The effect of sleep difficulties has achieved a great deal of attention recently, with university students considered as a homogenized population, particularly affected by sleep habits.
The objective of this study was to investigate whether Libyan college students experience sleep disturbance during their academic programmes.
A cross-sectional survey was conducted in the college of Pharmacy, Tripoli University, during February 2010. A total of 201 students, including 179 females (89.05%) and 22 males (10.95%), were recruited from different academic levels. Data were collected using a structured questionnaire and included a number of life-style variables. Epworth Sleepiness Scale (ESS) was used for the assessment of daytime sleepiness.
This study showed that the total sleep time (TST) on a weeknight was 6.40 h and 67 students reported napping during daytime. The TST plus naps totalled 7.39 h. Out of eight possible dozing situations, we found that the mean score for ESS was 8.78. In addition, 79 students showed an ESS score of >10. Furthermore, our results showed that the majority of students (>92%) reported poor sleep satisfaction with quality and duration of sleep hours. Thinking about difficulty of study but not increasing education programs or tea/coffee consumption is associated with sleep difficulties reported. Moreover, 77.6% of students reported an irregular sleep–wake schedule.
These findings indicate that students experienced excessive daytime sleepiness. The TST of pharmaceutical students in Libya, as in other developing countries, is less than those reported by Western students. Students experienced various environmental demands during their college years and, their quality of sleep was negatively affected.
college students; sleep habits; sleep disorders; Epworth Sleepiness Scale
Sleep patterns and habits in high school students in Iran have not been well studied to date. This paper aims to re-address this balance and analyse sleep patterns and habits in Iranian children of high school age.
The subjects were 1,420 high school students randomly selected by stratified cluster sampling. This was a self-report study using a questionnaire which included items about usual sleep/wake behaviours over the previous month, such as sleep schedule, falling asleep in class, difficulty falling asleep, tiredness or sleepiness during the day, difficulty getting up in the morning, nightmares, and taking sleeping pills.
The mean duration of night sleep was 7.7 h, with no difference between girls, boys, and school year (grade). The mean time of waking in the morning was not different between genders. About 9.9% of the girls and 4.6% of the boys perceived their quality of sleep as being bad, and 58% of them reported sleepiness during the day. About 4.2% of the subjects had used medication to enhance sleep. The time of going to bed was associated with grade level and gender. Sleep latency was not associated with gender and grade leve, l and 1.4% experienced bruxism more than four times a week.
Our results are in contrast with that of previous studies that concluded sleep duration is shorter in Asia than in Europe, that boys woke-up significantly later than girls, and that the frequency of sleep latency category was associated with gender and grade level. The magnitude of the daytime sleepiness, daytime sleepiness during classes, sleep latency, and incidences of waking up at night represent major public health concerns for Iran.
The relationship between sleep and headache is meaningful and complex. Children affected by migraines tend to show many sleep disorders, such as insufficient sleep duration and excessive daytime somnolence. Therefore, the aim of this study is to assess the rate of reported sleep habits and self-reported sleepiness in a large pediatric sample of individuals affected by migraine without aura (MoA).
The study population consisted of 271 children aged between 6 and 13 years affected by MoA. The control group was composed of 305 typically developing children. To assess the sleep habits of all individuals (MoA and control), parents filled out the Sleep Disturbance Scale for Children, and to check the degree of subjective perceived daytime sleepiness, all subjects were administered the Pediatric Daytime Sleepiness Scale.
The two study groups were matched for age (P = 0.124), sex distribution (P = 0.775), and body mass index z-score (P = 0.107). Parents of children affected by MoA reported a higher total score of sleep disorder symptoms (P <0.001), disorders of initiating and maintaining (P < 0.001), and disorders of arousal (P < 0.001) than did parents of controls. No significant differences were found in disorders of excessive somnolence. Conversely, in the Pediatric Daytime Sleepiness Scale, migraine children had higher scores (24.67 ± 3.19 vs 11.94 ± 4.81; P < 0.001) and a reduction in referred total sleep time mean duration (469.83 ± 98.112 vs 527.94 ± 83.02; P < 0.001) than typically developing children.
Our study identified differences in sleep habits and found a high prevalence of daytime somnolence in children affected by MoA, suggesting the need for routine sleep screening in the pediatric management of children with migraines.
excessive daytime sleepiness; drowsiness; sleep disorders; migraine without aura; children
Good quality sleep and adequate amount of sleep are important in order to have better cognitive performance and avoid health problems and psychiatric disorders.
The aim of this study was to describe sleep habits and sleep problems in a population of undergraduates, interns and postgraduate students of Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, India.
Subject and Methods:
Sleep habits and problems were investigated using a convenience sample of students from Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, India. The study was carried out during Oct. to Dec. 2011 with population consisted of total 150 medical students. A self-administered questionnaire developed based on Epworth Daytime Sleepiness Scale and Pittsburgh Sleep Quality Index was used. Data was analyzed by using Statistical Package of Social Sciences (SPSS) version 16.0.
In this study, out of 150 medical students, 26/150 (17.3%) students had abnormal levels of daytime sleepiness while 20/150 (13.3%) were border line. Sleep quality in females was better than the male.
Disorders related to poor sleep qualities are significant problems among medical students in our institution. Caffeine and alcohol ingestion affected sleep and there was high level of daytime sleepiness. Sleep difficulties resulted in irritability and affected lifestyle and interpersonal relationships.
Medical students; Sleep disorders; Sleep habits; Sleep quality
Evidence is growing that sleep problems in adolescents are significant impediments to learning and negatively affect behaviour, attainment of social competence and quality of life. The objectives of the study were to determine the level of sleepiness among students in high school, to identify factors to explain it, and to determine the association between sleepiness and performance in both academic and extracurricular activities
A cross-sectional survey of 2201 high school students in the Hamilton Wentworth District School Board and the Near North District School Board in Ontario was conducted in 1998/9. A similar survey was done three years later involving 1034 students in the Grand Erie District School Board in the same Province. The Epworth Sleepiness Scale (ESS) was used to measure sleepiness and we also assessed the reliability of this tool for this population. Descriptive analysis of the cohort and information on various measures of performance and demographic data were included. Regression analysis, using the generalised estimating equation (GEE), was utilized to investigate factors associated with risk of sleepiness (ESS>10).
Seventy per cent of the students had less than 8.5 hours weeknight sleep. Bedtime habits such as a consistent bedtime routine, staying up late or drinking caffeinated beverages before bed were statistically significantly associated with ESS, as were weeknight sleep quantity and gender. As ESS increased there was an increase in the proportion of students who felt their grades had dropped because of sleepiness, were late for school, were often extremely sleepy at school, and were involved in fewer extracurricular activities. These performance measures were statistically significantly associated with ESS. Twenty-three percent of the students felt their grades had dropped because of sleepiness. Most students (58–68%) reported that they were "really sleepy" between 8 and 10 A.M.
Sleep deprivation and excessive daytime sleepiness were common in two samples of Ontario high school students and were associated with a decrease in academic achievement and extracurricular activity. There is a need to increase awareness of this problem in the education and health communities and to translate knowledge already available to strategies to address it.
An irregular bedtime schedule is a prevalent problem in young adults, and could be a factor detrimentally affecting sleep quality. The goal of the present study was to explore the association between an irregular bedtime schedule and sleep quality, daytime sleepiness, and fatigue among undergraduate students in Taiwan.
A total of 160 students underwent a semi-structured interview and completed a survey comprising 4 parts: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and a rating of irregular bedtime frequency. Participants were grouped into 3 groups in terms of irregular bedtime frequency: low, intermediate, or high according to their 2-week sleep log. To screen for psychological disorders or distress that may have affected responses on the sleep assessment measures, the Chinese health questionnaire-12 (CHQ-12) was also administered.
We found an increase in bedtime schedule irregularity to be significantly associated with a decrease in average sleep time per day (Spearman r = -0.22, p = 0.05). Multivariate regression analysis revealed that irregular bedtime frequency and average sleep time per day were correlated with PSQI scores, but not with ESS or FSS scores. A significant positive correlation between irregular bedtime frequency and PSQI scores was evident in the intermediate (partial r = 0.18, p = 0.02) and high (partial r = 0.15, p = 0.05) frequency groups as compared to low frequency group.
The results of our study suggest a high prevalence of both an irregular bedtime schedule and insufficient sleep among university students in Taiwan. Students with an irregular bedtime schedule may experience poor sleep quality. We suggest further research that explores the mechanisms involved in an irregular bedtime schedule and the effectiveness of interventions for improving this condition.
The clear association between reports of sleep disturbance and poor school performance has been documented for sleepy adolescents. This study extends that research to students outside the adolescent age grouping in an associated school setting (98 middle school students, 67 high school students, and 64 college students). Reported restless legs and periodic limb movements are significantly associated with lower GPA's in junior high students. Consistent with previous studies, daytime sleepiness was the sleep variable most likely to negatively affects high school students. Sleep onset and maintenance insomnia were the reported sleep variables significantly correlated with poorer school performance in college students. This study indicates that different sleep disorder variables negatively affect performance at different age and educational levels.
adolescent; college; sleep; restless legs; school; insomnia; GPA
Student admission into the College of Medicine at King Saud University (KSU) is dependent on the achievement of a grade point average (GPA) of ≥3.5 /5 by the end of the premedical year. This study was undertaken to ascertain whether pre-selected medical students who achieve a relatively low GPA (≤3.75/5) in the premedical year are at risk of having academic difficulties in subsequent years.
A cross-sectional study of all students admitted to the College of Medicine at KSU during 5 academic years (1994 to 1998) was conducted in 2004. The likelihood of completing the program by 2004 and the dropout frequency were compared in the two groups based on their GPA in the premedical year: High GPA (>3.75) and Low GPA (≤3.75).
During the study period, 739 students were admitted to the college. Of these, 619 (84%) were in High GPA group, and 120 (16%) in the Low GPA group. Of the students with High GPA, 545 (88%) out of 619 graduated compared with 79 (66%) of 120 in the Low GPA group (OR 3.822 [95% CI: 2.44, 5.99]: P<0.0001). Overall, 28 students (3.8%) dropped out, but there was a significantly greater frequency of dropping out in the Low GPA group (10/120; 8.3%) compared with the High GPA group (18/619; 2.9%: OR 3.035 [95% CI: 1.37, 6.75], P=0.01).
Our results support the prerequisite of a minimum GPA in the premedical year before proceeding to the higher levels. The GPA of premedical year is a useful predictor of students who need close monitoring and academic support. The use of GPA in the premedical year for admission into medical colleges should help optimize the use of resources and reduce student wastage.
Medical student selection; GPA; Pre-medical year; drop-out; academic performance
A survey of sleep schedules, sleep health, and the impact on school performance was conducted in 585 adolescents in a high school in China. A high level of early and circadian-disadvantaged sleep/wake schedules during weekdays was observed. Significantly shorter sleep duration on weekdays was reported (P < 0.0001). Older teenagers slept significantly less than the younger teenagers (P < 0.0001). Complaints of inadequate sleep and sleepiness during weekdays were prevalent. Night awakenings were reported in 32.2% of students. Students with a sleep length of less than 7 hours, complaint of inadequate sleep, or excessive daytime sleepiness during weekdays were more likely to report an adverse effect of poor sleep on performance. The present observations are qualitatively similar to those reported in our study in American adolescents, particularly with respect to Chinese adolescents exhibiting a similar sleep deficiency on weekdays. We concluded that sleep deficiency and sleep health problems were prevalent in the participating adolescents in China, and were perceived to adversely affect school performance.
sleep deprivation; sleep health problem; adolescents; school performance
Sleep and wake have a homeostatic relation that influences most aspects of physiology and waking behavior. Sleep disturbance has a detrimental effect on sleepiness and psychomotor vigilance. The purpose of this study was to identify which actual or perceived sleep characteristics accounted for the most variance in daytime functioning among postpartum mothers. Seventy first-time postpartum mothers' actual sleep (actigraphically estimated: total sleep time, number of wake bouts, length of nocturnal wake, and sleep efficiency) and perceived sleep (self-reported: number of awakenings, wake time, and sleep quality) was measured along with their daytime functioning (Stanford Sleepiness Scale [SSS], Epworth Sleepiness Scale [ESS], Visual Analogue of Fatigue Scale [VAFS], and morning Psychomotor Vigilance Test [PVT]). Data were repeatedly collected from the same sample during postpartum weeks 2, 7, and 13. Four stepwise linear regressions were calculated for each postpartum week to examine which objective and/or subjective variable(s) accounted for the most variance in daytime functioning. The SSS and VAFS were both most consistently associated with perceived sleep quality. The ESS was most consistently associated with actual total sleep time. PVT performance was most consistently associated with estimates of actual and perceived sleep efficiency. Actual and perceived sleep profiles were differentially associated with specific daytime functions. These results from postpartum mothers may indicate that populations who experience specific forms of sleep disturbance (e.g. fragmentation, deprivation) may also experience specific daytime conditions.
Actual; actigraphy; subjective; objective; perceived; sleep; sleepiness; fatigue; performance; behavior; postpartum; maternal
An adult cohort with tuberous sclerosis complex was investigated for the prevalence of sleep disturbances and the relationship with seizure variables, medication, and psychological functioning. Information on 35 adults was gathered using four questionnaires: Epworth Sleepiness Scale (ESS), Sleep and Epilepsy Questionnaire (SEQ), Sleep Diagnosis List (SDL), and Adult Self-Report Scale (ASR). In addition, clinical, genetic and electrophysiological data were collected. Of 35 respondents, 25 had a history of epilepsy. A subjective sleep disorder was found in 31% of the cohort. Insomnia scores showed a significant positive correlation with obstructive sleep apnea syndrome and restless legs syndrome scores. Significant correlations were found between daytime sleepiness and scores on depression, antisocial behavior, and use of mental health medication. A subgroup using antiepileptic medication showed high correlations between daytime sleepiness, attention deficits, and anxiety scores.
Epilepsy; Sleep; Tuberous sclerosis complex; Behavior
To examine the relationship between depressive symptoms and subjective and objective sleep in older women.
Four US clinical centers.
3045 community-dwelling women ≥70 years.
Depressive symptoms were assessed with the Geriatric Depression Scale categorizing participants as “normal” (0–2, referent), “some depressive symptoms” (3–5), or “depressed” (≥6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep measures were assessed with wrist actigraphy.
In multivariable-adjusted models, there were graded associations between increased level of depressive symptoms and both worse subjective sleep quality and more subjective daytime sleepiness (p-trends <0.001). Women with some depressive symptoms (OR 1.82, CI 1.48–2.24) and depressed (OR 2.84, CI 2.08–3.86) women had greater odds of reporting poor sleep (PSQI>5). Women with some depressive symptoms (OR 1.97, CI 1.47–2.64) and depressed women (OR 1.70, CI 1.12–2.58) had greater odds of reporting excessive daytime sleepiness (ESS>10). There were also graded associations between increased level of depressive symptoms and objectively measured wake after sleep onset (WASO) (p-trend = 0.030) and long wake episodes >5 minutes (p-trend 0.006). Depressed women had modestly increased odds of WASO ≥1 hour (OR 1.37, CI 1.03–1.83). Women with some depressive symptoms (OR 1.49, CI 1.19–1.86) and depressed women (OR 2.04, CI 1.52–2.74) had greater odds of being in the highest quartile for number of nap episodes >5 minutes. No associations between depressive symptom level and prolonged sleep latency, reduced sleep efficiency, or reduced or increased total sleep time were found.
Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping.
Depression; sleep; actigraphy; elderly; age
A survey on sleep schedule, sleep health, school performance and school start times was conducted in 1,941 adolescents. A high level of early and circadian-disadvantaged sleep/wake schedules during weekdays was observed. Shorter sleep duration on weekdays was reported, especially in upper classmen. Complaints of inadequate sleep and sleepiness during weekdays, alarm clock use, and napping were prevalent. Night awakening and prolonged sleep onset were common and associated with poor school performance. Students with a sleep length of less than 7 hours on both weekdays and weekends exhibited poorer performance, while those who made up this sleep loss on weekends did not. The total number of poor sleep factors in an individual also correlated with poor school performance. Earlier school start times were associated with a perception of poor sleep quality, shorter sleep duration and more sleep health problems. We conclude that sleep inadequacies and sleep health problems were prevalent in this population, especially in those who started school earlier in the morning, and that these poor sleep factors were associated with school performance.
sleep deprivation; sleep health problem; adolescents; performance; school start time
In this report we describe the relationships between daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue in a sample of 128 individuals; we are reporting the baseline results of a longitudinal observational study. We examined sleep using the Pittsburg Sleep Quality Index (PSQI) (a measure of the quality of nighttime sleep), and the Epworth Sleepiness Scale (ESS), (a measure of daytime sleepiness). Recent stressful life events were measured via a methodology developed in a previous 9-year HIV study. Poor nighttime sleep was significantly correlated with fatigue intensity (r = 0.46, p < 0.05), as was daytime sleepiness (r = 0.20, p < 0.05). However, in multiple regression models, the association between stress and fatigue intensity was not explained by daytime sleepiness and was only partially explained by nighttime sleep quality. Further research is needed to better elucidate these relationships.
daytime sleepiness; HIV-related fatigue; nighttime sleep; stressful life events
Consequences of chronic exposure to cytokines of the innate immune system on sleep in humans and the association of cytokine-induced sleep alterations with behavior, motor performance and cortisol secretion are unknown.
Thirty-one patients with hepatitis C without pre-existing sleep disorders underwent nighttime polysomnography, daytime multiple sleep latency testing, behavioral assessments, neuropsychological testing and serial blood sampling at baseline and after ~12 weeks of either treatment with the innate immune cytokine, interferon (IFN)-alpha (n=19) or no treatment (n=12). Fatigue and sleepiness were assessed using the Multidimensional Fatigue Inventory and Epworth Sleepiness Scale.
IFN-alpha administration led to significant increases in wake after sleep onset and significant decreases in Stage 3/4 sleep and sleep efficiency. REM latency and Stage 2 sleep were significantly increased during IFN-alpha treatment. Decreases in Stage 3/4 sleep and increases in REM latency were associated with increases in fatigue, whereas decreases in sleep efficiency were associated with reduced motor speed. Increased wake after sleep onset was associated with increased evening plasma cortisol. Despite IFN-alpha-induced increases in fatigue, daytime sleepiness did not increase. In fact, IFN-alpha-treated patients exhibited decreased propensity to fall asleep during daytime nap opportunities.
Chronic exposure to an innate immune cytokine reduced sleep continuity and depth, and induced a sleep pattern consistent with insomnia and hyperarousal. These data suggest that innate immune cytokines may provide a mechanistic link between disorders associated with chronic inflammation including medical and/or psychiatric illnesses and insomnia, which in turn is associated with fatigue, motor slowing and altered cortisol.
Sleep; insomnia; hyperarousal; polysomnography; fatigue; depression; interferon-alpha; hepatitis C; neuropsychology; cortisol; cytokines
Despite its clinical importance, the issue of subjective sleep quality in children remains unexplored. Here we investigate, in school-aged children, the prevalence of bad sleep perception and its relationships with sleep habits and daytime functioning, to provide hints on its possible determinants. Subjective sleep perception, sleep habits, and daytime functioning were studied through a questionnaire survey in a sample of 482 children (6–12 yrs.). Being “bad sleeper” was reported by 6.9% of the sample. Compared to the “good sleepers”, these subjects displayed shorter sleep duration on schooldays, longer sleep latencies, and a more pronounced evening preference, beyond more frequent insufficient sleep. Though no differences emerged in sleepiness, bad sleepers showed higher impairments in daytime functioning, indicated by more frequent depressed mood and impulsivity. These distinctive features might be very important to precociously detect those children who are possibly more vulnerable to sleep disturbances and whose sleep-wake rhythms evolution should be paid particular attention thereafter.
“The good people sleep much better at night than the bad people.Of course, the bad people enjoy the waking hours much more”Woody Allen
The well-known excessive daytime sleepiness (EDS) assessment, Epworth Sleepiness Scale (ESS), is not consistently qualified for patients with diverse living habits. This study is aimed to build a modified ESS (mESS) and then to verify its feasibility in the assessment of EDS for patients with suspected sleep-disordered breathing (SDB) in central China.
A Ten-item Sleepiness Questionnaire (10-ISQ) was built by adding two backup items to the original ESS. Then the 10-ISQ was administered to 122 patients in central China with suspected SDB [among them, 119 cases met the minimal diagnostic criteria for obstructive sleep apnea by sleep study, e.g., apnea and hypopnea index (AHI) ≥ 5 h−1] and 117 healthy central Chinese volunteers without SDB. Multivariate exploratory techniques were used for item validation. The unreliable item in the original ESS was replaced by the eligible backup item, thus a modified ESS (mESS) was built, and then verified.
Item 8 proved to be the only unreliable item in central Chinese patients, with the least factor loading on the main factor and the lowest item-total correlation both in the 10-ISQ and in the original ESS, deletion of it would increase the Cronbach’s alpha (from 0.86 to 0.87 in the 10-ISQ; from 0.83 to 0.85 in the original ESS). The mESS was subsequently built by replacing item 8 in the original ESS with item 10 in the 10-ISQ. Verification with patients’ responses revealed that the mESS was a single-factor questionnaire with good internal consistency (Cronbach’s alpha = 0.86). The sum score of the mESS not only correlated with AHI (P < 0.01) but was also able to discriminate the severity of obstructive apnea (P < 0.01). Nasal CPAP treatment for severe OSA reduced the score significantly (P < 0.001). The performance of the mESS was poor in evaluating normal subjects.
The mESS improves the validity of ESS for our patients. Therefore, it is justified to use it instead of the original one in assessment of EDS for patients with SDB in central China.
Epworth Sleepiness Scale; Excessive daytime sleepiness; Sleep-disordered breathing
Despite routine use with older adults, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) have not been adequately validated in older samples, particularly those from diverse racial backgrounds. The objective of this study was to determine the reliability and validity of and to provide normative data for these questionnaires in community-dwelling older women.
Participants were 306 black and 2,662 white women aged ≥70 from the Study of Osteoporotic Fractures. Participants completed the PSQI and ESS, and provided self-reported assessments of mood, cognition, and functioning, and underwent wrist actigraphy for sleep-wake estimation.
Good internal consistency in both black and white women was demonstrated for the PSQI and ESS. Two PSQI subscales, however, were found to have inadequate reliability (Medications, Daytime Dysfunction). Both the PSQI and ESS were associated with theoretically similar measures in the expected directions. The PSQI also differentiated participants with no reported sleep disorder from those reporting at least one sleep disturbance, such as insomnia, sleep apnea, and restless legs. The ESS only differentiated women reporting no sleep disorder from those reporting insomnia.
In general, findings suggest that the PSQI and ESS are internally consistent, valid measures of self-reported sleep conditions problems in older women. Additional research is required to evaluate the impact of removing the Medications and Daytime Dysfunction PSQI subscales on this measure's internal consistency in older women.
sleep; geriatric assessment; actigraphy; oldest old; women; aged
Hypersomnia, a complaint of excessive daytime sleep or sleepiness, affects 4% to 6% of the population, with an impact on the everyday life of the patient Methodological tools to explore sleep and wakefulness (interview, questionnaires, sleep diary, polysomnography Multiple Sleep Latency Test, Maintenance of Wakefulness Test) and psy-chomotor tests (for example, psychomotor vigilance task and Oxford Sleep Resistance or Osier Test) help distinguish between the causes of hypersomnia. In this article, the causes of hypersomnia are detailed following the conventional classification of hypersomnic syndromes: narcolepsy, idiopathic hypersomnia, recurrent hypersomnia, insufficient sleep syndrome, medication- and toxin-dependent sleepiness, hypersomnia associated with psychiatric disorders, hypersomnia associated with neurological disorders, posttraumatic hypersomnia, infection (with a special emphasis on the differences between bacterial and viral diseases compared with parasitic diseases, such as sleeping sickness) and hypersomnia, hypersomnia associated with metabolic or endocrine diseases, breathing-related sleep disorders and sleep apnea syndromes, and periodic limb movements in sleep.
narcolepsy; idiopathic hypersomnia; recurrent hypersomnia; insufficient sleep syndrome; periodic limb movements in sleep; sleep apnea syndrome; human African trypanosomiasis; infectious disease
Increased daytime sleepiness is an important symptom of obstructive sleep apnea (OSA). OSA is frequently underdiagnosed, and the Epworth Sleepiness Scale (ESS) can be a useful tool in alerting physicians to a potential problem involving OSA.
To measure the prevalence and determinants of daytime sleepiness measured using the ESS in a rural community population.
A community survey was conducted to examine the risk factors associated with ESS in a rural population in 154 households comprising 283 adults. Questionnaire information was obtained regarding physical factors, social factors, general medical history, family medical history, ESS score, and self-reported height and weight. Multivariable binary logistic regression analysis based on the generalized estimating equations approach to account for clustering within households was used to predict the relationship between a binary ESS score outcome (normal or abnormal) and a set of explanatory variables.
The population included 140 men (49.5%) and 143 women (50.5%) with an age range of 18 to 97 years (mean [± SD] 52.0±14.9 years). The data showed that 79.2% of the study participants had an ESS score in the normal range (0 to 10) and 20.8% had an ESS score >10, which is considered to be abnormal or high sleepiness. Multivariable regression analysis revealed that obesity was significantly associated with an abnormal or high sleepiness score on the ESS (OR 3.40 [95% CI 1.31 to 8.80).
High levels of sleepiness in this population were common. Obesity was an important risk factor for high ESS score.
Epworth Sleepiness Scale; Obesity; Rural; Snoring
To investigate age-related changes in sleepiness symptoms associated
with sleep disordered breathing (SDB).
Wisconsin Sleep Cohort participants were assessed with
polysomnography, Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency
Test (MSLT). SDB was defined as an apnea/hypopnea index≥15
events/hour, sleepiness as ESS≥10 and MSLT≤5 minutes. Odds
ratios were calculated using generalized estimating equations associating
sleepiness with SDB, and conditional logistic regression examining changes
in longitudinal sleepiness status (ESS only). Models were, a priori,
stratified by gender.
ESS was measured in 1281 participants and MSLT in 998, at multiple
time points (ESS n=3695; MSLT n=1846). Significant interactions were found
between SDB and age in men, but not women. The odds ratios (OR) modeled for
sleepiness in a 40 year old male with SDB were significant, compared to a
male without SDB (OR: ESS 2.1; MSLT 2.9); however, these associations were
not significant at 60 years. The within-subject odds ratio for sleepiness
was also significant at 40 years (OR: 3.4), but not at 60 years.
The age-related reductions in the association between sleepiness and
SDB may have clinical implications for the diagnosis and treatment of SDB in
older people since sleepiness is often used as a therapeutic marker.
Sleep disordered breathing; Obstructive sleep apnea; Aging; Sleepiness
Muslims are required to wake up early to pray (Fajr) at dawn (approximately one and one-half hours before sunrise). Some Muslims wake up to pray Fajr and then sleep until it is time to work (split sleep), whereas others sleep continuously (consolidated sleep) until work time and pray Fajr upon awakening.
To objectively assess sleep architecture and daytime sleepiness in consolidated and split sleep due to the Fajr prayer.
SETTING AND DESIGN:
A cross-sectional, single-center observational study in eight healthy male subjects with a mean age of 32.0 ± 2.4 years.
The participants spent three nights in the Sleep Disorders Center (SDC) at King Khalid University Hospital, where they participated in the study, which included (1) a medical checkup and an adaptation night, (2) a consolidated sleep night, and (3) a split-sleep night. Polysomnography (PSG) was conducted in the SDC following the standard protocol. Participants went to bed at 11:30 PM and woke up at 7:00 AM in the consolidated sleep protocol. In the split-sleep protocol, participants went to bed at 11:30 PM, woke up at 3:30 AM for 45 minutes, went back to bed at 4:15 AM, and finally woke up at 7:45 AM. PSG was followed by a multiple sleep latency test to assess the daytime sleepiness of the participants.
There were no differences in sleep efficiency, the distribution of sleep stages, or daytime sleepiness between the two protocols.
No differences were detected in sleep architecture or daytime sleepiness in the consolidated and split-sleep schedules when the total sleep duration was maintained.
Consolidated sleep; daytime sleepiness; Fajr prayer; sleep architecture; split sleep
Delayed sleep phase syndrome (DSPS) is a circadian rhythm sleep disorder in which the timing of the sleep episode occurs later than desired and is associated with difficulty falling asleep, problems awakening on time (e.g., to meet work or school obligations), and daytime sleepiness. The phase relationship between the timing of sleep and endogenous circadian rhythms is critical to the initiation and maintenance of sleep, and significant alteration leads to impairment of sleep quality and duration. The aim of this retrospective study was to determine the phase relationship between sleep-wake times and physiological markers of circadian timing in clinic patients with DSPS. Objective and subjective measures of sleep timing and circadian phase markers (core body temperature and melatonin) were measured in patients with DSPS and compared with age-matched controls. As expected, significant delays in the timing of the major sleep episode and circadian phase of body temperature and melatonin rhythms were seen in the DSPS group when allowed to sleep at their own habitual schedules, but the phase relationship between sleep-wake times and circadian phase was similar between the two groups. These results suggest that the symptoms of insomnia and excessive daytime sleepiness in DSPS patients living under entrained real-life conditions cannot be explained by an alteration in the phase relationship between sleep-wake patterns and other physiological circadian rhythms.
DSPS; circadian rhythm sleep disorder; circadian phase; circadian phase angle
Objective To assess the effects of didgeridoo playing on daytime sleepiness and other outcomes related to sleep by reducing collapsibility of the upper airways in patients with moderate obstructive sleep apnoea syndrome and snoring.
Design Randomised controlled trial.
Setting Private practice of a didgeridoo instructor and a single centre for sleep medicine.
Participants 25 patients aged > 18 years with an apnoea-hypopnoea index between 15 and 30 and who complained about snoring.
Interventions Didgeridoo lessons and daily practice at home with standardised instruments for four months. Participants in the control group remained on the waiting list for lessons.
Main outcome measure Daytime sleepiness (Epworth scale from 0 (no daytime sleepiness) to 24), sleep quality (Pittsburgh quality of sleep index from 0 (excellent sleep quality) to 21), partner rating of sleep disturbance (visual analogue scale from 0 (not disturbed) to 10), apnoea-hypopnoea index, and health related quality of life (SF-36).
Results Participants in the didgeridoo group practised an average of 5.9 days a week (SD 0.86) for 25.3 minutes (SD 3.4). Compared with the control group in the didgeridoo group daytime sleepiness (difference -3.0, 95% confidence interval -5.7 to -0.3, P = 0.03) and apnoea-hypopnoea index (difference -6.2, -12.3 to -0.1, P = 0.05) improved significantly and partners reported less sleep disturbance (difference -2.8, -4.7 to -0.9, P < 0.01). There was no effect on the quality of sleep (difference -0.7, -2.1 to 0.6, P = 0.27). The combined analysis of sleep related outcomes showed a moderate to large effect of didgeridoo playing (difference between summary z scores -0.78 SD units, -1.27 to -0.28, P < 0.01). Changes in health related quality of life did not differ between groups.
Conclusion Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome.
Trial registration ISRCTN: 31571714.
To explore relationships among sleep disturbances, glucose tolerance, and pregnancy outcomes.
RESEARCH DESIGN AND METHODS
Four validated sleep questionnaires were administered to 169 pregnant women at the time of 50-g oral glucose tolerance testing (OGTT) during the second trimester. Pregnancy outcomes were analyzed in 108 women with normal glucose tolerance (NGT).
Of the participants, 41% had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >8); 64% had poor sleep quality; 25% snored frequently; 29% had increased risk of sleep-disordered breathing (SDB); 52% experienced short sleep (SS); 19% had both increased SDB risk and SS (SDB/SS); and 14% had daytime dysfunction. Reported sleep duration inversely correlated with glucose values from 50-g OGTT (r = −0.21, P < 0.01). Each hour of reduced sleep time was associated with a 4% increase in glucose levels. Increased likelihood of gestational diabetes mellitus (GDM) was found in subjects with increased SDB risk (odds ratio 3.0 [95% CI 1.2–7.4]), SS (2.4 [1.0–5.9]), SDB/SS (3.4 [1.3–8.7]), and frequent snoring (3.4 [1.3–8.8], after adjustment for BMI). Among NGT subjects, preterm delivery was more frequent in those with increased ESS (P = 0.02), poor sleep quality (P = 0.02), and SS (P = 0.03). Neonatal intensive care unit admissions were associated with increased ESS (P = 0.03), SDB/SS (P = 0.03), and daytime dysfunction (P < 0.01) in mothers.
Pregnant women experience significant sleep disturbances that are associated with increased risk of GDM and unfavorable pregnancy outcomes. Pregnant women with increased SDB risk, frequent snoring, and sleep duration of <7 h/night have increased risk of developing GDM.