Excessive sleepiness: under-recognized and essential marker for sleep/wake disorder management

Roth, Thomas; Bogan, Richard; Culpepper, Larry; Doghramji, Karl; Doghramji, Paul P.; Drake, Christopher L.; Grauke, John H.; Knoepflmacher, P; Silvershein, Daniel I.; Thorpy, Michael J.

doi:10.1185/03007995.2010.532544

Cited by 14 publications

(11 citation statements)

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“…Indeed, the prevalence of obstructive sleep apnoea syndrome is lower in our study than in previous general population studies which have employed more definitive diagnostic methods [11,12]. It seems likely therefore that some patients with obstructive sleep apnoea syndrome will have gone unrecognised altogether [13,14,43] although it is also possible that some may have been misdiagnosed as having another sleep problem, in which case they would have been classified firstly as “any sleep problem” and then as a “sleep problems other than sleep apnoea” in this study. However, previous studies indicate that a diagnosis of obstructive sleep apnoea made by a general practitioner is usually correct [14,44].…”

Section: Discussionmentioning

confidence: 54%

“…However, primary care consultation records have been widely used in gout research [1,2,41,42] and, although not undertaken during the current analysis, in a previous study undertaken using consultation data from the CiPCA database, scrutiny of consultation free text recorded by general practitioners confirmed features of inflammation and distribution of affected joints generally consistent with a diagnosis of gout [34]. Diagnosis in primary care is also an important consideration for obstructive sleep apnoea syndrome which is frequently unrecognized [14,43]. Indeed, the prevalence of obstructive sleep apnoea syndrome is lower in our study than in previous general population studies which have employed more definitive diagnostic methods [11,12].…”

Section: Discussionmentioning

confidence: 91%

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The association of gout with sleep disorders: a cross-sectional study in primary care

Roddy

Müller

Hayward

et al. 2013

BMC Musculoskelet Disord

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BackgroundBoth gout and sleep apnoea are associated with the metabolic syndrome. Hyperuricaemia is also prevalent in sleep apnoea syndrome. The objective of this study was to examine the association between gout and sleep apnoea and other sleep disorders.MethodsData were taken from a validated database of general practice records from nine practices in the UK between 2001 and 2008. People consulting for gout were identified via Read codes and each matched with four controls for age, gender, practice and year of gout consultation. Sleep problems and confounding comorbidities were also identified via Read codes. Medications were identified through a linked database of prescription records. The association between gout and sleep disorders was assessed using a logistic regression model, adjusting for ischaemic heart disease, hypertension, diabetes mellitus and diuretic use.Results1689 individuals with gout were identified and each successfully matched to four controls. Amongst those with gout, the prevalence of any sleep problem was 4.9%, sleep problems other than sleep apnoea 4.2%, and sleep apnoea 0.7%, compared to 3.5%, 3.2% and 0.3% respectively in controls. Gout was associated with any sleep problem (odds ratio (OR) 1.44; 95% confidence interval (CI) 1.11, 1.87), sleep problems other than sleep apnoea (OR 1.36; 95% CI 1.03, 1.80), and sleep apnoea (OR 2.10; 95% CI 1.01, 4.39). On multivariable analysis, gout remained significantly associated with any sleep problem (OR 1.39; 95% CI 1.06, 1.81) and sleep problems other than sleep apnoea (OR 1.37; 95% CI 1.03, 1.82), however the association with sleep apnoea was attenuated (OR 1.48, 95% CI 0.70, 3.14).ConclusionsGout and sleep problems appear to be associated and clinicians should be aware of the co-existence of these two conditions. Larger prospective epidemiological studies are required to explore causality.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 91%

The association of gout with sleep disorders: a cross-sectional study in primary care

Roddy

Müller

Hayward

et al. 2013

BMC Musculoskelet Disord

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“…Several clinical trials have shown the ability of oral and intravenous bisphosphonates to reduce the incidence and frequency of SREs and skeletal morbidity and prevent bone loss in patients with breast cancer bone metastasis when administrated alone or in combination with adjuvant therapy (5,19–24). However, results from the recent AZURE (4) trial, in which over 3000 patients with stage II/III breast cancer were randomized to receive standard therapy (chemotherapy, endocrine therapy, radiation) or standard therapy plus 4 mg of ZOL showed no significant difference between patients receiving ZOL in addition to adjuvant therapy compared to patients receiving only standard therapy, in terms of recurrence of breast cancer or on overall survival.…”

Section: Discussionmentioning

confidence: 99%

“…The pathologic complications of bone metastasis can have devastating effects and patients experience debilitating skeletal-related events (SREs), including pathological fractures, hypercalcaemia of malignancy and spinal cord compression. SREs are accompanied by severe bone pain and loss of mobility, which eventually leads to reduction of quality of life and survival (3–5). …”

Section: Introductionmentioning

confidence: 99%

Pharmacologic inhibition of bone resorption prevents cancer-induced osteolysis but enhances soft tissue metastasis in a mouse model of osteolytic breast cancer

Zinonos

Luo

Labrinidis

et al. 2014

International Journal of Oncology

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Osteoprotegerin (OPG) is a secreted member of the TNF receptor superfamily, which binds to the receptor activator of nuclear factor κB ligand (RANKL) and inhibits osteoclast activity and bone resorption. Systemic administration of recombinant OPG was previously shown to inhibit tumor growth in bone and to prevent cancer-induced osteolysis. In this study, we examined the effect of OPG, when produced locally by breast cancer cells located within bone, using a mouse model of osteolytic breast cancer. MDA-MB-231-TXSA breast cancer cells, tagged with a luciferase reporter gene construct and engineered to overexpress full-length human OPG, were transplanted directly into the tibial marrow cavity of nude mice. Overexpression of OPG by breast cancer cells protected the bone from breast cancer-induced osteolysis and diminished intra-osseous tumor growth but had no effect on extra-skeletal tumor growth. This effect was associated with a significant reduction in the number of osteoclasts that lined the bone surface, resulting in a net increase in bone volume. Despite limiting breast cancer-mediated bone loss, OPG overexpression resulted in a significant increase in the incidence of pulmonary metastasis. Our results demonstrate that inhibition of osteoclastic bone resorption by OPG when secreted locally by tumors in bone may affect the behaviour of cancer cells within the bone microenvironment and their likelihood of spreading and establishing metastasis elsewhere in the body.

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“…Nocturia is often not considered among the common sleep problems, but it may have deleterious effects on both sleep and quality of life (20), which was not assessed in this study. Inadequate sleep and excess sleepiness are similarly under-recognized (21) and detrimental to physical and mental health.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Self-Reported Sleep Problems Among People With Diabetes in the United States, 2005-2008

Plantinga

Rao²,

Schillinger³

2012

Prev. Chronic. Dis.

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Introduction Sleep problems, including insomnia, apnea, and restless legs syndrome, are common, burdensome, and under-recognized in the United States. We sought to examine the association of sleep problems with diabetes among community-dwelling US adults. Methods We examined self-reported sleep problems in 9,848 adults (aged ≥20 y) participating in the National Health and Nutrition Examination Survey 2005 through 2008. Sleep problem information was elicited via validated questionnaire. Diabetes was defined by self-reported diagnosis or glycohemoglobin of 6.5% or higher. Multivariable logistic regression with US population-based weighting was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for various sleep problems by diabetes status. Results Sleep problems were common (>90% for any problem; 10%-40% for individual problems) overall, and people with diabetes were more likely than those without diabetes to report multiple problems (mean, 3.1 vs 2.5, respectively, P < .001). After adjustment for potential confounders (including demographics, body mass index, cardiovascular and kidney disease, and alcohol use), restless legs symptoms (OR, 1.40; 95% CI, 1.12-1.78), sleep apnea (OR, 1.45; 95% CI, 1.06-1.98), and nocturia (OR, 1.51; 95% CI, 1.22-1.87) were all positively associated with diabetes status. Conclusion Diabetes is associated with a higher risk of sleep problems, including not only sleep apnea but also inadequate sleep, excessive sleepiness, leg symptoms, and nocturia, independent of body mass index. Clinicians should be aware of the high prevalence of sleep problems among their patients with diabetes and should consider screening and treatment, which may improve patients' quality of life.

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Excessive sleepiness: under-recognized and essential marker for sleep/wake disorder management

Cited by 14 publications

References 91 publications

The association of gout with sleep disorders: a cross-sectional study in primary care

The association of gout with sleep disorders: a cross-sectional study in primary care

Pharmacologic inhibition of bone resorption prevents cancer-induced osteolysis but enhances soft tissue metastasis in a mouse model of osteolytic breast cancer

Prevalence of Self-Reported Sleep Problems Among People With Diabetes in the United States, 2005-2008

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