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Neuropsychiatric consequences in sleep breathing disorders
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Abstracts / Sleep Medicine 14S (2013) e18–e92
Neuropsychiatric consequences in sleep breathing disorders A. Buettner-Teleaga Antje Buettner-Teleaga, Institute of Tumorbiology/Albert Ludwigs University, Germany Introduction: Sleep Breathing Disorders (SBD), especially Obstructive Sleep Apnea Syndromes (OSAS) lead to a lot of physical problems like hypertension and arrhythmias and even to neuropsychiatric consequences like Brain atrophy, Depression, Anxiety and Insomnia. Apart from a multitude of physical complaints, OSAS patients suffer from Excessive Daytime Sleepiness (EDS), reduced sustained attention, limited memory processes and cognitive functions and reduced Quality of Life (QoL). The apnea related neuropsychiatric diseases could be associated with conditions interfering with the mechanisms of mental and sensory-motor plasticity. Materials and methods: In our study we used neuropsychological and neuropsychiatric methods in different patient groups in a sleep laboratory. Over the past five years we have tested more than 2000 patients. During admission to the clinic, all patients were selected according to their clinical diagnosis (ICD-10) and all patients were examined neurologically, neuro-psychologically and psychiatrically. All test persons must not suffer from any severe psychiatric disorders. The study was carried out involving all groups of randomly selected patients with OSAS on a number of neuropsychiatric parameters. In this context we analyzed e.g. (1) excessive daytime sleepiness by Epworth Sleepiness Scale (ESS) and Reading Test (2) attention deficits by vigilance test Carda and Clock Test and by sustained attention test Carsim, (3) memory dysfunction by Number Connection Test (ZVT) and Benton Test, (4) psychiatric consequences (e.g. depression by BDI, anxiety by HADS) and (5) quality of life by different questionnaires (SWLS, MLDL, FOSQ, SAQLI). Results: Testing of neuropsychiatric diseases, memory processes and quality of life revealed a highly significant difference between healthy persons and OSAS patients (p < 0.05). Examination of specific domains of neuropsychiatric diseases, memory processes and quality of life showed significant differences in patients with OSAS. In all dimensions of neuropsychiatric diseases, memory processes and quality of life, untreated OSAS patients had inferior scores to those who had undergone therapy. After more than 6 weeks of nCPAP therapy, the neuropsychiatric diseases of the OSAS patients, memory processes and quality of life improved to a significant degree (p < 0.05). Analysis of the degree of severity showed for OSAS that on the whole, there is a significant difference concerning neuropsychiatric diseases, memory processes and quality of life. Conclusion: The study revealed that patients with OSAS show neuropsychiatric problems and deficits concerning their vigilance achievements, their memory processes and their quality of life. The improvement of vigilance achievements and memory processes show a lower driving fitness (traffic safety) in untreated patients and increasing traffic safety in treated patients. In summary, based on our results, it is to be said that although a continuous nCPAP therapy improves the OSAS symptoms; neuropsychiatric consequences, memory processes and the quality of life require longer-term recovery. http://dx.doi.org/10.1016/j.sleep.2013.11.047
Patients with severe/moderate asthma crisis show abnormal stanford sleepiness scale score C. Fransolin 1, K. Carlos 1, D. Martins 1, A. Prado 2, L. Prado 1, G. Prado 1 1 Neuro-Sono Unifesp, Brazil 2 Universidade de São Paulo, Brazil Introduction: Asthmatic patients have difficulty maintaining sleep due to breathing difficulty or nocturnal cough. The emergency
physician usually does not evaluate the degree of sleepiness in these patients, and there are no studies evaluating this population when they seek care in the asthmatic acute phase. Materials and methods: We applied the Stanford Sleepiness Scale in 42 patients treated at the Emergency Room of the São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo. Patients had moderate or severe asthma and SSS was applied one hour after the initial measures recommended by the Global Initiative for Asthma. We guided patients to return to the clinic for reassessment of SSS and respiratory functions. SSS was applied to patients seen in the emergency room during the morning and afternoon. We did not include patients seen at night. The SSS scores range from 1 to 8 (fully alert to sleeping). Data were analyzed through the Mann–Whitney test. Results: Median SSS in 42 patients in admission was 3, and 7 had a score of 6. Thirty patients returned 7 days later for reevaluation and presented a median SSS of 1, and only 3 had scores 6. There was statistically significant reduction in SSS (p = 0.015). Conclusion: Patients with moderate/severe asthma had high scores on the SSS during their stay in the emergency room. The SSS score decreased one week after treatment of the acute phase and treatment reorientation. In this preliminary work we did not investigate the reasons for these findings, but it is possible that the patient had poor sleep at night (or nights) before the visit to the emergency room, or inflammatory mechanisms of asthma itself, or association with obstructive sleep apnea, were responsible for drowsiness. It should be noted that the evaluations were performed one hour after the initial measures (GIA), and that patients had received drugs with potential stimulating effect (beta agonist and corticosteroid). Acknowledgements: Supported by FAPESP 2009/16758–4, 2010/ 02633–2, #2010/06188–3. http://dx.doi.org/10.1016/j.sleep.2013.11.048
Allergy as a risk factor for sleep disordered breathing L. Oliveira 1, C. Gomes 2, R. Ferreira 2 1 Department of Pediatrics, Santa Maria Hospital-CHLN, Academic Medical Center of Lisbon, Portugal 2 Pneumology Unit, Department of Pediatrics, Santa Maria HospitalCHLN, Academic Medical Center of Li, Portugal
Introduction: Allergy is strongly associated with poor sleep quality, being sleep disruption and sleep disordered breathing (SDB) the most common alterations, both in asthma and allergic rhinitis (AR). Nasal obstruction and congestion are a risk factor for SDB and for its persistence after adenotonsillectomy (AT). This study aims to describe and characterize the population with respiratory allergic disease (rhinitis and asthma) referred to specialized sleep clinic for snoring and/or breathing pauses and its follow-up. Materials and methods: Retrospective descriptive study, reviewing the clinical files of patients referred to our sleep clinic for SDB who had a history of asthma and/or AR from January 2008 to December 2012. Allergy was considered present if reported by the parents in child past medical history. Allergic patients represent 15.8% (n = 58) out of the total of the children referred for SDB. Descriptive and comparative (non-parametric tests) statistics were done. Results: All the 68 children files were reviewed. Male gender predominates (42; 72.4%) and the median age at first observation was 9 (3; 16) years. Most children had a regular growth (56; 96.6%). Regarding respiratory allergic disease, 15 (25.9%) children had rhinitis, 27 (46.6%) had asthma, 16 (27.6%) had both. Fourteen (24.1%) had been previously submitted to TA. Family history of atopy was frequent (24; 41.4%), as well as family history of snoring (28; 48.3%).
Abstracts / Sleep Medicine 14S (2013) e18–e92
Neuropsychiatric consequences in sleep breathing disorders A. Buettner-Teleaga Antje Buettner-Teleaga, Institute of Tumorbiology/Albert Ludwigs University, Germany Introduction: Sleep Breathing Disorders (SBD), especially Obstructive Sleep Apnea Syndromes (OSAS) lead to a lot of physical problems like hypertension and arrhythmias and even to neuropsychiatric consequences like Brain atrophy, Depression, Anxiety and Insomnia. Apart from a multitude of physical complaints, OSAS patients suffer from Excessive Daytime Sleepiness (EDS), reduced sustained attention, limited memory processes and cognitive functions and reduced Quality of Life (QoL). The apnea related neuropsychiatric diseases could be associated with conditions interfering with the mechanisms of mental and sensory-motor plasticity. Materials and methods: In our study we used neuropsychological and neuropsychiatric methods in different patient groups in a sleep laboratory. Over the past five years we have tested more than 2000 patients. During admission to the clinic, all patients were selected according to their clinical diagnosis (ICD-10) and all patients were examined neurologically, neuro-psychologically and psychiatrically. All test persons must not suffer from any severe psychiatric disorders. The study was carried out involving all groups of randomly selected patients with OSAS on a number of neuropsychiatric parameters. In this context we analyzed e.g. (1) excessive daytime sleepiness by Epworth Sleepiness Scale (ESS) and Reading Test (2) attention deficits by vigilance test Carda and Clock Test and by sustained attention test Carsim, (3) memory dysfunction by Number Connection Test (ZVT) and Benton Test, (4) psychiatric consequences (e.g. depression by BDI, anxiety by HADS) and (5) quality of life by different questionnaires (SWLS, MLDL, FOSQ, SAQLI). Results: Testing of neuropsychiatric diseases, memory processes and quality of life revealed a highly significant difference between healthy persons and OSAS patients (p < 0.05). Examination of specific domains of neuropsychiatric diseases, memory processes and quality of life showed significant differences in patients with OSAS. In all dimensions of neuropsychiatric diseases, memory processes and quality of life, untreated OSAS patients had inferior scores to those who had undergone therapy. After more than 6 weeks of nCPAP therapy, the neuropsychiatric diseases of the OSAS patients, memory processes and quality of life improved to a significant degree (p < 0.05). Analysis of the degree of severity showed for OSAS that on the whole, there is a significant difference concerning neuropsychiatric diseases, memory processes and quality of life. Conclusion: The study revealed that patients with OSAS show neuropsychiatric problems and deficits concerning their vigilance achievements, their memory processes and their quality of life. The improvement of vigilance achievements and memory processes show a lower driving fitness (traffic safety) in untreated patients and increasing traffic safety in treated patients. In summary, based on our results, it is to be said that although a continuous nCPAP therapy improves the OSAS symptoms; neuropsychiatric consequences, memory processes and the quality of life require longer-term recovery. http://dx.doi.org/10.1016/j.sleep.2013.11.047
Patients with severe/moderate asthma crisis show abnormal stanford sleepiness scale score C. Fransolin 1, K. Carlos 1, D. Martins 1, A. Prado 2, L. Prado 1, G. Prado 1 1 Neuro-Sono Unifesp, Brazil 2 Universidade de São Paulo, Brazil Introduction: Asthmatic patients have difficulty maintaining sleep due to breathing difficulty or nocturnal cough. The emergency
physician usually does not evaluate the degree of sleepiness in these patients, and there are no studies evaluating this population when they seek care in the asthmatic acute phase. Materials and methods: We applied the Stanford Sleepiness Scale in 42 patients treated at the Emergency Room of the São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo. Patients had moderate or severe asthma and SSS was applied one hour after the initial measures recommended by the Global Initiative for Asthma. We guided patients to return to the clinic for reassessment of SSS and respiratory functions. SSS was applied to patients seen in the emergency room during the morning and afternoon. We did not include patients seen at night. The SSS scores range from 1 to 8 (fully alert to sleeping). Data were analyzed through the Mann–Whitney test. Results: Median SSS in 42 patients in admission was 3, and 7 had a score of 6. Thirty patients returned 7 days later for reevaluation and presented a median SSS of 1, and only 3 had scores 6. There was statistically significant reduction in SSS (p = 0.015). Conclusion: Patients with moderate/severe asthma had high scores on the SSS during their stay in the emergency room. The SSS score decreased one week after treatment of the acute phase and treatment reorientation. In this preliminary work we did not investigate the reasons for these findings, but it is possible that the patient had poor sleep at night (or nights) before the visit to the emergency room, or inflammatory mechanisms of asthma itself, or association with obstructive sleep apnea, were responsible for drowsiness. It should be noted that the evaluations were performed one hour after the initial measures (GIA), and that patients had received drugs with potential stimulating effect (beta agonist and corticosteroid). Acknowledgements: Supported by FAPESP 2009/16758–4, 2010/ 02633–2, #2010/06188–3. http://dx.doi.org/10.1016/j.sleep.2013.11.048
Allergy as a risk factor for sleep disordered breathing L. Oliveira 1, C. Gomes 2, R. Ferreira 2 1 Department of Pediatrics, Santa Maria Hospital-CHLN, Academic Medical Center of Lisbon, Portugal 2 Pneumology Unit, Department of Pediatrics, Santa Maria HospitalCHLN, Academic Medical Center of Li, Portugal
Introduction: Allergy is strongly associated with poor sleep quality, being sleep disruption and sleep disordered breathing (SDB) the most common alterations, both in asthma and allergic rhinitis (AR). Nasal obstruction and congestion are a risk factor for SDB and for its persistence after adenotonsillectomy (AT). This study aims to describe and characterize the population with respiratory allergic disease (rhinitis and asthma) referred to specialized sleep clinic for snoring and/or breathing pauses and its follow-up. Materials and methods: Retrospective descriptive study, reviewing the clinical files of patients referred to our sleep clinic for SDB who had a history of asthma and/or AR from January 2008 to December 2012. Allergy was considered present if reported by the parents in child past medical history. Allergic patients represent 15.8% (n = 58) out of the total of the children referred for SDB. Descriptive and comparative (non-parametric tests) statistics were done. Results: All the 68 children files were reviewed. Male gender predominates (42; 72.4%) and the median age at first observation was 9 (3; 16) years. Most children had a regular growth (56; 96.6%). Regarding respiratory allergic disease, 15 (25.9%) children had rhinitis, 27 (46.6%) had asthma, 16 (27.6%) had both. Fourteen (24.1%) had been previously submitted to TA. Family history of atopy was frequent (24; 41.4%), as well as family history of snoring (28; 48.3%).