Impact of lifestyle modifications on snoring and mild sleep apnoea patients.

OBJECTIVE: Behavioural modification through increasing nutritional awareness, along with customised dietary changes and education about physical inactivity, for obese snorers and mildly sleep apnoeic patients would help improve their quality of life. METHODS: A one-year prospective interventional study enrolled snorers and/or mild obstructive sleep apnoea sufferers, with 36 patients each in the test group and control group. Nutritional information and tailor-made diet charts were given to the 36 test subjects. The severity of snoring and daytime sleepiness after 6 and 12 months was compared using the Epworth Sleepiness Scale and Thornton Snoring Scale as measures of quality of life. RESULTS: Subjective scores on both scales showed highly significant improvement (p ≤ 0.001) in the test group. No significant improvement was seen in the control group. CONCLUSION: Awareness of basic nutrition and customised diet plans help to achieve behavioural modification in the long term, resulting in a better quality of life.

"You have to do something": Snoring, sleep interembodiment and the emergence of agency.

Although the sociology of sleep is a growing subfield, little is known about agency in the context of sleep. This article contributes to the sociological literature by showing how different types of agency emerge as a result of sleep interembodiment (i.e., experiencing sleep partners' bodies as intertwined). The study draws on qualitative data generated through in-depth interviews with 70 snorers and 20 sleep partners of snorers. Interviews were conducted in Israel and were analysed following constructivist grounded theory principles. Results indicate that two types of agency coexist and, in fact, co-constitute one another: The first type, herein termed material agency, reflects the post-humanist tradition, which conceptualizes agents as entities (whether human or nonhuman) that alter a state of affairs by making a difference in another agent's action. This type of agency exists in both wakefulness and throughout periods of sleep, as the snorer's body acts and interacts with a partner's body in ways that engender significant change in their lives, relationships, and actions. In contrast, the second type, herein termed reflexive agency, reflects the humanist tradition, which regards agency as individuals' creative and assertive capacities motivated by intentionality and reflexivity. This type of agency declines significantly during stages of deep sleep but re-emerges in response to partners' actions. The article adds to the literature by refining the concept of agency and elucidating its relationship to both accountability and interembodiment. In addition, the article provides much-needed empirical evidence showing how "personal responsibility" for health, as required by neoliberal discourses, is invoked within families, specifically with regard to sleep. This study therefore shows how certain macro-level structures of neoliberalism are enacted and reinforced within micro-level interactions.

Comorbid monosymptomatic nocturnal enuresis and snoring exhibit an additive effect on impairments in health-related quality of life.

INTRODUCTION/BACKGROUND: Health-related quality of life (HRQOL) is a relatively new concept in pediatrics, but it has shown to be extremely important in terms of clinical care, treatment planning, and compliance with medical and behavioral recommendations. Two groups of children who are at risk for impairments in HRQOL are those who have bed-wetting and those who snore or have sleep apnea. OBJECTIVE: The present study sought to determine whether the combination of monosymptomatic nocturnal enuresis (MNE) and sleep-disordered breathing (SDB) results in diminished HRQOL in a pediatric sample. STUDY DESIGN: A retrospective chart review was conducted in an outpatient pediatric urology clinic and in an outpatient pulmonology clinic. Parents of the patients completed the Pediatric Sleep Questionnaire (PSQ) to assess the presence of SDB and snoring, and HRQOL was assessed using the Obstructive Sleep Apnea Syndrome-18-item (OSAS-18) scale, both validated measures, as part of the child's clinical workup. RESULTS: One hundred fifty-two (85 males and 67 females ) patients were included and were categorized into any of the following four groups: (1) MNE only, (2) SDB only, (3) MNE + SDB, or (4) healthy control. Patients in the SDB-only group had significantly more severe SDB than those in the other groups. As such, severity of SDB was controlled for in analyses. Results revealed that the four groups significantly differed on all subscales of the OSAS-18, which are Sleep Disturbance, Physical Symptoms, Emotional Symptoms, Daytime Functioning, and Caregiver Concerns. Post hoc analyses revealed the MNE + SDB group had more impairments on each subscale. Analysis of the total impairments revealed that children with only one condition (MNE or SDB) reported similar levels of impairments in HRQOL and patients with MNE + SBD reported significantly higher levels of impairments, as it appears that these comorbid conditions have an additive effect on HRQOL. DISCUSSION: Children with comorbid MNE and SDB are at significantly higher risk for reporting impairments in their HRQOL than children who have only one of these conditions. While it is already known that children with MNE are at risk for emotional, behavioral, and social difficulties and children with SDB are at risk for neurobehavioral difficulties, it is possible that children with both conditions are at risk for a multitude of negative consequences. CONCLUSION: These data emphasize the importance of urologist screening for SDB and pulmonologist screening for MNE as part of their routine clinical practice.

The Presence of Snoring as Well as its Intensity Is Underreported by Women.

STUDY OBJECTIVES: Women are underrepresented and thus sleep conditions are underdiagnosed at sleep clinics that evaluate sleep-disordered breathing. The most common sign of obstructive sleep apnea (OSA) is snoring; therefore, it is one of the main red flags for suspected OSA. The aim of this study is to determine whether self-reported snoring and snoring intensity by women and men correlates with snoring volume measured objectively during sleep laboratory study. METHODS: Consecutive patients who were referred to a polysomnography (PSG) study in a university hospital over a 2-year period had their snoring volume quantified by means of a calibrated digital sound survey meter. Participants were given a questionnaire in which they were asked to rate the severity of their snoring. The correlation between objective snoring intensity as measured during PSG and the self-reported snoring intensity was evaluated. RESULTS: A total of 1,913 patients were enrolled in the study. A positive correlation was found between objectively measured snoring intensity and the intensity listed by each participant in the questionnaire. Measurement of the volume of snoring revealed that women snored as loudly as men; however, 28% of the females (189/675) considered themselves to be nonsnorers compared to only 6.9% of men (P < .05). Furthermore, 36.5% of women (69/189) who reported themselves as nonsnorers turned out to have severe or very severe snoring intensity, whereas, in contrast, only 11.7% of men (10/85) of men had this discrepancy. These findings are in concordance with the finding that fewer women quantified their snoring as very severe or severe (38.4%), significantly less than men of whom 61.5% reported their snoring to be severe or very severe. CONCLUSIONS: In a population of individuals referred to a PSG study, although no difference in snoring intensity was found between sexes, women tend to underreport the fact that they snore and to underestimate the loudness of their snoring. Improved awareness of this discrepancy may increase women's access to sleep laboratories, and improve diagnostic rates of sleep apnea in females.

The first night effect during polysomnography, and patients' estimates of sleep quality.

We surveyed patients the next morning after in-laboratory polysomnography (PSG) to compare the first night effect (FNE) and reverse first night effect (RFNE) in different sleep disorders. A questionnaire was given to 852 patients with insomnia (n = 171), restless legs syndrome (n = 186), obstructive sleep apnea (n = 369), simple snoring (n = 54), REM sleep behavior disorder (n = 39), and hypersomnia (n = 33). FNE was seen in 48.9%, 30.5% slept as usual, and 20.6% had RFNE. The highest incidences of FNE were seen in OSA, simple snoring, hypersomnia, and in men. We propose to use these findings as a reference when interpreting nocturnal in-laboratory PSG results.

A prospective, non-randomized evaluation of a novel low energy radiofrequency treatment for nasal obstruction and snoring.

BACKGROUND: Weak or inward-bent cartilage of the nasal sidewall at the level of the internal nasal valve (INV) can produce narrowness or collapse of the nasal valve. This is a common cause of impaired nasal breathing during daily activities and there is also an established connection between nasal obstruction and snoring. The condition is often difficult to treat, although even a small enlargement of the lumen at the nasal valve can lead to a significant improvement in the ease of nasal breathing. METHODS: The primary objective of this prospective study was to evaluate the safety and efficacy of the Vivaer system for the treatment of narrowed nasal valves and to measure changes in the symptoms of nasal obstruction and snoring. The Vivaer system uses low energy radiofrequency to remodel the nasal sidewall in order to improve airflow. RESULTS: The study involved 31 patients presenting from 1st September 2017 to 1st May 2018 with symptoms of nasal obstruction and snoring. In all patients, an improvement was observed in nasal breathing measured by NOSE score, sleep quality by SOS questionnaire and quality of life as measured by EQ-5D and SNOT-22. CONCLUSION: Vivaer intranasal remodeling can provide a durable and well-tolerated non-invasive treatment for those patients who are suffering congestion due to narrowness or collapse of the INV.

The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: A literature review.

OBJECTIVE: To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (aged 10-19 years). DATA SOURCES: Searches were performed in MEDLINE, Embase, Health Technology Assessment Database, and National Health Service Economic Evaluation Database for studies that evaluated concepts of symptoms, quality of life (QOL), daily activities, sleep, examination performance, school absenteeism and presenteeism, and treatment burden in adolescents with AR or ARC. STUDY SELECTIONS: English-language journal articles indexed in the last 15 years describing noninterventional, population-based studies. Records were assessed by 2 independent reviewers. RESULTS: A total of 27 articles were identified; outcomes evaluated were symptoms (n = 6 studies), QOL (n = 9), daily activities (n = 5), emotional aspects (n = 3), sleep (n = 6), education (n = 7), and treatment burden (n = 2). AR symptoms rated most bothersome were rhinorrhea, nasal congestion, and itchy eyes. QOL was worse in adolescents with AR vs controls regardless of QOL instrument used. Nasal symptoms and nasal obstruction were more likely to be associated with poor QOL in adolescents than in adults or younger children, respectively. Daily functioning and sleep were also negatively affected by AR. In addition, a detrimental effect on absenteeism, school productivity, and academic performance was reported. CONCLUSION: Although AR and ARC are sometimes perceived as trivial conditions, this review indicates that their effect on adolescent life is negative and far-reaching. It is critical that clinicians gain a greater understanding of the unique burden of AR and ARC in adolescents to ensure they receive prompt and appropriate care and treatment to improve clinical and academic outcomes.

The effects of seasonal affective disorder and alcohol abuse on sleep and snoring functions in a population-based study in Finland.

Seasonal affective disorder (SAD) is a recurrent depressive disorder with a seasonal pattern. In addition to some specific symptoms such as sad mood, low energy or carbohydrate craving, this mood disorder is also characterized by the presence of sleeping problems and alcohol disorders. Interestingly, there is a strong link between alcohol use and sleeping deficits. Although previous studies have focused extensively on the sleep patterns in SAD patients and patients with alcohol use disorder (AUD), no research has yet been conducted on subjects with comorbid SAD and AUD. The aim of this study was to examine the differences in sleep functioning between subjects with SAD, AUD and SAD+AUD. A total of 4554 Finnish subjects from the population-based Health 2011 survey were interviewed, and of these 2430 individuals completed all the questionnaires. We selected those participants who fulfilled the criteria for SAD (n = 298), AUD (n = 359), SAD+AUD (n = 69), controls 1 (no current alcohol use, n = 226) and controls 2 (current alcohol use but not AUD, n = 1445). Controls with a history of alcohol abuse were excluded (n = 33). All the participants completed the EuroQoL five-dimensions questionnaire (EQ-5), the Seasonal Pattern Assessment Questionnaire (SPAQ), the Alcohol Use Disorders Identification Test (AUDIT) and several questions about sleeping, based on the Basic Nordic Sleep Questionnaire (BNSQ). Our results showed that those subjects with SAD+AUD reported the highest levels of subjective sleeping problems compared to controls, SAD and AUD. These findings suggest the relevance of examining the comorbidity of SAD and AUD when studying sleep functioning in these groups of patients.

Frequency of snoring, rather than apnea-hypopnea index, predicts both cognitive and behavioral problems in young children.

OBJECTIVE: Primary snoring (PS) and obstructive sleep apnea (OSA) not only affect the quality of sleep in a large number of young children, but have also been repeatedly associated with a variety of behavioral and cognitive problems. However, little is known about the potentially differing relationships of behavioral and cognitive pathology within the sleep disordered breathing (SDB) spectrum. METHOD: This study examined data from an enriched for snoring community sample of 631 children aged between 4 and 10 years. Multivariate mixed models were used to assess the relationship between both snoring and the apnea-hypopnea index (AHI). Numerous cognitive and behavioral variables were used, while adjusting for several important demographic variables. These were followed by univariate analyses of individual measures and sensitivity analyses. RESULTS: Results indicated that snoring status is a significant predictor of general behavioral (p = 0.008) and cognitive (p = 0.013) domains, even after adjusting for baseline covariates and AHI severity. More frequent snoring was associated with poorer outcomes independent of AHI. However, AHI did not emerge as a significant predictor of the overall cognitive functioning domain (p = 0.377). Additionally, although AHI was a significant predictor of the general behavioral functioning domain (p = 0.008), the significance pattern and nature of its relationship with individual behavioral measures were inconsistent in post-hoc analyses. CONCLUSION: The findings of this study suggest that general behavioral and cognitive function may decline with greater snoring severity. Further, snoring should not simply be assumed to represent a lower severity level of SDB, but should be examined as a potential predictor of relevant outcomes.

Sleep disturbances and cognitive decline in the Northern Manhattan Study.

OBJECTIVE: To examine frequent snoring, sleepiness, and sleep duration with baseline and longitudinal performance on neuropsychological (NP) battery. METHODS: The analysis consists of 711 participants of the Northern Manhattan Study (NOMAS) with sleep data and NP assessment (age 63 ± 8 years, 62% women, 18% white, 17% black, 67% Hispanic) and 687 with repeat NP testing (at a mean of 6 ± 2 years). The main exposures were snoring, sleepiness, and sleep duration obtained during annual follow-up. Using factor analysis-derived domain-specific Z scores for episodic memory, language, executive function, and processing speed, we constructed multivariable regression models to evaluate sleep symptoms with baseline NP performance and change in performance in each NP domain. RESULTS: In the cross-sectional analysis, adjusting for demographics and the NOMAS vascular risk score, participants with frequent snoring had worse executive function (ß = -12; p = 0.04) and processing speed (ß = -13; p = 0.02), but no difference in with episodic memory or language. Those with severe daytime sleepiness (ß = -26; p = 0.009) had worse executive function, but no changes in the other NP domains. There was no cross-sectional association between sleep duration and NP performance. Frequent snoring (ß = -29; p = 0.0007), severe daytime sleepiness (ß = -29; p = 0.05), and long sleep duration (ß = -29; p = 0.04) predicted decline in executive function, adjusting for demographic characteristics and NOMAS vascular risk score. Sleep symptoms did not explain change in episodic memory, language, or processing speed. CONCLUSIONS: In this race-ethnically diverse community-based cohort, sleep symptoms led to worse cognitive performance and predicted decline in executive function.

Sleep of Māori and non-Māori of Advanced Age.

AIM: To estimate prevalence and identify predictors and outcomes of reporting sleep problems in Māori and non-Māori of advanced age. METHOD: Participants were 251 Māori, and 398 non-Māori adults (79-90 years) from Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: A Cohort Study in New Zealand. Multiple logistic regression identified predictors of reporting a current sleep problem and investigated relationships between current sleep problems and physical and mental health. RESULTS: 26.3% of Māori and 31.7% of non-Māori reported a current sleep problem. Reporting a current sleep problem was associated with ethnicity (non-Māori, adjusted OR=0.52, 95% CI=0.30-0.90), and reporting a past sleep problem (adjusted OR=2.67, 95% CI=1.25-5.72). Sleep problems were related to poorer physical and mental health, and falling. CONCLUSION: Sleep problems are commonly reported and associated with poorer health. Early recognition and management of sleep problems could improve physical and mental health.

Predicting poor school performance in children suspected for sleep-disordered breathing.

OBJECTIVE: Habitually snoring children are at a greater risk of poor school performance (PSP). We investigated the ability of conventional sleep-disordered breathing (SDB) measures for predicting PSP in habitually snoring children. METHODS: The dataset of Hannover Study on Sleep Apnea in Childhood (HASSAC), a large community-based study in primary school children, was retrospectively analyzed. All habitual snorers were included. Based on their grades, children were grouped into good and poor school performers. SDB measures obtained by a parental questionnaire, a home pulse oximetry, and a home polysomnography were evaluated for their accuracy in predicting poor school performance by calculating receiver operating characteristic curves and area under this curve (AUC). The most predictive single factors were identified and entered into a prediction model. RESULTS: Of 114 habitual snorers (mean age 9.6 years, 51 boys), 59 had PSP. All investigated SDB measures showed low accuracy (ie, AUC <0.8). The highest AUC observed was 0.686 for a questionnaire score, 0.565 for an oximetry factor, and 0.624 for a polysomnography factor. Of 20 single significant predictors for PSP, five were selected for inclusion into a prediction model. The model reached an unadjusted AUC of 0.826 and an adjusted AUC of 0.851. CONCLUSIONS: Conventional SDB measures obtained with questionnaire, oximetry, or polysomnography may not be sufficiently predictive of PSP in children suspected for SDB. However, combining factors in a clinical prediction model may improve prediction. Results of such a model may be used to assess the risk of developing neurocognitive impairment and to decide whether a child suspected for SDB might benefit from treatment.

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers.

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia.

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia. .

OBJETIVO: avaliar, por meio de tomografias, as mudanças em curto prazo nas vias aéreas superiores e na qualidade de vida em pacientes respiradores bucais, após expansão rápida da maxila (ERM). MÉTODOS: foram avaliados 25 pacientes respiradores bucais com atresia maxilar, com idade média de 10,5 anos, por meio de tomografia computadorizada de feixe cônico (TCFC) e questionário padronizado de qualidade de vida submetido aos pais/responsáveis, antes e imediatamente após a ERM. RESULTADOS: a ERM promoveu uma expansão, de forma semelhante e significativa, tanto na largura do soalho nasal anterior (2,8mm, p < 0,001) quanto na largura do soalho nasal posterior (2,8mm, p < 0,001). No volume aéreo da nasofaringe e fossas nasais, houve aumento significativo (+1646,1mm3 p < 0,001); entretanto, no volume aéreo da orofaringe, houve aumento não significativo (+1450,6 mm3 p = 0,066). Os resultados do questionário de qualidade de vida indicaram melhora significativa na qualidade de vida dos pacientes após a ERM, em comparação ao questionário inicial. CONCLUSÕES: a ERM promoveu aumento dimensional significativo nas fossas nasais e na nasofaringe, bem como melhorou significativamente a qualidade de vida dos pacientes. .

Psychological screening for the children with habitual snoring.

OBJECTIVES: Adenotonsillar hypertrophy is the major determinants of habitual snoring in pediatric population. Behavioral hyperactivity and schooling problems have been repeatedly reported in these children, and it may underlie more extensive behavioral disturbances, particularly for the obese children. The aim of the present study is to evaluate the incidence and characteristics of emotional and behavioral problems using outpatient-based psychological screening tools in the children with habitual snoring. METHODS: Total 235 patients and 170 controls, who aged 4-9 years were enrolled. Body mass index (BMI) z-score was obtained for age and gender and parental sleep-related breathing disorder (SRBD) questionnaire was used to assess severity of sleep-disordered breathing (SBD). Psychological assessment was performed using standardized questionnaires including Strength and Difficulties Questionnaire (SDQ), Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS: Children presenting habitual snoring had significantly higher mean scores on almost all scales of SDQ, and SCARED than community controls. Around 20% of the children with habitual snoring, compared with 10-11% of controls had significant levels of distress that could adversely impact treatment outcomes. There was no interaction between obstructive sleep apnea severity and behavioral ratings. The scores for emotional distress and hyperactivity were more prominent in the obese children. Significant psychological distress or impairment in social interactions was observed in children with higher SRBD scores. CONCLUSIONS: Our findings suggest that the presence of habitual snoring in young children is associated wide spectrum of behavioral problems and the level of psychological distress might be evaluated at the time of the diagnosis.

Polygraphy vs. polysomnography: missing osas in symptomatic snorers--a reminder for clinicians.

PURPOSES: The purposes of this study are to investigate the usefulness of polygraphy (PG) in diagnosing obstructive sleep apnea (OSA) in sleepy/tired snorers compared to polysomnography (PSG) and, further, to search for suspected respiratory arousals in the PG. METHODS: One hundred eighty-seven adults suffering from sleepiness/tiredness and snoring had undergone ambulant PG and were considered to be normal, using American Academy of Sleep Medicine's 2007 hypopnea criteria A. After approximately 7 months, in-lab PSG was performed using hypopnea criteria B, where arousals are also recognized. Validated questionnaires (Hospital Anxiety and Depression Scale, self-rated general health) were answered. In a subgroup, the sensitivity and specificity were calculated for flow limitation index (FLI) and flattening index (FlatI) in PG compared with the respiratory distress index (RDI) in PSG. RESULTS: Despite the normal PG, at PSG, the median RDI was 11.0 (range, 0-89.1). One hundred sixty-eight out of one hundred seventy-eight (90%) were found to have at least mild OSA and 119/187 (64%) with moderate-severe OSA according to the RDI values. The sensitivity and specificity were low (<70%) for FLI and FlatI. Forty-nine percent of the patients rated anxiety at borderline or pathological levels, 35% rated corresponding depression levels, and 45% rated poor or fair general health. CONCLUSIONS: PG was insufficient to rule out OSA when the respiratory events were mainly associated with arousals. Almost half of these patients experience low general health and psychiatric problems. We recommend a full-night PSG when PG is "normal", and patients have symptoms of snoring and sleepiness/tiredness.

Do nocturnal headaches matter? A prospective diary study on subjective sleep parameters in snorers and their bed partners.

BACKGROUND: The objective of this study was to assess the influence of nocturnal headaches (NH) on subjective sleep parameters prospectively in habitual snorers and their bed partners. METHODS: We recruited habitual snorers and their bed partners via newspaper articles. The participants completed a semistructured interview, filled in questionnaires about quality of sleep (PSQI), daytime sleepiness (ESS), depression (SDS) and anxiety (SAS) and they kept a 90-day headache and sleep diary. RESULTS: Seventy-six snorers (25 female) and 41 bed partners (31 female) completed the study recording a total of 6690 and 3497 diary days, respectively. NH were recorded on 222 (3.3%) and 79 (2.2%) days in 32 (42%) snorers and 17 (41%) bed partners, respectively. Snorers with NH showed significantly higher PSQI (5 ± 3 vs. 4 ± 2, p = 0.004), SAS (38 ± 11 vs. 31 ± 10, p = 0.011) and SDS scores (39 ± 12 vs. 34 ± 10, p = 0.048) than snorers without NH. For bed partners with NH we found a significant female predominance (sex ratio f:m = 16:1 vs. 12:12, p = 0.005) and significantly higher SAS scores (38 ± 6 vs. 33 ± 8, p = 0.030) compared with bed partners without NH. The subjective quality of sleep in habitual snorers (p < 0.001) as well as their bed partners (p = 0.017) was negatively influenced by NH, but not total sleep time. DISCUSSION: NH occurred in around 40% of snorers and their bed partners at least once during the 90-day observation period. Our results confirmed a negative impact on the subjective quality of sleep in both groups.

Sleepiness in elderly veterans.

PURPOSE: This observational study seeks to describe the distribution of sleepiness among elderly male veterans and to explain the relationship between sleepiness and age, function, mobility, and depression in this population. METHODS: Veterans who were age 60 or older and had two or more functional limitations based on their activities of daily living or instrumental activities of daily living were recruited in outpatient clinics. They were recruited as part of a longitudinal study and completed questionnaires reported here at the 18-month data collection time point. RESULTS: Veterans report higher sleepiness than normal controls. Self-reported sleepiness scores are similar to those of patients who have been diagnosed with sleep disturbances. CONCLUSIONS: Interventions to identify and support aging veterans with perceived sleepiness should be developed and carefully evaluated.

[Psychiatric evaluation in patients with obstructive sleep apnea syndrome]. / Obstrüktif uyku apne sendromlu hastalarin psikiyatrik açidan degerlendirilmesi.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) might cause neuropsychiatric problems as well as cardiovascular and cerebrovascular complications. Daily life of the patients are effected and their quality of life decreases. In the present study, we aimed to evaluate anxiety and depression and to test their ability to cope with strees in patients with OSAS. MATERIALS AND METHODS: The patients with OSAS suspect admitting to our sleep laboratuary, were classed as simple snoring, mild-moderate and severe OSAS according to their apnea-hypopnea index (AHI). Hospital anxiety and depression, stres coping and skill loss scales were applied to the patients accepted to participate to the study. RESULTS: Fifty four patients participated into the study. Forty-one (75.9%) were OSAS and 13 (24.1%) were simple snoring (control group). Mean age was 52.3 ± 9.2 years in OSAS group, while it was 50.5 ± 9.9 years in control group. Snoring was found in every patient of two groups. Thirty-one (79.5%) patients with OSAS had witnessed apneas and 23 (60.5%) had exceesive OSAS patients had excessive daytime sleepiness. There was no significant differences in age, BMI, sleep efficency, HAD and skill loss scales between both groups. Autism was found higher in OSAS group with stres coping test (p= 0.031). Moreover, social support necessicity was found higher in moderate and severe OSAS patients. CONCLUSION: We found that neuropsyhiatric problems are highly seen in moderate and severe OUAS patients.

Snoring is associated with an impaired motor function, disease severity and the quality of life but not with excessive daytime sleepiness in patients with Parkinson's disease.

OBJECTIVE: There are conflicting results regarding the frequency and clinical significance of sleep related breathing disorders in patients with Parkinson's disease (PD). The aim of this study was to investigate the relationship between snoring and its clinical correlates in patients with PD. METHODS: A total of 93 PD patients and 93 controls were analyzed from a previously conducted cross-sectional study. Snoring was defined as a snoring frequency of ≥ 2 days/week (a score of 2 or higher on the PD Sleep Scale-2 subitem 15). Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of ≥ 10. RESULTS: Snoring was more prevalent in the patients with PD than in the controls (14.0% vs. 1.1%). The PD patients who snored exhibited greater disease severity, worse scores on the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson fatigue scale and more impaired scores in several domains of the Parkinson's Disease Questionnaire, including the domains of mobility, activities of daily living, emotional well-being, communication and bodily discomfort, when compared to those who did not snore. No between-group differences were found in EDS. A higher proportion of the UPDRS motor scores for bradykinesia was seen in the PD patients who snored compared to that observed in the PD patients who did not snore. CONCLUSION: We found that snoring was more frequent in PD patients than in controls. Furthermore, snoring in PD patients was associated with disease severity, an impaired motor function and a decreased quality of life, although it was not associated with EDS.