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Impact of a supervised muscular training on perceived quality of sleep and health in a population with knee osteoarthritis
Abstracts / Sleep Medicine 14S (2013) e18–e92
Acknowledgements: A grateful thanks to the collaborating Canadian and Brazilian couples who made possible the study data collection and analysis. http://dx.doi.org/10.1016/j.sleep.2013.11.116
Medical technology assessment of polysomnography, type 2: full PSG at home – night to night variability in Apnea Hypopnea Index (AHI) and Periodic Limb Movement Index (PLMI) W. Arends-Derks 1, M. Horst-Haverkamp 1, K. Schreuder 1, L. Rohling 2, A. De Weerd 1 1 Sleepcenter SEIN Zwolle-Groningen 2 Sleepcenter SEIN Zwolle-Groningen, Technical Medicine of Sleep
Introduction: Polysomnography (PSG) in a clinical setting (CPSG, type 1) is time consuming and expensive. Type 2, i.e. full PSG at home, is thought to be a good alternative, but has never been evaluated in terms of regular Medical Technology Assessment (MTA). In some countries this lack of MTA precludes reimbursement for PSG type 2. This communication is part of a series of posters which add up to MTA of PSG, type 2, and deals with night to night sleep variability. This study is designed to investigate the differences between the first and the second night, during two full PSG’s type 2, on AHI and PLMI. Materials and methods: Retrospective case control study of 325 patients (49,1% male, mean age = 45.0, SD = 16.7) who underwent full PSG type 2 for two consecutive days. The number of patients who were diagnosed with Sleep Related Breathing Disorder (SRBD) (n = 54), and those who were diagnosed with Sleep Related Movement Disorder (SRMD) (n = 47), were compared with the total group of patients on the parameters AHI and PLMI. Results: Looking at the two nights and a mean AHI less than 10 per hour, which implies no or a mild Obstructive Sleep Apnea Syndrome (OSAS), we found no internight variability. Looking at the two nights and a mean AHI greater than 15 per hour, which implies moderate or severe OSAS, we found high internight variability. The results referring to the group of patients who are diagnosed for SRMD (with a PLMI cut-off point of 8–10 per hour) are similar. Conclusion: On the basis of this study, it can be concluded that one measurement would be valid in cases of no or mild disturbances in either Breathing Disorder or Movement Disorder. In order to determine the severity of OSAS or PLMD of clinical importance, a twonight PSG, type 2, is mandatory to give a valid diagnosis. http://dx.doi.org/10.1016/j.sleep.2013.11.117
Sleep quality and sleepiness repercussion on cognitive impairment in community-dwelling older men and women B. Gallego-Ariza, I. Cabrera-Martos, L. Cerón-Lorente, M. Flores-Barba, I. Torres-Sánchez, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Ederly have recognized sleep disturbances. Chronically disrupted sleep has negative consequences such as deficits in attention, alertness, vigilance and memory. This study investigates whether poor sleep quality and sleepiness are associated with cognitive impairment. Materials and methods: The sample comprises 200 communitydwelling older adults with a mean age of 76:61 8:665. Participants were recruited in Granada, Spain. All subjects had a Mini-Mental score over than 24 to be included in the study. Data were obtained
e63
from the participants during two in-home interviews separated 24. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness was assessed with Epworth sleepiness score (ESS). Cognitive impairment was evaluated with Trailmaking Test (TMT), memory alteration test (MAT) and clock drawing test (CDT). All the subjects were grouped according to their punctuations into three groups: Group 1 included participants without diurnal sleepiness ðESS < 6Þ and good Sleep quality (PSQI < 6), Group 2 included those people with bad sleep quality ðPSQI P 6Þ and Group 3 the participants with scores concerning bad sleep quality ðPSQI P 6Þ and daytime sleepiness ðESS P 6Þ. Differences between groups were analyzed using ANOVA test. Results: Lower results on TMT were significantly (p < 0.05) linked with poorer sleep quality group (F: 6,252 with significant differences between groups 1 and 3). Better results on MAT were significantly linked with better sleep quality group (F: 7,989 with significant differences with groups 2 and 3, p < 0.05). Clock drawing test shows similar results, with higher scores in the group 1 and lower results in the group 3 (8:9 1:21 vs 8:7 1:77 vs 8:4 2:27, respectively). Conclusion: Sleep quality in elders should receive particular attention by clinicians regarding to the relationship between poor sleep quality and 0cognitive decline. Further studies should examine whether the poor sleep quality preceding cognitive decline is the consequence of particular sleep disorders and/or an underlying neurodegenerative disorder. http://dx.doi.org/10.1016/j.sleep.2013.11.118
Impact of a supervised muscular training on perceived quality of sleep and health in a population with knee osteoarthritis B. Gallego-Ariza, S. Mateos-Toset, I. Cabrera-Martos, A. Correa-Toledo, M. Badillo-Fontalvo, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Knee osteoarthritis (KO) is the most prevalent type of osteoarthritis and it is expected to increase in the next years. It is characterized by stiffness and pain, commonly affecting both knees. The main symptoms of KO usually develop disorders in the performance of daily activities, such as climbing stairs or walking and they also affects subjective perception of health-related quality of life and quality of sleep. The purpose of this study was to evidence the effectiveness of an eight-weeks muscular training program with elastic thera-band in patients with KO. Materials and methods: Randomized controlled clinical trial, single-blind. Thirty-eight subjects with OA of the knee were randomly assigned to an exercise treatment group (n = 17; 11 female; 6 male; mean age 76 years old) or a control group (n = 17; 12 female; 5 male; mean age 72 years old). Subjects who were admitted to the study were diagnosed with OA by a clinician. The patients included in the thera-band exercise group received supervised and individualized physical activity during 8 weeks. Measured outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Pittsburgh Sleep Quality Index (PSQI) and the index of health-related quality of life Equroqol (EQ-5D). Results: In the preintervention assessment, both intervention and control groups showed disturbances in health-related quality of life (intervention group 8:00 1:5146, control group 8:12 1:4738) and also they reported a bad quality of sleep (intervention group 9:23 3:6063, control group 9:24 3:7168). The intervention group showed clinically and statistically significant (p < 0.05) improvements in WOMAC scores (mean change intervention group 11:44 7:0089; control group 0:18 0:6054) at 8 weeks and in EQ-5D (mean change intervention group 1:18 0:7165; control
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Abstracts / Sleep Medicine 14S (2013) e18–e92
group 0:06 1:0993) and in the PSQI (mean change intervention group 2:29 3:1094; control group 0:62 2:0153). Conclusion: The results shows that an 8-weeks supervised exercise program with thera-band provides benefits in health-related quality of life and subjective quality of sleep. The use of thera-band is costeffective and well-tolerated and it has shown applicability in KO patients. http://dx.doi.org/10.1016/j.sleep.2013.11.119
Sleep pattern, quality and sleepiness among patients with exacerbation of chronic obstructive pulmonary disease B. Gallego-Ariza, I. Torres-Sánchez, M. Flores-Barba, I. Cabrera-Martos, A. Correa-Toledo, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Sleep is very important for optimal daily activities and contributes significantly to health and quality of life. Patients with chronic obstructive pulmonary disease (COPD) have various sleep related problems that can be increased on exacerbation periods. We aim to study sleep pattern and sleepiness in COPD patients with an acute exacerbation. Materials and methods: 70 COPD patients were recruited from San Cecilio and Virgen de las Nieves Hospitals (Granada, Spain). Data regarding the sleep pattern, the clinical and the social characteristics were obtained. The assessment included the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale. Results: 70 subjects were studied with a mean age of 72:8 8:35 years. 79.5% of the subjects were smokers. The predominant sleep problems were frequent night time awakenings which were present in 54 (60%), while problems initiating sleep were very prevalent among the cases 20 (22.2%). Sleepiness was reported in 14 (15.6%) and none (24, 26.7 %). Overall 8.9% of the cases described their sleep as good. PSQI is significantly related with level of dyspnea, Levels of Depression and Anxiety and Cough (p < 0.001). Conclusion: This study shows that COPD patients have poor sleep quality, disorders in the sleep pattern and daytime sleepiness during acute exacerbations. Their sleep quality is significantly related to anxiety, depression, cough and dyspnea. http://dx.doi.org/10.1016/j.sleep.2013.11.120
An 8-weeks exercise muscle training improves subjective fatigue and quality of sleep in Parkinson Disease’s patients B. Gallego-Ariza, I. Cabrera-Martos, A. Correa-Toledo, S. Mateos-Toset, M. Flores-Barba, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Numerous studies have previously shown that physical activity improves quality of life in patients with Parkinson Disease (PD) in several areas. Between non-motor difficulties, PD patients develop sleep disturbances. Poor reported sleep quality is very common in this condition and it is important to be taken into account because it impacts seriously on daily function. The objective of this study was to assess the effectiveness of an eight weeks exercise program with elastic bands on the subjective quality of sleep in PD patients. Materials and methods: A sample including 23 PD patients with more than 21 punctuation in the MiniMental State Examination were recruited from a local association. Each participant underwent an individual assessment. Anthropometric data were measured.
Outcomes measures were perceived sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) and perceived fatigue evaluated with the Piper Questionnaire. The participants were included in an eight weeks-physical activity program with elastic bands during an hour three times per week. Results: The majority of the participants were men (74%) with a mean age of 74:12 6:11 years old. The Geriatric Functional Rating Scale (GFRS) showed a 70% value of functionality. Their Hoen & Yahr score in off condition was I in the 4.3% of participants, II in 17.4%, III in 52.2% and IV in the 26.1%. Pre-to-postintervention significant improvements (p = 0.011) are important to consider regarding to perceived quality of sleep in total punctuation of PSQI. Significant differences (p = 0.005) were found in the sleep disturbances subscale, that appear to be reduced after the 8 weeks training program. Perceived fatigue was also significantly better (p < 0.05) after the exercise program. The participants reported improvements in the areas of behavioural, affective and sensorial fatigue. Conclusion: The exercise program used in this study was safe and effective in order to improve perceived fatigue and quality of sleep in PD patients. http://dx.doi.org/10.1016/j.sleep.2013.11.121
The clinical importance of obstructive sleep apnea in Alzheimers disease E. Arnardottir 1, K. Hannesdottir 2, S. Davidsdottir 3, A. Valgardsdottir 3, T. Gislason 4, J. Snaeligidal 3 1 Department of Respiratory Medicine and Sleep, Landspitali and Faculty of Medicine, University of Ic 2 AstraZeneca R&D, Neuroscience iMed and Division of Psychiatry, Landspitali 3 Department of Geriatrics, Landspitali 4 Department of Respiratory Medicine and Sleep, Landspitali, Faculty of Medicine, University of Ice
Introduction: Recent findings suggest that obstructive sleep apnea (OSA) is very common and underdiagnosed in the early stages of dementia and Alzheimer’s disease (AD). The objective of this study was to assess the prevalence and nightly variance in OSA in mild AD patients in relation to repeated assessments of cognitive function and neuropsychiatric symptoms. Materials and methods: Twenty mild AD patients (mini-mental state examination [MMSE] >20; age 45–80 years), over a time period of four weeks, underwent a home type 3 sleep study including pulse oximetry, assessment of respiratory effort, airflow, body position and movement. CogState computerized cognitive assessments and the psychomotor vigilance test (PVT) were performed each morning following the sleep assessments to measure visual memory, attention/ vigilance and working memory. Participants additionally completed the Epworth Sleepiness Scale and the Neuropsychiatric Inventory (NPI) was administered to their caregivers. Results: The preliminary results showed an OSA prevalence of 90% (AHI¡Y´5) and an average (¡ÀSD) AHI of 13.0 (¡À5.7) events/hour over 5 assessments (12 patients had mild OSA, 3 moderate and 3 severe OSA). Substantial nightly fluctuations in OSA were seen with an average AHI fluctuation of 13.4 (¡À9.9) events/hour. Moreover, patients with an average AHI¡Y´10 (n = 10 subjects) performed significantly worse on a test of visual attention/vigilance and presented with more apathy as a neuropsychiatric symptom than patients with an average AHI < 10 (n = 10 subjects). However, no differences were found in other cognitive tests performed or in the PVT performance and only 5% of patients reported excessive daytime sleepiness (Epworth Sleepiness Scale ¡Y´10).
Acknowledgements: A grateful thanks to the collaborating Canadian and Brazilian couples who made possible the study data collection and analysis. http://dx.doi.org/10.1016/j.sleep.2013.11.116
Medical technology assessment of polysomnography, type 2: full PSG at home – night to night variability in Apnea Hypopnea Index (AHI) and Periodic Limb Movement Index (PLMI) W. Arends-Derks 1, M. Horst-Haverkamp 1, K. Schreuder 1, L. Rohling 2, A. De Weerd 1 1 Sleepcenter SEIN Zwolle-Groningen 2 Sleepcenter SEIN Zwolle-Groningen, Technical Medicine of Sleep
Introduction: Polysomnography (PSG) in a clinical setting (CPSG, type 1) is time consuming and expensive. Type 2, i.e. full PSG at home, is thought to be a good alternative, but has never been evaluated in terms of regular Medical Technology Assessment (MTA). In some countries this lack of MTA precludes reimbursement for PSG type 2. This communication is part of a series of posters which add up to MTA of PSG, type 2, and deals with night to night sleep variability. This study is designed to investigate the differences between the first and the second night, during two full PSG’s type 2, on AHI and PLMI. Materials and methods: Retrospective case control study of 325 patients (49,1% male, mean age = 45.0, SD = 16.7) who underwent full PSG type 2 for two consecutive days. The number of patients who were diagnosed with Sleep Related Breathing Disorder (SRBD) (n = 54), and those who were diagnosed with Sleep Related Movement Disorder (SRMD) (n = 47), were compared with the total group of patients on the parameters AHI and PLMI. Results: Looking at the two nights and a mean AHI less than 10 per hour, which implies no or a mild Obstructive Sleep Apnea Syndrome (OSAS), we found no internight variability. Looking at the two nights and a mean AHI greater than 15 per hour, which implies moderate or severe OSAS, we found high internight variability. The results referring to the group of patients who are diagnosed for SRMD (with a PLMI cut-off point of 8–10 per hour) are similar. Conclusion: On the basis of this study, it can be concluded that one measurement would be valid in cases of no or mild disturbances in either Breathing Disorder or Movement Disorder. In order to determine the severity of OSAS or PLMD of clinical importance, a twonight PSG, type 2, is mandatory to give a valid diagnosis. http://dx.doi.org/10.1016/j.sleep.2013.11.117
Sleep quality and sleepiness repercussion on cognitive impairment in community-dwelling older men and women B. Gallego-Ariza, I. Cabrera-Martos, L. Cerón-Lorente, M. Flores-Barba, I. Torres-Sánchez, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Ederly have recognized sleep disturbances. Chronically disrupted sleep has negative consequences such as deficits in attention, alertness, vigilance and memory. This study investigates whether poor sleep quality and sleepiness are associated with cognitive impairment. Materials and methods: The sample comprises 200 communitydwelling older adults with a mean age of 76:61 8:665. Participants were recruited in Granada, Spain. All subjects had a Mini-Mental score over than 24 to be included in the study. Data were obtained
e63
from the participants during two in-home interviews separated 24. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness was assessed with Epworth sleepiness score (ESS). Cognitive impairment was evaluated with Trailmaking Test (TMT), memory alteration test (MAT) and clock drawing test (CDT). All the subjects were grouped according to their punctuations into three groups: Group 1 included participants without diurnal sleepiness ðESS < 6Þ and good Sleep quality (PSQI < 6), Group 2 included those people with bad sleep quality ðPSQI P 6Þ and Group 3 the participants with scores concerning bad sleep quality ðPSQI P 6Þ and daytime sleepiness ðESS P 6Þ. Differences between groups were analyzed using ANOVA test. Results: Lower results on TMT were significantly (p < 0.05) linked with poorer sleep quality group (F: 6,252 with significant differences between groups 1 and 3). Better results on MAT were significantly linked with better sleep quality group (F: 7,989 with significant differences with groups 2 and 3, p < 0.05). Clock drawing test shows similar results, with higher scores in the group 1 and lower results in the group 3 (8:9 1:21 vs 8:7 1:77 vs 8:4 2:27, respectively). Conclusion: Sleep quality in elders should receive particular attention by clinicians regarding to the relationship between poor sleep quality and 0cognitive decline. Further studies should examine whether the poor sleep quality preceding cognitive decline is the consequence of particular sleep disorders and/or an underlying neurodegenerative disorder. http://dx.doi.org/10.1016/j.sleep.2013.11.118
Impact of a supervised muscular training on perceived quality of sleep and health in a population with knee osteoarthritis B. Gallego-Ariza, S. Mateos-Toset, I. Cabrera-Martos, A. Correa-Toledo, M. Badillo-Fontalvo, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Knee osteoarthritis (KO) is the most prevalent type of osteoarthritis and it is expected to increase in the next years. It is characterized by stiffness and pain, commonly affecting both knees. The main symptoms of KO usually develop disorders in the performance of daily activities, such as climbing stairs or walking and they also affects subjective perception of health-related quality of life and quality of sleep. The purpose of this study was to evidence the effectiveness of an eight-weeks muscular training program with elastic thera-band in patients with KO. Materials and methods: Randomized controlled clinical trial, single-blind. Thirty-eight subjects with OA of the knee were randomly assigned to an exercise treatment group (n = 17; 11 female; 6 male; mean age 76 years old) or a control group (n = 17; 12 female; 5 male; mean age 72 years old). Subjects who were admitted to the study were diagnosed with OA by a clinician. The patients included in the thera-band exercise group received supervised and individualized physical activity during 8 weeks. Measured outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Pittsburgh Sleep Quality Index (PSQI) and the index of health-related quality of life Equroqol (EQ-5D). Results: In the preintervention assessment, both intervention and control groups showed disturbances in health-related quality of life (intervention group 8:00 1:5146, control group 8:12 1:4738) and also they reported a bad quality of sleep (intervention group 9:23 3:6063, control group 9:24 3:7168). The intervention group showed clinically and statistically significant (p < 0.05) improvements in WOMAC scores (mean change intervention group 11:44 7:0089; control group 0:18 0:6054) at 8 weeks and in EQ-5D (mean change intervention group 1:18 0:7165; control
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Abstracts / Sleep Medicine 14S (2013) e18–e92
group 0:06 1:0993) and in the PSQI (mean change intervention group 2:29 3:1094; control group 0:62 2:0153). Conclusion: The results shows that an 8-weeks supervised exercise program with thera-band provides benefits in health-related quality of life and subjective quality of sleep. The use of thera-band is costeffective and well-tolerated and it has shown applicability in KO patients. http://dx.doi.org/10.1016/j.sleep.2013.11.119
Sleep pattern, quality and sleepiness among patients with exacerbation of chronic obstructive pulmonary disease B. Gallego-Ariza, I. Torres-Sánchez, M. Flores-Barba, I. Cabrera-Martos, A. Correa-Toledo, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Sleep is very important for optimal daily activities and contributes significantly to health and quality of life. Patients with chronic obstructive pulmonary disease (COPD) have various sleep related problems that can be increased on exacerbation periods. We aim to study sleep pattern and sleepiness in COPD patients with an acute exacerbation. Materials and methods: 70 COPD patients were recruited from San Cecilio and Virgen de las Nieves Hospitals (Granada, Spain). Data regarding the sleep pattern, the clinical and the social characteristics were obtained. The assessment included the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale. Results: 70 subjects were studied with a mean age of 72:8 8:35 years. 79.5% of the subjects were smokers. The predominant sleep problems were frequent night time awakenings which were present in 54 (60%), while problems initiating sleep were very prevalent among the cases 20 (22.2%). Sleepiness was reported in 14 (15.6%) and none (24, 26.7 %). Overall 8.9% of the cases described their sleep as good. PSQI is significantly related with level of dyspnea, Levels of Depression and Anxiety and Cough (p < 0.001). Conclusion: This study shows that COPD patients have poor sleep quality, disorders in the sleep pattern and daytime sleepiness during acute exacerbations. Their sleep quality is significantly related to anxiety, depression, cough and dyspnea. http://dx.doi.org/10.1016/j.sleep.2013.11.120
An 8-weeks exercise muscle training improves subjective fatigue and quality of sleep in Parkinson Disease’s patients B. Gallego-Ariza, I. Cabrera-Martos, A. Correa-Toledo, S. Mateos-Toset, M. Flores-Barba, M. Valenza University of Granada, Department of Physical Therapy
Introduction: Numerous studies have previously shown that physical activity improves quality of life in patients with Parkinson Disease (PD) in several areas. Between non-motor difficulties, PD patients develop sleep disturbances. Poor reported sleep quality is very common in this condition and it is important to be taken into account because it impacts seriously on daily function. The objective of this study was to assess the effectiveness of an eight weeks exercise program with elastic bands on the subjective quality of sleep in PD patients. Materials and methods: A sample including 23 PD patients with more than 21 punctuation in the MiniMental State Examination were recruited from a local association. Each participant underwent an individual assessment. Anthropometric data were measured.
Outcomes measures were perceived sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) and perceived fatigue evaluated with the Piper Questionnaire. The participants were included in an eight weeks-physical activity program with elastic bands during an hour three times per week. Results: The majority of the participants were men (74%) with a mean age of 74:12 6:11 years old. The Geriatric Functional Rating Scale (GFRS) showed a 70% value of functionality. Their Hoen & Yahr score in off condition was I in the 4.3% of participants, II in 17.4%, III in 52.2% and IV in the 26.1%. Pre-to-postintervention significant improvements (p = 0.011) are important to consider regarding to perceived quality of sleep in total punctuation of PSQI. Significant differences (p = 0.005) were found in the sleep disturbances subscale, that appear to be reduced after the 8 weeks training program. Perceived fatigue was also significantly better (p < 0.05) after the exercise program. The participants reported improvements in the areas of behavioural, affective and sensorial fatigue. Conclusion: The exercise program used in this study was safe and effective in order to improve perceived fatigue and quality of sleep in PD patients. http://dx.doi.org/10.1016/j.sleep.2013.11.121
The clinical importance of obstructive sleep apnea in Alzheimers disease E. Arnardottir 1, K. Hannesdottir 2, S. Davidsdottir 3, A. Valgardsdottir 3, T. Gislason 4, J. Snaeligidal 3 1 Department of Respiratory Medicine and Sleep, Landspitali and Faculty of Medicine, University of Ic 2 AstraZeneca R&D, Neuroscience iMed and Division of Psychiatry, Landspitali 3 Department of Geriatrics, Landspitali 4 Department of Respiratory Medicine and Sleep, Landspitali, Faculty of Medicine, University of Ice
Introduction: Recent findings suggest that obstructive sleep apnea (OSA) is very common and underdiagnosed in the early stages of dementia and Alzheimer’s disease (AD). The objective of this study was to assess the prevalence and nightly variance in OSA in mild AD patients in relation to repeated assessments of cognitive function and neuropsychiatric symptoms. Materials and methods: Twenty mild AD patients (mini-mental state examination [MMSE] >20; age 45–80 years), over a time period of four weeks, underwent a home type 3 sleep study including pulse oximetry, assessment of respiratory effort, airflow, body position and movement. CogState computerized cognitive assessments and the psychomotor vigilance test (PVT) were performed each morning following the sleep assessments to measure visual memory, attention/ vigilance and working memory. Participants additionally completed the Epworth Sleepiness Scale and the Neuropsychiatric Inventory (NPI) was administered to their caregivers. Results: The preliminary results showed an OSA prevalence of 90% (AHI¡Y´5) and an average (¡ÀSD) AHI of 13.0 (¡À5.7) events/hour over 5 assessments (12 patients had mild OSA, 3 moderate and 3 severe OSA). Substantial nightly fluctuations in OSA were seen with an average AHI fluctuation of 13.4 (¡À9.9) events/hour. Moreover, patients with an average AHI¡Y´10 (n = 10 subjects) performed significantly worse on a test of visual attention/vigilance and presented with more apathy as a neuropsychiatric symptom than patients with an average AHI < 10 (n = 10 subjects). However, no differences were found in other cognitive tests performed or in the PVT performance and only 5% of patients reported excessive daytime sleepiness (Epworth Sleepiness Scale ¡Y´10).