- Email: [email protected]
P474 The profile of patients undergoing diagnostic sleep studies at an Eastern teaching hospital in Singapore
S122
Abstracts / Sleep Medicine 7 (2006) S1–S127
p < .01), and shorter REM sleep (16.7 ± 7.5% vs. 21.7 ± 6.5%, p < .001). However, AHI (22.4 ± 18.1 vs. 22.1 ± 14.4), number of central (12.4 ± 28.8 vs. 16.2 ± 25.5) and obstructive apneas (132.8 ± 114.5 vs. 98.6 ± 80.5), and lowest SpO2 (73.1 ± 11.1 vs. 72.8 ± 11.0) did not significantly differ between nights. Based on the criterion of the worst AHI over two nights, 30 and 19 DM1 patients were found to have moderate and severe sleep apneas, respectively. The first-night PSG would have correctly identified 83.3% of patients with moderate (kappa = 0.6), and 73.7% of those with severe sleep apneas (kappa = 0.3, see Table). NNV in severe sleep apnea of DM1 patients (n = 42) Night 2
Night 1
AHI
<30
P30
<30 P30
18 7
5 7
Conclusions: A majority of DM1 patients seems to suffer from moderate or severe sleep apneas and there is a less than moderate agreement between two sequential PSG as regards the diagnosis of severe sleep apnea. Indeed, a single night of PSG monitoring may not be sufficient to safely identify severe sleep apnea in about 1 of every 4 patients with DM1. Performing two consecutive nights of PSG may thus be considered in this patient population whenever severe sleep apnea is suspected. Funded by the Canadian Institutes of Health Research Keywords: Cheyne-Stokes respiration; Congestive heart failure; Ventilation; Oxygen therapy.
Subjects: Twenty nine HNT patients (mean age [±SD] = 32 ± 11 years, mean apnea/hypopnea index (AHI) [±SD] = 6.7 ± 7.6, ESS [±SD] = 7.7 ± 4.3, subjective chronic fatigue [±SD] = 18.3 ± 7.2) were recruited. Six patients received anti-epileptic and/or antidepressive drugs. Thirteen patients presented nocturnal breathing disorders (NBD) (mean AHI [±SD] = 12.3 ± 8.4). Results: Eleven patients felt asleep during the MWT trials (mean sleep latency = 30 min 20 s). NBD did not influence sleepiness at the MWT trial (Khi2 = .002, n.s.). Older patients tended to have more apneas than young ones (mean age [±SD] 37,9 ± 12,35 vs. 27,68 ± 7,12; Student test, t = 2.79, p < .01). Patients falling asleep during at least one MWT trial reported more fatigue than alert patients (mean EIF [±SD] = 22,27 ± 8,9 vs. 15,88 ± 4,86; Student test, t = 2.5, p < .05). Subjective sleepiness (ESS score) also correlated with fatigue (Spearman, r = .409, p < .05). Treated patients did not present more sleep episodes during the MWT than drug free patients (Khi2 = 1.75, n.s.). Conclusion: Sleepiness can explain fatigue in HNT patients. Both subjective and objective measures of sleepiness are associated to increased fatigue. Sleepiness cannot be explained by drug intake in our patients. Our HNT patients present a higher prevalence of NBD which are not associated with excessive daytime sleepiness. The causality of the Head-neck Trauma in the occurrence of nocturnal breathing disorders remains unknown but should be explored in further studies. doi:10.1016/j.sleep.2006.07.282
doi:10.1016/j.sleep.2006.07.281
P473 Fatigue, sleepiness and nocturnal breathing disorders in head-neck trauma patients Annie MacLeod 1,2, Jean-Michel Mazaux 3, Guillaume Chaumet 1,4, Jacques Taillard 1,5, Maria-Antonia Quera-Salva 6, Bernard Bioulac 1,5, Pierre Philip a,e,*
P474 The profile of patients undergoing diagnostic sleep studies at an Eastern teaching hospital in Singapore S. Venkateswaran * Department of Medicine, Changi General Hospital, Singapore
1
Clinique du Sommeil, CHU Pellegrin, Bordeaux, France Universite´ Victor Segalen, 33076 Bordeaux Cedex, France 3 Service de Re´e´ducation fonctionnelle, CHU Pellegrin, Bordeaux, France 4 Laboratoire de Psychologie EA-3662, Universite´ Victor Segalen, 33076 Bordeaux Cedex, France 5 CNRS UMR-5543, Universite´ Victor Segalen, Bordeaux, France 6 CHU Raymond Poincare´, 92380 Garches, France 2
Objective: To test the relationship between sleepiness and fatigue in Head-neck Trauma (HNT) patients Methods: Nocturnal polysomnography, Epworth Sleepiness Scale (ESS), Subjective fatigue intensity (Krupps scale) and Maintenance of Wakefulness Test (MWT).
Objectives: To determine the profile of patients undergoing diagnostic sleep studies at our institution. Design: An audit involving retrospective case review of patients who underwent diagnostic polysomnography (PSG) between July and September of 2005. Methods and measurements: Medical records of patients for the afore-mentioned 3-month period were audited. Demographic and anthropometric data, subjective sleepiness scores using the Epworth Sleepiness Scale (ESS), relevant polysomnographic data as well as other underlying medical conditions were recorded. Results: There were 103 patients of which 12(11.7%) were female and 91(88.3%) male. Of these 76.7% were Chinese, 14.5% Malay, 4.9% Indian and 3.9% others
Abstracts / Sleep Medicine 7 (2006) S1–S127
S123
respectively. Their mean age was 42.1 ± 11.9 years. The mean Apnoea-Hypopnoea Index (AHI) was 29.2 ± 24.4 events/hour with 62.1% of patient’s severe, 20.4% moderate and 17.5% in the mild category based on the Chicago criteria. In 59 of the patients the mean ESS score was 9.9 ± 4.9 and in 60 patients the BMI was 27.5 ± 6.5 kg/m2. Snoring was noted in 95.1% of the cohort. A third of the patients (33.9%) had associated hypertension. The mean arousal index was 25.6 ± 17.3 and the mean minimum oxygen saturation was 79.5% ± 11.2. Conclusions: Patients attending our centre for diagnostic PSG are predominantly male, lower middle-aged, obese, exhibit borderline sleepiness and have severe OSA. They also generally have marked sleep fragmentation with moderate oxygen desaturation during the study. Hypertension appears to be the commonest associated medical condition.
ever, on day 14 of CPAP treatment, a significant lower MAP than before treatment was observed (P < 0.05). Conclusion: CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAHS patients. Hypoadiponectinemia might be involved in the pathogenesis of OSAHS-mediated hypertension. Keywords: Obstructive sleep apnea hypopnea syndrome; Continuous positive airway pressure; Adiponectin; Mean arterial pressure
doi:10.1016/j.sleep.2006.07.283
Objectives: To investigate the efficacy of adaptive servoventilation (ASV) in patients with congestive heart failure (CHF) and Cheyne-Stokes respiration (CSR), by comparison of oxygen therapy. Materials and methods: Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were performed for two weeks respectively. Comparison before and after each treatment was made for the following items: (a) parameters of sleep respiration, sleep structure and quality; (b) left ventricle ejection fraction (LVEF) and 6-minute walk distance; (c). plasma endothelin-1 (ET-1) levels. Results: Compared with the baseline levels before treatment, the apnea hypopnea index significantly decreased during oxygen therapy (P < 0.05) and further reduced during ASV treatment (P < 0.01); on the contrary, the minimal pulse oxygen saturation markedly increased during oxygen therapy (P < 0.05) and further elevated during ASV treatment (P < 0.01). Compared with before treatment, arousal index significantly decreased during oxygen therapy (P < 0.05) and further declined during ASV treatment (P < 0.01). Compared with both during oxygen therapy and before treatment, during ASV treatment stageI+IIsleep/ total sleep time (TST) (%) was significantly lower while stage III+IV sleep/ TST (%) was significantly higher. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment (P > 0.05). LVEF was significantly higher on day 14 of ASV treatment than on day 14 of oxygen therapy and before treatment (all P < 0.05). 6-minute walk distance was the shortest before treatment and the longest on day 14 of ASV treatment, with a significant difference among that before treatment, on day 14 of oxygen therapy and ASV treatment(all P < 0.01). The plasma ET-1 level showed significantly lower on day 14 of ASV treatment than both before treatment and on day 14 of oxygen therapy (P < 0.05), but no significant difference between ET-1
P475 Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome Zhang Xilong *, Yin Kaisheng, Wang Hong The First Affiliated Hospital of Nanjing Medical University, China Objectives: Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hyponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes, etc. This study was conducted to investigate the effect of continuous positive airway pressure (CPAP) treatment on bilateral changes of serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients. Materials and methods: 23 adult male patients with moderate or severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood samples were collected and morning mean arterial pressure (MAP) was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay. Results: Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment (P > 0.05). It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur (P < 0.01). Meanwhile, the MAP showed no statistically different among its levels before CPAP, on day 3 and day 7 of CPAP treatment (P > 0.05). How-
doi:10.1016/j.sleep.2006.07.284
P476 Efficacy of adaptive servo-ventilation in patients with congestive heart failure and Cheyne-Stokes respiration Zhang Xilong *, Yin Kaisheng, Su Mei The First Affiliated Hospital of Nanjing Medical University, China
Abstracts / Sleep Medicine 7 (2006) S1–S127
p < .01), and shorter REM sleep (16.7 ± 7.5% vs. 21.7 ± 6.5%, p < .001). However, AHI (22.4 ± 18.1 vs. 22.1 ± 14.4), number of central (12.4 ± 28.8 vs. 16.2 ± 25.5) and obstructive apneas (132.8 ± 114.5 vs. 98.6 ± 80.5), and lowest SpO2 (73.1 ± 11.1 vs. 72.8 ± 11.0) did not significantly differ between nights. Based on the criterion of the worst AHI over two nights, 30 and 19 DM1 patients were found to have moderate and severe sleep apneas, respectively. The first-night PSG would have correctly identified 83.3% of patients with moderate (kappa = 0.6), and 73.7% of those with severe sleep apneas (kappa = 0.3, see Table). NNV in severe sleep apnea of DM1 patients (n = 42) Night 2
Night 1
AHI
<30
P30
<30 P30
18 7
5 7
Conclusions: A majority of DM1 patients seems to suffer from moderate or severe sleep apneas and there is a less than moderate agreement between two sequential PSG as regards the diagnosis of severe sleep apnea. Indeed, a single night of PSG monitoring may not be sufficient to safely identify severe sleep apnea in about 1 of every 4 patients with DM1. Performing two consecutive nights of PSG may thus be considered in this patient population whenever severe sleep apnea is suspected. Funded by the Canadian Institutes of Health Research Keywords: Cheyne-Stokes respiration; Congestive heart failure; Ventilation; Oxygen therapy.
Subjects: Twenty nine HNT patients (mean age [±SD] = 32 ± 11 years, mean apnea/hypopnea index (AHI) [±SD] = 6.7 ± 7.6, ESS [±SD] = 7.7 ± 4.3, subjective chronic fatigue [±SD] = 18.3 ± 7.2) were recruited. Six patients received anti-epileptic and/or antidepressive drugs. Thirteen patients presented nocturnal breathing disorders (NBD) (mean AHI [±SD] = 12.3 ± 8.4). Results: Eleven patients felt asleep during the MWT trials (mean sleep latency = 30 min 20 s). NBD did not influence sleepiness at the MWT trial (Khi2 = .002, n.s.). Older patients tended to have more apneas than young ones (mean age [±SD] 37,9 ± 12,35 vs. 27,68 ± 7,12; Student test, t = 2.79, p < .01). Patients falling asleep during at least one MWT trial reported more fatigue than alert patients (mean EIF [±SD] = 22,27 ± 8,9 vs. 15,88 ± 4,86; Student test, t = 2.5, p < .05). Subjective sleepiness (ESS score) also correlated with fatigue (Spearman, r = .409, p < .05). Treated patients did not present more sleep episodes during the MWT than drug free patients (Khi2 = 1.75, n.s.). Conclusion: Sleepiness can explain fatigue in HNT patients. Both subjective and objective measures of sleepiness are associated to increased fatigue. Sleepiness cannot be explained by drug intake in our patients. Our HNT patients present a higher prevalence of NBD which are not associated with excessive daytime sleepiness. The causality of the Head-neck Trauma in the occurrence of nocturnal breathing disorders remains unknown but should be explored in further studies. doi:10.1016/j.sleep.2006.07.282
doi:10.1016/j.sleep.2006.07.281
P473 Fatigue, sleepiness and nocturnal breathing disorders in head-neck trauma patients Annie MacLeod 1,2, Jean-Michel Mazaux 3, Guillaume Chaumet 1,4, Jacques Taillard 1,5, Maria-Antonia Quera-Salva 6, Bernard Bioulac 1,5, Pierre Philip a,e,*
P474 The profile of patients undergoing diagnostic sleep studies at an Eastern teaching hospital in Singapore S. Venkateswaran * Department of Medicine, Changi General Hospital, Singapore
1
Clinique du Sommeil, CHU Pellegrin, Bordeaux, France Universite´ Victor Segalen, 33076 Bordeaux Cedex, France 3 Service de Re´e´ducation fonctionnelle, CHU Pellegrin, Bordeaux, France 4 Laboratoire de Psychologie EA-3662, Universite´ Victor Segalen, 33076 Bordeaux Cedex, France 5 CNRS UMR-5543, Universite´ Victor Segalen, Bordeaux, France 6 CHU Raymond Poincare´, 92380 Garches, France 2
Objective: To test the relationship between sleepiness and fatigue in Head-neck Trauma (HNT) patients Methods: Nocturnal polysomnography, Epworth Sleepiness Scale (ESS), Subjective fatigue intensity (Krupps scale) and Maintenance of Wakefulness Test (MWT).
Objectives: To determine the profile of patients undergoing diagnostic sleep studies at our institution. Design: An audit involving retrospective case review of patients who underwent diagnostic polysomnography (PSG) between July and September of 2005. Methods and measurements: Medical records of patients for the afore-mentioned 3-month period were audited. Demographic and anthropometric data, subjective sleepiness scores using the Epworth Sleepiness Scale (ESS), relevant polysomnographic data as well as other underlying medical conditions were recorded. Results: There were 103 patients of which 12(11.7%) were female and 91(88.3%) male. Of these 76.7% were Chinese, 14.5% Malay, 4.9% Indian and 3.9% others
Abstracts / Sleep Medicine 7 (2006) S1–S127
S123
respectively. Their mean age was 42.1 ± 11.9 years. The mean Apnoea-Hypopnoea Index (AHI) was 29.2 ± 24.4 events/hour with 62.1% of patient’s severe, 20.4% moderate and 17.5% in the mild category based on the Chicago criteria. In 59 of the patients the mean ESS score was 9.9 ± 4.9 and in 60 patients the BMI was 27.5 ± 6.5 kg/m2. Snoring was noted in 95.1% of the cohort. A third of the patients (33.9%) had associated hypertension. The mean arousal index was 25.6 ± 17.3 and the mean minimum oxygen saturation was 79.5% ± 11.2. Conclusions: Patients attending our centre for diagnostic PSG are predominantly male, lower middle-aged, obese, exhibit borderline sleepiness and have severe OSA. They also generally have marked sleep fragmentation with moderate oxygen desaturation during the study. Hypertension appears to be the commonest associated medical condition.
ever, on day 14 of CPAP treatment, a significant lower MAP than before treatment was observed (P < 0.05). Conclusion: CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAHS patients. Hypoadiponectinemia might be involved in the pathogenesis of OSAHS-mediated hypertension. Keywords: Obstructive sleep apnea hypopnea syndrome; Continuous positive airway pressure; Adiponectin; Mean arterial pressure
doi:10.1016/j.sleep.2006.07.283
Objectives: To investigate the efficacy of adaptive servoventilation (ASV) in patients with congestive heart failure (CHF) and Cheyne-Stokes respiration (CSR), by comparison of oxygen therapy. Materials and methods: Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were performed for two weeks respectively. Comparison before and after each treatment was made for the following items: (a) parameters of sleep respiration, sleep structure and quality; (b) left ventricle ejection fraction (LVEF) and 6-minute walk distance; (c). plasma endothelin-1 (ET-1) levels. Results: Compared with the baseline levels before treatment, the apnea hypopnea index significantly decreased during oxygen therapy (P < 0.05) and further reduced during ASV treatment (P < 0.01); on the contrary, the minimal pulse oxygen saturation markedly increased during oxygen therapy (P < 0.05) and further elevated during ASV treatment (P < 0.01). Compared with before treatment, arousal index significantly decreased during oxygen therapy (P < 0.05) and further declined during ASV treatment (P < 0.01). Compared with both during oxygen therapy and before treatment, during ASV treatment stageI+IIsleep/ total sleep time (TST) (%) was significantly lower while stage III+IV sleep/ TST (%) was significantly higher. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment (P > 0.05). LVEF was significantly higher on day 14 of ASV treatment than on day 14 of oxygen therapy and before treatment (all P < 0.05). 6-minute walk distance was the shortest before treatment and the longest on day 14 of ASV treatment, with a significant difference among that before treatment, on day 14 of oxygen therapy and ASV treatment(all P < 0.01). The plasma ET-1 level showed significantly lower on day 14 of ASV treatment than both before treatment and on day 14 of oxygen therapy (P < 0.05), but no significant difference between ET-1
P475 Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome Zhang Xilong *, Yin Kaisheng, Wang Hong The First Affiliated Hospital of Nanjing Medical University, China Objectives: Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hyponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes, etc. This study was conducted to investigate the effect of continuous positive airway pressure (CPAP) treatment on bilateral changes of serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients. Materials and methods: 23 adult male patients with moderate or severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood samples were collected and morning mean arterial pressure (MAP) was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay. Results: Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment (P > 0.05). It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur (P < 0.01). Meanwhile, the MAP showed no statistically different among its levels before CPAP, on day 3 and day 7 of CPAP treatment (P > 0.05). How-
doi:10.1016/j.sleep.2006.07.284
P476 Efficacy of adaptive servo-ventilation in patients with congestive heart failure and Cheyne-Stokes respiration Zhang Xilong *, Yin Kaisheng, Su Mei The First Affiliated Hospital of Nanjing Medical University, China