- Email: [email protected]
CPAP can reduce blood pressure in symptomatic patients with OSAS
e56
Abstracts / Sleep Medicine 14S (2013) e18–e92
information compiled in Fiehn’s and NIST libraries. The same set of samples were analysed by liquid chromatography coupled with quadrupole time-of-flight mass spectrometer (LC-QTOF-MS). Profiles were aligned and filtered using Mass Profiler Professional. Univariate and multivariate statistical analysis were applied for screening potential biomarkers. Results: OPLS-DA plots obtained using SIMCA-P+, based on GC-MS and LC-MS data, show clear separation between control and severe patient. Changes in the metabolic profiles of amino acids were found between both groups, showing an increase trend, including some branched-chain amino acid (BCAAs). Different metabolic pathways could be altered under conditions related to insulin resistance, such as metabolic syndrome and obesity causing alterations in branchedchain keto acid dehydrogenase that could be reflected in the increased level of BCAAs. Phosphocholine and compounds related to the glycine and glutamate metabolism were putatively assigned. Glutamate receptors have recently being found present in the lung (NMDA receptors) causing a wide range of damage (lipid peroxidation, DNA bridges broken, activation of the system caspases, loss of energy and cell death). Conclusion: These findings reflect considerable differences in individual metabolite fingerprints of OSAHS patients and open the possibility of identifying novel biomarkers associated to sleep disorders, that can help to uncover the complexity underlyingthe metabolic alterations occurring in OSAHS. Acknowledgements: The research leading to these results has received funding from the [European Union] Seventh Framework Programme [FP7/2007- 2013] under grant agreement no 264864’’. http://dx.doi.org/10.1016/j.sleep.2013.11.097
Sleep disorders in chronic renal failure patients M. Eltawdy 1, A. Rabah 1, M. Nada 2, R. Refaat 1, L. Afifi 2 1 Neurology Dept, Cairo University, Egypt 2 Clinical Neurophysiology, Cairo University, Egypt
Introduction: This work aims to assess the prevalence and quality (type) of sleep disorders in chronic renal failure patients. Materials and methods: A study was conducted on 40 patients with chronic renal failure (CRF) who were subdivided into two groups; patients not on heamodialysis (HD) (group I) (n = 20), and patients on regular HD (group II) (n = 20), and 20 sex and age matched control subjects. All subjects were subjected to through neurological examination, sleep complaints history and polysomnography. Results: All CRF patients had sleep complaints in the form of difficulty falling asleep (45%), fragmented sleep (55%), early morning awakening (45%) excess daytime sleepiness (25%) and jerking leg movements (15%). Patients group had significantly lower total sleep time, sleep efficiency, slow wave sleep percentage, oxyden desaturation and higher apnea hypopnea index and number of awakenings compared to control group. Sleep efficiency was significantly lower in group I compared to group II while periodic limb movement disorder was more in group II. Conclusion: There is a high prevalence of sleep disorders in chronic renal failure CRF patients whether they are on regular HD or not and, proper management of these disorders will improve the morbidity and quality of life of those patient. http://dx.doi.org/10.1016/j.sleep.2013.11.098
Repeated sleepiness ratings throughout the day – A normative field study in 800 individuals across one working week T. Akerstedt, G. Kecklund, D. Hallvig Stockholm University, Sweden
Introduction: Sleepiness ratings are frekvently used in field and laboratory studies in relation to altered sleep/wake patterns. In field studies sleepiness ratings are often the only reasible way for measuring sleepiness. Most studies have been small, however, and focused on a particular occupational group. There is a need for normative values of sleepiness at different times of day in relation to factors that might affect sleepiness, for example, work/leisure, stress, gender, age, night sleep, and health. No similar studies have been carried out before and to obtain such data was the purpose of the present study. Materials and methods: The participants rated their sleepiness on the Karolinska Sleepiness Scale (KSS) at 07, 10, 13, 16, 19, and 22 h each day for one week (scale 1–9) and filled out daily sleep diaries on sleep, stress (same time as KSS), workload, wori/nonwork, subjective health and others. Results: The results showed a very pronounced diurnal pattern with high levels at 07 h (4.6 ) and 22 h (6.6) with 3.5 around noon. Having a day off reduced the level by 0.4 units, being male reduced the levels by 0.4 units and higher age (60 years) reduced levels by 0.3 units (compared to 30 year olds) (all p- values <.001). In a multiple regression analysis was observed that sleepiness was considerably higher in individuals high on stress (workday mean) or higher in individuals low on subjective health (p < .001). Subjective sleep quality predicted lower sleepiness, but sleep duration did not. Conclusion: It was concluded that subjective sleepiness has a pronounced circadian pattern which differe depending on age and gender, and is affected by prior sleep, although stress and the state of health play important roles. The results emphasize the importance of accounting for the modifying factors when using self-rated sleepiness. Acknowledgements: This study was supported by The Swedish Research council and Stockholm Stress Center. http://dx.doi.org/10.1016/j.sleep.2013.11.099
CPAP can reduce blood pressure in symptomatic patients with OSAS D. Al-Abri Sultan Qaboos University Hospital, Oman
Introduction: obstructive sleep apnea syndrome (OSAS) is associated with raised arterial blood pressure (BP). There are controversial evidences about the effect of continues positive airway pressure (CPAP) in lowering nocturnal and daytime BP in patients with OSAS and therefore, the aim was to examine the real effect of CPAP in blood pressure in these patients. Materials and methods: We conducted a randomized sham- controlled cross-over study of the effects of 6 weeks of continuous positive airway pressure (CPAP) or Sham CPAP on 24-h blood pressure in 39 sleepy patients (37 males, 2 females) with mean age of 50 8, mean apnea- hypopnea index [AHI], 47 29 and mean ESS 16 3. Five patients were receiving anti-hypertension medications and 7 patients who had nocturnal dipping. Ambulatory blood pressure was recorded for the last 48 h at baseline and after each treatment. Epworth Sleepiness Score (ESS) was also recorded.
Abstracts / Sleep Medicine 14S (2013) e18–e92
Results: There was a small decrease in nighttime diastolic blood pressure (DBP) (Sham CPAP, 75.5 10.5 mmHg; CPAP, 71.9 10.5 mmHg; p = 0.03). There was also reduction but not significant in daytime DBP (p = 0.06). The mean DBP for 24 h was also reduced by CPAP (p = 0.03). there was no significant difference in systolic blood pressure (SBP) between sham-CPAP and CPAP treatment the average CPAP use was > or = 4 h per night. Conclusion: Thus, CPAP can reduce daytime and nighttime diastolic blood pressure in symptomatic patients with OSAS. Acknowledgements: Dr. Renata Riha, Dr. Tom Mackay and Prof Neil Douglas,Department of Sleep Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, UK. http://dx.doi.org/10.1016/j.sleep.2013.11.100
The oxford sleep resistance test (OSLER) is sensitive in showing modifications in vigilance with CPAP therapy in sleep apnea patients A. Alakuijala 1, P. Maasilta 2, A. Bachour 3 1 Helsinki University Hospital, Department of Clinical Neurophysiology, Finland 2 Helsinki University Hospital, Pulmonary Department, Finland 3 Helsinki University Hospital, Sleep Unit, Finland
Introduction: Patients with obstructive sleep apnea (OSA) usually demonstrate cognitive dysfunction both subjectively and objectively. The Oxford Sleep Resistance Test (OSLER) is a behavioral test measuring the ability to maintain wakefulness. The subject is seated in a dark and quite room and is instructed to remain awake and to respond by hitting a button on a portable device each time a dim light flashes at 3-s interval. The test consists of 3 to 4 sessions of 40 min each. When the subject fails to respond for 21 s (i.e., 7 consecutive illuminations), the test is ended and it is assumed that the subject has fallen asleep. Analyzing the error profile (including 1–6 consecutive missed hits) is considered as a sensitive mean of detecting fluctuations in vigilance. Here, we report the results of the OSLER test before and under CPAP therapy in professional drivers referred for OSA. Materials and methods: 29 professional drivers (27 men and 2 women with a mean age of 50 yrs) referred for a suspicion of sleep apnea underwent an OSLER test at baseline and after two months from CPAP initiation. We started the first session at 9:00 AM followed by two sessions at 2-h interval. We also calculated the total number of missed hits (errors) and divided that by the duration of the test to obtain the number of errors per hour (OSLER error index). Results: With CPAP therapy the mean AHI dropped significantly (p<0.05) from 50/h to 10/h, ODI4 from 44/h to 11/h, time with SpO2 below 90% from 35% to 2%, and the Epworth sleepiness scale score from 9.5 to 7.4. Furthermore, the mean OSLER sleep latency time improved significantly (p < 0.05) with CPAP from 33 min 2 s to 36 min 48 s, and the OSLER error index decreased from 51 errors/h to 20/h. Conclusion: The OSLER test is a practical tool for measuring improvement in vigilance due to CPAP therapy in professional drivers suffering from sleep apnea. http://dx.doi.org/10.1016/j.sleep.2013.11.101
e57
CSF beta-amyloid levels are altered in narcolepsy: a link with the inflammatory hypothesis? M. Albanese, C. Liguori, F. Placidi, F. Izzi, M. Marciani, A. Romigi University Hospital of Rome ‘Tor Vergata’, Department of Neuroscience, Sleep Medicine Center, Italy
Introduction: Autoimmune and inflammatory mechanisms are suggested as a possible cause of the hypocretin cell loss in human narcolepsy. Interestingly, decreased CSF levels of beta-amyloid1– 42 (Abeta–42) are described related to brain inflammation. In fact the Abeta–42 metabolism is strongly regulated by inflammatory mechanisms and the inflammatory pathways of the immune system represent targets for modulating â-amyloid generation and accumulation. The aim of our study was to evaluate the CSF levels of Abeta– 42, total-tau (t- tau) and phosphorylated-tau (ptau) in narcoleptic patients, compared with matched healthy controls, to test if the inflammatory pathways in narcolepsy may interfere with CSF Abeta–42 and/or tau metabolisms. Materials and methods: Lumbar CSF of patients with narcolepsy and healthy individuals was analyzed by ELISA tests in order to detect the CSF levels of orexin A, Abeta–42, t-tau and ptau proteins. Results: We analysed 15 narcoleptic patients and 15 sex and agematched controls. More than one-and-a-half Abeta–42 CSF levels decrease was detected in narcoleptic patients compared with healthy controls. Moreover in 5 narcoleptic patients (33%) we documented pathological CSF Abeta–42 levels (<500 pg/ml) and 14 of the 15 narcoleptic subjects (93%) presented CSF Abeta–42 levels lower than the CSF Abeta–42 mean value of the matched controls. Conversely, CSF levels of t- tau and ptau proteins did not statistically differ between groups. Conclusion: We hypothesize that the significant decrease of the CSF Abeta–42 levels in narcoleptic patients may support the inflammatory/autoimmune hypothesis at the basis of the pathogenesis of narcolepsy. Therefore, our findings may be particularly appealing since narcolepsy is a neurological disorder caused by possible underlying autoimmune processes, aroused by viral or bacterial infections, responsible for the selective orexinergic neurons loss. In addition, a secondary explanation may be represented by the prevalence of an ‘‘amyloidogenic’’ pathway, due to the deficiency of the alpha-secretase ADAM10, previously described in narcolepsy, which cause the reduction of the CSF Abeta–42 levels in narcoleptic patients. Therefore, further studies are needed to better clarify the pathogenesis of narcolepsy, to understand the role of Abeta–42 and its links with degeneration and loss of the orexinergic neurons. Acknowledgements: We thank for their precious help and assistance: N.B. Mercuri, PhD, S. Bernardini, PhD, M. Nuccetelli, MD. http://dx.doi.org/10.1016/j.sleep.2013.11.102
Validation of the efficacy of an anti-snoring pillow J. Albares 1, E. Esteller 2, C. Estivill 1, C. Martinez 1, F. Segarra 1, E. Estivill 1 1 USP Institut Universitari Dexeus, Clinica del Son Estivill, Spain 2 Hospital general de Catalunya, Department of Otolaryngology, Spain
Introduction: The aim of the study is to test the functionality of a prototype anti snoring pillow (position ‘‘forced supine’’) on threedimensional tissues ‘‘spacer’’ in order to assess the possible reduction of snoring and the possible reduction of respiratory events (apneas/ hypopneas).
Abstracts / Sleep Medicine 14S (2013) e18–e92
information compiled in Fiehn’s and NIST libraries. The same set of samples were analysed by liquid chromatography coupled with quadrupole time-of-flight mass spectrometer (LC-QTOF-MS). Profiles were aligned and filtered using Mass Profiler Professional. Univariate and multivariate statistical analysis were applied for screening potential biomarkers. Results: OPLS-DA plots obtained using SIMCA-P+, based on GC-MS and LC-MS data, show clear separation between control and severe patient. Changes in the metabolic profiles of amino acids were found between both groups, showing an increase trend, including some branched-chain amino acid (BCAAs). Different metabolic pathways could be altered under conditions related to insulin resistance, such as metabolic syndrome and obesity causing alterations in branchedchain keto acid dehydrogenase that could be reflected in the increased level of BCAAs. Phosphocholine and compounds related to the glycine and glutamate metabolism were putatively assigned. Glutamate receptors have recently being found present in the lung (NMDA receptors) causing a wide range of damage (lipid peroxidation, DNA bridges broken, activation of the system caspases, loss of energy and cell death). Conclusion: These findings reflect considerable differences in individual metabolite fingerprints of OSAHS patients and open the possibility of identifying novel biomarkers associated to sleep disorders, that can help to uncover the complexity underlyingthe metabolic alterations occurring in OSAHS. Acknowledgements: The research leading to these results has received funding from the [European Union] Seventh Framework Programme [FP7/2007- 2013] under grant agreement no 264864’’. http://dx.doi.org/10.1016/j.sleep.2013.11.097
Sleep disorders in chronic renal failure patients M. Eltawdy 1, A. Rabah 1, M. Nada 2, R. Refaat 1, L. Afifi 2 1 Neurology Dept, Cairo University, Egypt 2 Clinical Neurophysiology, Cairo University, Egypt
Introduction: This work aims to assess the prevalence and quality (type) of sleep disorders in chronic renal failure patients. Materials and methods: A study was conducted on 40 patients with chronic renal failure (CRF) who were subdivided into two groups; patients not on heamodialysis (HD) (group I) (n = 20), and patients on regular HD (group II) (n = 20), and 20 sex and age matched control subjects. All subjects were subjected to through neurological examination, sleep complaints history and polysomnography. Results: All CRF patients had sleep complaints in the form of difficulty falling asleep (45%), fragmented sleep (55%), early morning awakening (45%) excess daytime sleepiness (25%) and jerking leg movements (15%). Patients group had significantly lower total sleep time, sleep efficiency, slow wave sleep percentage, oxyden desaturation and higher apnea hypopnea index and number of awakenings compared to control group. Sleep efficiency was significantly lower in group I compared to group II while periodic limb movement disorder was more in group II. Conclusion: There is a high prevalence of sleep disorders in chronic renal failure CRF patients whether they are on regular HD or not and, proper management of these disorders will improve the morbidity and quality of life of those patient. http://dx.doi.org/10.1016/j.sleep.2013.11.098
Repeated sleepiness ratings throughout the day – A normative field study in 800 individuals across one working week T. Akerstedt, G. Kecklund, D. Hallvig Stockholm University, Sweden
Introduction: Sleepiness ratings are frekvently used in field and laboratory studies in relation to altered sleep/wake patterns. In field studies sleepiness ratings are often the only reasible way for measuring sleepiness. Most studies have been small, however, and focused on a particular occupational group. There is a need for normative values of sleepiness at different times of day in relation to factors that might affect sleepiness, for example, work/leisure, stress, gender, age, night sleep, and health. No similar studies have been carried out before and to obtain such data was the purpose of the present study. Materials and methods: The participants rated their sleepiness on the Karolinska Sleepiness Scale (KSS) at 07, 10, 13, 16, 19, and 22 h each day for one week (scale 1–9) and filled out daily sleep diaries on sleep, stress (same time as KSS), workload, wori/nonwork, subjective health and others. Results: The results showed a very pronounced diurnal pattern with high levels at 07 h (4.6 ) and 22 h (6.6) with 3.5 around noon. Having a day off reduced the level by 0.4 units, being male reduced the levels by 0.4 units and higher age (60 years) reduced levels by 0.3 units (compared to 30 year olds) (all p- values <.001). In a multiple regression analysis was observed that sleepiness was considerably higher in individuals high on stress (workday mean) or higher in individuals low on subjective health (p < .001). Subjective sleep quality predicted lower sleepiness, but sleep duration did not. Conclusion: It was concluded that subjective sleepiness has a pronounced circadian pattern which differe depending on age and gender, and is affected by prior sleep, although stress and the state of health play important roles. The results emphasize the importance of accounting for the modifying factors when using self-rated sleepiness. Acknowledgements: This study was supported by The Swedish Research council and Stockholm Stress Center. http://dx.doi.org/10.1016/j.sleep.2013.11.099
CPAP can reduce blood pressure in symptomatic patients with OSAS D. Al-Abri Sultan Qaboos University Hospital, Oman
Introduction: obstructive sleep apnea syndrome (OSAS) is associated with raised arterial blood pressure (BP). There are controversial evidences about the effect of continues positive airway pressure (CPAP) in lowering nocturnal and daytime BP in patients with OSAS and therefore, the aim was to examine the real effect of CPAP in blood pressure in these patients. Materials and methods: We conducted a randomized sham- controlled cross-over study of the effects of 6 weeks of continuous positive airway pressure (CPAP) or Sham CPAP on 24-h blood pressure in 39 sleepy patients (37 males, 2 females) with mean age of 50 8, mean apnea- hypopnea index [AHI], 47 29 and mean ESS 16 3. Five patients were receiving anti-hypertension medications and 7 patients who had nocturnal dipping. Ambulatory blood pressure was recorded for the last 48 h at baseline and after each treatment. Epworth Sleepiness Score (ESS) was also recorded.
Abstracts / Sleep Medicine 14S (2013) e18–e92
Results: There was a small decrease in nighttime diastolic blood pressure (DBP) (Sham CPAP, 75.5 10.5 mmHg; CPAP, 71.9 10.5 mmHg; p = 0.03). There was also reduction but not significant in daytime DBP (p = 0.06). The mean DBP for 24 h was also reduced by CPAP (p = 0.03). there was no significant difference in systolic blood pressure (SBP) between sham-CPAP and CPAP treatment the average CPAP use was > or = 4 h per night. Conclusion: Thus, CPAP can reduce daytime and nighttime diastolic blood pressure in symptomatic patients with OSAS. Acknowledgements: Dr. Renata Riha, Dr. Tom Mackay and Prof Neil Douglas,Department of Sleep Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, UK. http://dx.doi.org/10.1016/j.sleep.2013.11.100
The oxford sleep resistance test (OSLER) is sensitive in showing modifications in vigilance with CPAP therapy in sleep apnea patients A. Alakuijala 1, P. Maasilta 2, A. Bachour 3 1 Helsinki University Hospital, Department of Clinical Neurophysiology, Finland 2 Helsinki University Hospital, Pulmonary Department, Finland 3 Helsinki University Hospital, Sleep Unit, Finland
Introduction: Patients with obstructive sleep apnea (OSA) usually demonstrate cognitive dysfunction both subjectively and objectively. The Oxford Sleep Resistance Test (OSLER) is a behavioral test measuring the ability to maintain wakefulness. The subject is seated in a dark and quite room and is instructed to remain awake and to respond by hitting a button on a portable device each time a dim light flashes at 3-s interval. The test consists of 3 to 4 sessions of 40 min each. When the subject fails to respond for 21 s (i.e., 7 consecutive illuminations), the test is ended and it is assumed that the subject has fallen asleep. Analyzing the error profile (including 1–6 consecutive missed hits) is considered as a sensitive mean of detecting fluctuations in vigilance. Here, we report the results of the OSLER test before and under CPAP therapy in professional drivers referred for OSA. Materials and methods: 29 professional drivers (27 men and 2 women with a mean age of 50 yrs) referred for a suspicion of sleep apnea underwent an OSLER test at baseline and after two months from CPAP initiation. We started the first session at 9:00 AM followed by two sessions at 2-h interval. We also calculated the total number of missed hits (errors) and divided that by the duration of the test to obtain the number of errors per hour (OSLER error index). Results: With CPAP therapy the mean AHI dropped significantly (p<0.05) from 50/h to 10/h, ODI4 from 44/h to 11/h, time with SpO2 below 90% from 35% to 2%, and the Epworth sleepiness scale score from 9.5 to 7.4. Furthermore, the mean OSLER sleep latency time improved significantly (p < 0.05) with CPAP from 33 min 2 s to 36 min 48 s, and the OSLER error index decreased from 51 errors/h to 20/h. Conclusion: The OSLER test is a practical tool for measuring improvement in vigilance due to CPAP therapy in professional drivers suffering from sleep apnea. http://dx.doi.org/10.1016/j.sleep.2013.11.101
e57
CSF beta-amyloid levels are altered in narcolepsy: a link with the inflammatory hypothesis? M. Albanese, C. Liguori, F. Placidi, F. Izzi, M. Marciani, A. Romigi University Hospital of Rome ‘Tor Vergata’, Department of Neuroscience, Sleep Medicine Center, Italy
Introduction: Autoimmune and inflammatory mechanisms are suggested as a possible cause of the hypocretin cell loss in human narcolepsy. Interestingly, decreased CSF levels of beta-amyloid1– 42 (Abeta–42) are described related to brain inflammation. In fact the Abeta–42 metabolism is strongly regulated by inflammatory mechanisms and the inflammatory pathways of the immune system represent targets for modulating â-amyloid generation and accumulation. The aim of our study was to evaluate the CSF levels of Abeta– 42, total-tau (t- tau) and phosphorylated-tau (ptau) in narcoleptic patients, compared with matched healthy controls, to test if the inflammatory pathways in narcolepsy may interfere with CSF Abeta–42 and/or tau metabolisms. Materials and methods: Lumbar CSF of patients with narcolepsy and healthy individuals was analyzed by ELISA tests in order to detect the CSF levels of orexin A, Abeta–42, t-tau and ptau proteins. Results: We analysed 15 narcoleptic patients and 15 sex and agematched controls. More than one-and-a-half Abeta–42 CSF levels decrease was detected in narcoleptic patients compared with healthy controls. Moreover in 5 narcoleptic patients (33%) we documented pathological CSF Abeta–42 levels (<500 pg/ml) and 14 of the 15 narcoleptic subjects (93%) presented CSF Abeta–42 levels lower than the CSF Abeta–42 mean value of the matched controls. Conversely, CSF levels of t- tau and ptau proteins did not statistically differ between groups. Conclusion: We hypothesize that the significant decrease of the CSF Abeta–42 levels in narcoleptic patients may support the inflammatory/autoimmune hypothesis at the basis of the pathogenesis of narcolepsy. Therefore, our findings may be particularly appealing since narcolepsy is a neurological disorder caused by possible underlying autoimmune processes, aroused by viral or bacterial infections, responsible for the selective orexinergic neurons loss. In addition, a secondary explanation may be represented by the prevalence of an ‘‘amyloidogenic’’ pathway, due to the deficiency of the alpha-secretase ADAM10, previously described in narcolepsy, which cause the reduction of the CSF Abeta–42 levels in narcoleptic patients. Therefore, further studies are needed to better clarify the pathogenesis of narcolepsy, to understand the role of Abeta–42 and its links with degeneration and loss of the orexinergic neurons. Acknowledgements: We thank for their precious help and assistance: N.B. Mercuri, PhD, S. Bernardini, PhD, M. Nuccetelli, MD. http://dx.doi.org/10.1016/j.sleep.2013.11.102
Validation of the efficacy of an anti-snoring pillow J. Albares 1, E. Esteller 2, C. Estivill 1, C. Martinez 1, F. Segarra 1, E. Estivill 1 1 USP Institut Universitari Dexeus, Clinica del Son Estivill, Spain 2 Hospital general de Catalunya, Department of Otolaryngology, Spain
Introduction: The aim of the study is to test the functionality of a prototype anti snoring pillow (position ‘‘forced supine’’) on threedimensional tissues ‘‘spacer’’ in order to assess the possible reduction of snoring and the possible reduction of respiratory events (apneas/ hypopneas).