Evaluation of Berlin questionnaire validity for sleep apnea risk in sleep clinic populations

Introduction: The Berlin questionnaire [BQ] is a common tool to screen for Obstructive Sleep Apnea [OSA] in the general population, but its application in the clinical sleep setting is still challenging. The aim of this study was to determine the specificity and sensitivity of the BQ compared to the apnea-hypopnea index obtained from polysomnography recordings obtained from a sleep clinic in Iran

Methods: We recruited 100 patients who were referred to the Sleep Disorders Research Center of Kermanshah University of Medical Sciences for the evaluation of suspected sleep-disorder breathing difficulties. Patients completed a Persian version of BQ and underwent one night of PSG. For each patient, Apnea-Hypopnea Index [AHI] was calculated to assess the diagnosis and severity of OSA. Severity of OSA was categorized as mild when AHI was between 5 and 15, moderate when it was between 15 and 30, and severe when it was more than 30

Results: BQ results categorized 65% of our patients as high risk and 35% as low risk for OSA. The sensitivity and the specificity of BQ for OSA diagnosis with AHI>5 were 77.3% and 23.1%, respectively. Positive predictive value was 68.0% and negative predictive value was 22.0%. Moreover, the area under curve was 0.53 [95% CI: 0.49 - 0.67, P=0.38]

Discussion: Our findings suggested that BQ, despite its advantages in the general population, is not a precise tool to determine the risk of sleep apnea in the clinical setting, particularly in the sleep clinic population

Prevalence of symptoms and risk of obstructive sleep Apnea syndrome in the general population

Obstructive sleep apnea [OSA] syndrome is one of the most common sleep breathing disorders with significant consequences. The present study aims to determine prevalence of symptoms and risk of OSA in the general population of Kermanshah, Iran. From 2007-2008 by random-cluster-sampling, 527 adult subjects were selected from the urban region of Kermanshah. The age range of the sample was from 20 to 87 years. Assessment was carried-out using the Berlin questionnaire, a valid scale that determined those at [high risk] and [low risk] for OSA symptoms. Common symptoms were later defined. There were 144 [27.3%] out of the 527 subjects with a mean age of 48.6_16.6 years and a body mass index [BMI] of 25.1 +/- 3.3 at high risk for OSA [men 19%; women 8.3%]; 261 [49.5%] suffered from snoring with a higher frequency among women [51.5%]. From those who snored during sleep, 51 [10%] reported a breathing pause more than once per week. Subjects considered at high risk had a clinical history of diabetes [15.3%] and heart failure [16.7%].Prevalence of symptoms, risk of OSA and associated factors in Kermanshah are noticeable. Considering the adverse effects of this condition on quality of life, further research in an effort for early diagnosis and treatment are recommended

Gene and environment interaction in familial suicidal behavior: a single family with 4 committed suicides

Family history of suicide is among the strongest predictors of suicide risk. From the context of gene by environment interactions, this manuscript presents a case study of the "M" family, which experienced 4 committed suicides within a short time period. Over the course of 5 years, the father and 3 sons committed suicide. Suicidal ideations developed in several other members of the family. The family's suicide risk appears to have stemmed from both environmental and genetic factors, and likely from an interactive effect between both. Environmental factors included low level of education, opium dependency among male family members, unemployment, and poverty, and limited access to mental health services. Genotype analyses of A218C polymorphism among surviving family members revealed that all individuals were associated with the gene variation [genotypes CC and AC] in tryptophan hydroxylase. The genetic by environmental interaction influence is discussed

Insomnia treatment by Olanzapine. Is sleep state misperception a psychotic disorder?

Offering a new perspective on sleep state misperception, we discuss a patient who presented with sleep state misperception and was ultimately diagnosed with delusional disorder. A 60- year -old woman with chief complaints of insomnia, agitation, and suicidal ideation, was admitted to an inpatient psychiatric ward. Based on information from her family and a mental state examination, her primary diagnosis was sleep state misperception. She was treated with Trazodone. Because she was unresponsive to the treatment, a full psychiatric evaluation and wrist actigraphy report were undertaken, resulting in a revised diagnosis of delusional disorder. She was started on Olanzapine and, after 6 weeks was discharged with good improvement. Sleep state misperception might be considered not just as a sleep disorder, but also as a psychiatric disorder with psychotic symptoms. Further research is recommended

effects of chronic partial sleep deprivation on cognitive functions of medical residents

Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety. Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation [<6 hours of sleep per 24h for 5 consecutive days and nights]. The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: [a] the Wisconsin Card Sorting Test [WCST] to assess abstract reasoning and prefrontal cortex performance; [b] the Time Perception Task [TPT] to assess time estimation and time reproduction skills; and [c] the Iowa Gambling Task [IGT] to assess decision-making ability. The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately [all ps > .05]. These results may have emerged for several possible reasons: [a] chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; [b] fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or [c] our research may have suffered from poor statistical power. Future research is recommended

Serum lipid concentrations in Iranian veterans with combat-related chronic posttraumatic stress disorder

Several studies demonstrated changes in serum lipid concentrations in chronic post traumatic stress disorder [cPTSD] patients. The purpose of this study was to assess serum lipid concentrations in soldiers with cPTSD and compare it with chronic major depressive disorder [cMDD] patients. We measured serum lipid concentrations in patients with cPTSD [n=40] and cMDD [n=40] and compared the results. The patients were all male [30-48 years old] and had an illness history of more than 2 years prior to conducting the study. The groups were matched regarding their body mass index [BMI] and duration of symptoms. Laboratory investigations and psychiatric evaluations were carried-out 5 days after admission. Serum lipid concentrations were measured by enzyme assay [EA]. cPTSD group showed significantly greater mean cholesterol concentrations [227.3 +/- 69.7 mg/dL] than the cMDD group [190.7 +/- 35.4 mg/dL] [p=0.004]. Mean high density lipoprotein cholesterol [HDL-C] concentrations for cPTSD patients [66.6 +/- 17.6 mg/dl] was significantly lower than HDL-C level in cMDD patients [76.5 +/- 19.7 mg/dL] [p= 0.02]. In contrast, mean low density lipoprotein cholesterol [LDL-C] concentrations for cPTSD patients [118.9 +/- 60.1 mg/dL] was significantly higher than LDL-C level in cMDD patients [76.5 +/- 25.2 mg/dL] [p= 0.000]. Although similar differences was noticed on triglycerides concentration [cPTSD; 220.2 +/- 79.0 and cMDD; 201.0 +/- 61.8], it was statistically non-significant [p= 0.23]. Our findings suggest that cPTSD patients are at high risk of developing arteriosclerosis and vascular incident secondary to low levels of HDL-C and high levels of LDL-C