Health status in subjects with suspected obstructive sleep apnea and comparison with a general population.

The purpose of this study was to assess health status (HS) in patients with clinical suspicion of obstructive sleep apnea (OSA) in order to estimate the dose response relationship between HS and OSA severity, and to compare HS in this clinical cohort with a general population sample (N = 5000). Patients referred to an overnight sleep study due to suspected OSA, whom also responded to the SF-36 questionnaire, were included (N = 418). Of these, 194 showed normal findings, while 111, 60 and 53 demonstrated mild, moderate and severe OSA, respectively. Mean age was 47.5 (SD 11.9) and 69% were males. Only the mental health scale (p = 0.015) and mental component summary score (p = 0.023) were associated with OSA severity. This association, however, disappeared in multivariable analysis. All SF-36 scores in the sleep study group were lower than that of the general population sample, in both unadjusted and multivariable linear regression analysis. In this study, there was a lack of association between OSA severity and general HS. However, as a whole, patients in this clinical population referred to an overnight sleep study due to suspected OSA had impaired HS on all scales compared to a general population, with greatest differences in the vitality domain.

Comparison of Sleep Latency and Number of SOREMPs in the Home and Hospital With a Modified Multiple Sleep Latency Test: A Randomized Crossover Study.

PURPOSE: Comparison of mean sleep latencies and number of sleep-onset rapid eye movement periods (SOREMPs) between modified multiple sleep latency test (MSLT) performed in the unattended home and in-hospital laboratory setting. METHODS: A randomized crossover single-blinded design. Thirty-four subjects referred to MSLT for suspected hypersomnia or narcolepsy were included. Participants were randomized to perform modified MSLT in the unattended home or in the hospital first. Scores in the two settings were compared using Wilcoxon signed-rank test or exact McNemar test. Agreement between home and hospital categorized mean sleep latency and number of SOREMPs was assessed using simple kappa (κ) and proportion agreement. Agreement between home and hospital mean sleep latency was assessed using a Bland-Altman plot and an intraclass correlation coefficient. RESULTS: There was no difference between home and hospital assessment of mean sleep latency (P = 0.86). Two or more SOREMPs were found more frequently on modified MSLTs performed at home compared with those at the hospital (7 and 2, respectively; P = 0.025). Agreement was moderate for categorized sleep latency (κ = 0.53) and fair for categorized SOREMPs (κ = 0.39) in the 2 settings. Analysis of mean sleep latency using intraclass correlation coefficient showed a very good agreement between the two settings. CONCLUSIONS: Group mean sleep latency for home modified MSLTs seems to be reliable compared with that for the attended sleep-laboratory setting. Higher rate of SOREMP in the unattended home suggests that napping in a familiar environment facilitates the transition into REM sleep. Further studies are needed to assess the normal limit, sensitivity, and specificity for SOREMP at home before the clinical utility of home-based napping can be determined.

Sleep problems in Parkinson's disease: a community-based study in Norway.

BACKGROUND: The purpose of this study was to examine the prevalence of sleep problems in a community-based sample of patients with Parkinson's disease (PD) in Norway, and their associated factors. METHODS: 176 consecutive PD outpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson's Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate possible sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS). RESULTS: The mean age was 68.5 years (range 35-90); the mean Hoehn and Yahr stage was 2.11 (SD 0.86), and the mean UPDRS part III was 22.3 (SD 11.7). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS; whereas fatigue, mental health problems, and RLS were associated with PDSS score. CONCLUSIONS: The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS.

Reliability and validity of a Norwegian version of the Epworth sleepiness scale.

OBJECTIVE: The objective of this study was to assess the reliability and validity of a Norwegian version of the self-administered Epworth sleepiness scale (ESS). MATERIALS AND METHODS: Two samples responded to the ESS: (1) 226 patients previously evaluated for obstructive sleep apnea, of whom 51 also responded to a retest 2 weeks later, and (2) 37 ambulant patients complaining of excessive daytime sleepiness, who were referred to multiple sleep latency testing (MSLT). We assessed internal consistency reliability with Cronbach's alpha and test-retest reliability with weighted kappa (Kw) or an intraclass correlation coefficient (ICC). The validity of the Norwegian ESS was assessed by correlating ESS item and total scores with the number of times a patient fell asleep and the mean latency found on the MSLT. RESULTS: Internal consistency reliability, as assessed with Cronbach's alpha, was 0.84 (n = 154). Test-retest reliability for the eight ESS items ranged from Kw of 0.61 to 0.80 (n = 50) and for the total score. ICC was 0.81.There was only fair to moderate correlation of ESS item and total scores with MSLT variables, mainly in a subset of patients with total ESS score >10. CONCLUSIONS: The Norwegian version of the ESS had acceptable internal consistency and test-retest reliability. The association of the ESS items and total score with the MSLT was only fair to moderate, in line with previous studies.