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Patel, Sanjay R.; Malhotra, Atul; Gottlieb, Daniel J.; White, David P.; Hu, Frank B.
doi: 10.1093/sleep/29.7.881pmid: 16895254
AbstractStudy Objective:Sleeping more than 7 to 8 hours per day has been consistently associated with increased mortality. Whether this association is causal and what pathways explain this association are unknown. We sought to identify factors that could potentially explain the association between long sleep and mortality.Design:Cross-sectional epidemiologic survey.Participants:Middle-aged women (n = 60,028) participating in the Nurses Health Study II who reported a habitual sleep duration of 7 hours or more.Results:Multiple sclerosis (odds ratio [OR] = 3.7, 95% confidence interval [3.0–4.5]), antidepressant use (OR = 3.1, [2.9–3.3]), benzodiazepine use (OR = 3.0 [2.6–3.3]), and systemic lupus erythematosus (OR = 2.9, [2.3–3.6]) were the factors most strongly associated with prolonged sleep. Combining these data with prevalence information and a range of plausible associations with mortality, the confounding rate ratio was estimated. This parameter is the ratio of the unadjusted long sleep–mortality rate ratio to the rate ratio adjusted for the factor and measures the extent that the factor can alter the long sleep—mortality association, either through confounding or as a causal intermediate. Based on this parameter, psychiatric and socioeconomic factors have the greatest potential to influence the long sleep–mortality relationship. Assuming each factor doubles mortality risk, the confounding rate ratios for depression, antidepressant use, and unemployment were 1.10, 1.18, and 1.12. Lesser influential factors were benzodiazepine use, poverty, low societal status, sedentary lifestyle, and obesity.Conclusion:Depression and low socioeconomic status are strong candidates for producing the statistical association between long sleep and mortality, either as confounders or as causal intermediates. Future causal research on the effects of long sleep should include a detailed assessment of psychiatric disease and socioeconomic status.
Singh, Meeta; Drake, Christopher L.; Roth, Thomas
doi: 10.1093/sleep/29.7.890pmid: 16895255
AbstractStudy Objective:The presence of 2 or more sleep-onset rapid eye movement periods (SOREMPs) on a Multiple Sleep Latency Test (MSLT) has been used as 1 of the criteria for the diagnosis of narcolepsy and is thought to be specific to this disorder. However, previous studies have shown the prevalence of SOREMPS in healthy volunteers and apneic patients to be higher than expected. The present study determined the prevalence of 2 or more SOREMPs in a representative sample of the population from southeast Michigan and investigated potential associations with other sleep-related variables.Design:Cross-sectional laboratory-based analysis.Settings:Sleep disorders clinic.Participants:Population-based sample.Interventions:N/A.Measurements:A population-based sample of 333 subjects was assessed by nocturnal polysomnography and daytime MSLT (5 naps), and an additional 206 subjectively sleepy people were also assessed (total = 539). Sample demographics were comparable to the 2000 census. Epworth Sleepiness Scale scores were also determined. Groups were formed based on a median split of each sleep variable (Epworth Sleepiness Scale, MSLT, total sleep time from nocturnal polysomnography) for comparisons of SOREMPs in each group.Results:The prevalence of 2 or more SOREMPs was 3.9%. Only mean sleep latency on the MSLT was a discriminator for the presence of 2 or more SOREMPs (short latency = 6.3%, long latency = 1.9%, p < .05). Among the subjects who had an MSLT of 5 minutes or less (an indicator of a pathologic level of sleepiness), 9.5% had 2 or more SOREMPS.Conclusions:The overall prevalence of 2 or more SOREMPs in our sample is 3.9%. Interestingly, of the variables assessed (MSLT, Epworth Sleepiness Scale, and total sleep time from nocturnal polysomnography), objective sleepiness, as determined by the MSLT, was the only measure significantly associated with 2 or more SOREMPs. Therefore, subpopulations with excessive sleepiness (eg, shift workers, young adults, patients with apnea) are likely to have a greater prevalence of SOREMPs.
Thomas, G Neil; Jiang, CQ; Lao, XQ; McGhee, Sarah M.; Zhang, WS; Schooling, C Mary; Adab, Peymane; Lam, Tai Hing; Cheng, KK
doi: 10.1093/sleep/29.7.896pmid: 16895256
AbstractStudy Objective:Snoring is a common condition, but data describing the relationship between snoring and vascular disease is very limited in Asian populations. We therefore describe the association between snoring and vascular disease and associated risk factors.Design:Cross-sectional study of baseline data from the Guangzhou Biobank Cohort Study.Setting:Community-based elderly association from Guangzhou, China.Participants:10413 Chinese subjects (50–85 years of age).Measurements:Self-reported snoring status and frequency and frequency of daytime tiredness were collected by questionnaire, as were demographic and socioeconomic data, disease histories, and potential confounders, such as smoking and alcohol consumption. Anthropometry, blood pressure, and fasting glucose and lipid profile were also measured.Results:Self-reported snoring frequency was identified in 8325 (80.0%) subjects, with 51.6% reporting that they snored, of whom 15.5% were daily snorers. Increasing prevalence of snoring showed a clear positive relationship with cardiovascular risk factors, including age, obesity, blood pressure, and lipid levels (p < .001 for all). The prevalence of self-reported vascular-disease history was low but significantly associated with increasing snoring frequency. Logistic regression showed that snoring frequency was an independent predictor of vascular-disease history (odds ratios [95% confidence intervals] 1.68 [1.32–2.13] for daily snorers compared with the never-snorer reference group), of the metabolic syndrome (2.16 [1.88–2.49]) and each of its components (hypertension [1.37 (1.20–1.56)], and of dyslipidemia [1.22 (1.07–1.40)], central obesity [2.39 (2.08–2.76)], and diabetes [1.30 (1.09–1.56)]) after adjustment for potential confounders.Conclusion:Increasing snoring frequency was associated with an increasing prevalence of risk factors and self-reported vascular disease. Snoring may a useful marker for increased risk of vascular disease.
Nuckton, Thomas J.; Glidden, David V.; Browner, Warren S.; Claman, David M.
doi: 10.1093/sleep/29.7.903pmid: 16895257
AbstractStudy Objective:To assess the clinical usefulness of the Mallampati score in patients with obstructive sleep apnea. Mallampati scoring of the orophyarynx is a simple noninvasive method used to assess the difficulty of endotracheal intubation, but its clinical usefulness has not been validated in patients with sleep-disordered breathing.Design:Prospective multivariate assessment of a predictor variable.Setting:The UCSF Sleep Disorders Center.Patients or Participants:One hundred thirty-seven adult patients who were evaluated for possible obstructive sleep apnea.Interventions:Prospective determination of the Mallampati score, assessment of other variables for multivariate analysis, and subsequent overnight polysomnography.Measurements and Results:The Mallampati score was an independent predictor of both the presence and severity of obstructive sleep apnea. On average, for every 1-point increase in the Mallampati score, the odds of having obstructive sleep apnea (apnea-hypopnea index ≥ 5) increased more than 2-fold (odds ratio [per 1-point increase] = 2.5; 95% confidence interval: 1.2–5.0; p = .01), and the apnea-hypopnea index increased by more than 5 events per hour (coefficient = 5.2; 95% confidence interval: 0.2–10; p = .04). These results were independent of more than 30 variables that reflected airway anatomy, body habitus, symptoms, and medical history.Conclusions:Our results indicate that Mallampati scoring is a useful part of the physical examination of patients prior to polysomnography. The independent association between Mallampati score and presence and severity of obstructive sleep apnea suggests that this scoring system will have practical value in clinical settings and prospective studies of sleepdisordered breathing.
Okubo, Mau; Suzuki, Masaaki; Horiuchi, Atsushi; Okabe, Shinichi; Ikeda, Katsuhisa; Higano, Shuichi; Mitani, Hideo; Hida, Wataru; Kobayashi, Toshimitsu; Sugawara, Junji
doi: 10.1093/sleep/29.7.909pmid: 16895258
Matsui, Hideaki; Nishinaka, Kazuto; Oda, Masaya; Hara, Narihiro; Komatsu, Kenichi; Kubori, Tamotsu; Udaka, Fukashi
doi: 10.1093/sleep/29.7.917pmid: 16895259
AbstractStudy Objectives:The underlying pathologic mechanism of excessive daytime sleepiness (EDS) in Parkinson disease and the relative contributions of brain function to this process are poorly understood. We compared brain perfusion images between patients with Parkinson disease and EDS and those without EDS using n-isopropyl-p-123I iodoamphetamine single photon emission computed tomography.Design:Clinical study.Setting:Sumitomo Hospital.Patients:Thirteen patients with Parkinson disease with EDS (EDS group) and 27 patients with Parkinson disease without EDS (no-EDS group) were studied. Whether or not each case had EDS was determined according to the response to the Epworth Sleepiness Scale: patients with an Epworth Sleepiness Scale score ≥ 10 were included in the EDS group, and patients with an Epworth Sleepiness Scale score ≤ 9 were included in the no-EDS group.Measurements and Results:There were significant hypoperfusions in the left parietal and temporal association cortex in the EDS group. In the multivariable logistic regression model, attention and decreased regional cerebral blood flow of the left parietal association cortex and right caudate and increased regional cerebral blood flow of the right thalamus were the independent and significant factors.Conclusions:The cortical hypofunction relative to hyperfunction of the brain stem may relate to EDS in Parkinson disease. This is the first imaging study about EDS in Parkinson disease, and further studies are required.
Caselli, Richard J.; Chen, Kewei; Bandy, Dan; Smilovici, Oded; Boeve, Bradley F.; Osborne, David; Alexander, Gene E.; Parish, James M.; Krahn, Lois E.; Reiman, Eric M.
doi: 10.1093/sleep/29.7.927pmid: 16895260
Showing 1 to 10 of 16 Articles
AbstractStudy Objectives:To evaluate the morphological features of the mandible and the volume of the upper airway soft tissues in determining the anatomical risk factors for the upper airway in Japanese male patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:Five morphological parameters of the mandible at the mandibular base plane and three volumetric parameters of the upper airway soft tissue were analyzed using three-dimensional (3D) magnetic resonance imaging software in 31 OSAHS and 20 controls.Results:There were no significant differences between the two groups in mandibular internal width (the distance between the internal right and left gonia [IRG and ILG]) and mandibular bony thickness. However, the patients with OSAHS had a significantly wider mandibular divergence (the angle between the spina mentalis (SM)- IRG line and SM- ILG line), a smaller mandibular internal length (the perpendicular distance from SM to the RG- LG line), and a smaller area than the normal subjects at the mandibular base plane. There were no significant differences in these morphological parameters for the mandible between obese and nonobese OSAHS patients. The volumes of the tongue, soft palate, and lateral pharyngeal walls were not significantly different between the OSAHS and the control groups.Conclusions:Japanese male OSAHS patients had specific anatomical features in the bottom part of the mandible; however, obesity seemed to be a less significant risk factor. Investigators and clinicians must realize that ethnicity may modify the effects of obesity and abnormal craniofacial anatomy as risk factors for the pathogenesis of OSAHS.
AbstractStudy Objectives:To test the hypothesis that healthy adults reporting dream-enactment behavior (DEB+) have reduced cerebral metabolic rate for glucose (CMRgl) in regions preferentially affected in patients with dementia with Lewy bodies (DLB).Design:Automated brain-mapping algorithms were used to compare regional fluorodeoxyglucose (FDG) positron emission tomography (PET) measurements from previously evaluated DEB cases and controls.Setting:Tertiary-care academic medical centers.Participants:Seventeen cognitively normal patients with DEB+ and 17 control subjects (DEB-) who were individually matched for age (59 ± 11 years), education level (16 ± 4 years), sex (67% women), body mass index (26 ± 4.8 kg/m2), first-degree relative with dementia (85%), and proportion of apolipoprotein E (APOE) e4 carriers (13 e4 carriers, 4 noncarriers).Interventions:FDG-PET.Measurements and Results:DEB was associated with significantly lower CMRgl in several brain regions known to be preferentially affected in both DLB and Alzheimer disease (parietal, temporal, and posterior cingulate cortexes) and in several other regions, including the anterior cingulate cortex (p < .001, uncorrected for multiple comparisons). The DEB-associated CMRgl reductions were significantly greater in the APOE e4 noncarriers than in the carriers.Conclusions:These preliminary findings suggest that cognitively normal persons with DEB have reduced CMRgl in brain regions known to be metabolically affected by DLB, supporting further study of DEB as a possible risk factor for the development of DLB.