excessiva pode ser investigada por meio de questionários como o de Epworth (7) . No entanto, a avaliação tem maior acurácia quando são utilizados exames objetivos como o teste das múltiplas latências do sono (TMLS) e o teste da manutenção da vigília (TMV) (8)(9)(10)(11)(12)(13)(14) . No entanto, deve-se considerar que fatores psicológicos podem influenciar as metodologias disponíveis para a avaliação da sonolência diurna, em especial fatores motivacionais e penalidades (14) .…”

Section: Introductionunclassified

Estudo da capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília

Sobrinho¹,

Roizenblatt

Lopes

et al. 2008

Rev. Bras. Reumatol.

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Objective: To assess in an objective way the degree of alertness in patients with fibromyalgia through the Maintenance Wakefulness Test ( MWT). Method: Fifteen patients with fibromyalgia and 15 age and sex-matched healthy controls were sequentially selected. The inclusion criteria for fibromyalgia were the presence of at least 11 of the 18 tender points and diffuse pain during three months prior to evaluation. All participants answered the Epworth Sleepiness Scale (ESS) and underwent four 20 minutes sessions of MWT scheduled at 2-hour intervals. Mean sleep latency higher than 20 minutes or lower than 10 minutes was considered normal or pathological, respectively. Results: Although ESS scores did not differ between fibromyalgia patients and controls, the fibromyalgia group showed a significant decrease in the sleep latency by MWT ( 9.9 ± 4.6 and 14.9 ± 5.1, respectively, p = 0.01). Pathological results were obtained in 66.7% of the patients, in comparison to 26.7% of the controls ( p = 0.03). Conclusion: In this pilot study, patients with fibromyalgia showed decrease in the sleep latency by the Wakefulness Maintenance Test.Keywords: fidromyalgia, daytime, excessive sleepiness, maintenance wakefulness test. RESUMOObjetivo: Avaliar, de forma objetiva, a capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília (TMV). Método: Foi realizado um estudo caso-controle de 15 pacientes com diagnóstico de fibromialgia com pelo menos 11 de 18 pontos dolorosos e dor difusa nos últimos três meses. O grupocontrole foi constituído de 15 indivíduos hígidos pareados por idade e sexo, selecionados seqüencialmente. Os participantes responderam à escala de sonolência de Epworth e foram submetidos ao TMV. Foram realizadas quatro captações, cada uma com duração mínima de 20 minutos e com intervalo de duas horas. Considerou-se como normal a latência para o início do sono maior do que 20 minutos, e patológica a latência menor que 11 minutos. Resultados: O grupo com fibromialgia apresentou significante redução da latência para o início do sono no TMV, comparado ao grupo-controle 9,9 ± 4,6 e 14,9 ± 5,1, respectivamente, p = 0,01, sendo que em 66,7% dos casos o resultado foi patológico, em comparação com 26,7% no grupocontrole (p = 0,03). Não se observou correlação entre o resultado do TMV e a idade dos pacientes ou a pontuação na escala de sonolência de Epworth. Conclusão: Neste estudo-piloto, pacientes com fibromialgia apresentam redução da latência do sono no TMV. , Suely Roizenblatt (2) , Antônio Carlos Lopes Palavras, Roberto Cordeiro A. Teixeira (1) , Sergio Tufik INtRODUÇÃOA fibromialgia é uma síndrome dolorosa crônica que acomete 1% a 5% da população em geral (1)(2)(3) . Caracteriza-se por queixa de dor musculoesquelética difusa e pela presença de pontos dolorosos em regiões anatomicamente determinadas. Na maioria dos casos, distúrbios do sono acompanham o quadro que se manifesta como sono fragmentado e não reparador (4) . A presença de despertares intermitentes e a intrusão de o...

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Comparing MSLT and ESS in the measurement of excessive daytime sleepiness in obstructive sleep apnoea syndrome

Cited by 123 publications

References 23 publications

Obstructive Sleep Apnea in Patients with End-Stage Lung Disease

Obstructive Sleep Apnea in Patients with End-Stage Lung Disease

Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy

Estudo da capacidade de manter o alerta em pacientes com fibromialgia por meio do teste da manutenção da vigília

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