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REM sleep behavioral disorder in Parkinson’s disease: preliminary results
Abstracts / Sleep Medicine 14S (2013) e93–e164
Acknowledgements: Research funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de recherche du Québec – Santé (FRQS). http://dx.doi.org/10.1016/j.sleep.2013.11.242
Sleep problems in patients with parkinson’s disease in a hospital setting from Romania M. Dumitru University Hospital of Psychiatry ‘‘Socola’’, Romania
Introduction: Sleep dysfunction is common among patients with Parkinson’s disease and occurs in approximately two thirds of patients. The objective of this study was to examine the prevalence of sleep problems in patients with Parkinson’s disease in Romania, and their associated factors. Materials and methods: 44 consecutive PD inpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS). Results: The mean age was 67.8 years (range 35–74); the mean Hoehn and Yahr stage was 2.13 (SD 0.89), and the mean UPDRS part III was 22.6 (SD 11.5). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. Conclusion: The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS. Physicians and patients must be educated so that sleep problems can be appropriately recognized and treated. Acknowledgement: I thank Proffesor Cornel Dinu Popescu for his skillfull assistance during the study. http://dx.doi.org/10.1016/j.sleep.2013.11.243
A new vibratory postural device for the treatment of positional obstructive sleep apnea (OSA). A pilot study J. Duran-Cantolla 1, F. Barbe 2, J. Rigau 3, D. Oreja 1,2,3,4, C. Martinez-Null 4, C. Egea Santaolalla 4 1 Araba University Hospital, UPV, BioAraba Institute, CIBERES, Spain 2 IRB Lleida, CIBERES, Spain 3 SibelMed SA, Spain 4 Araba University Hospital, UPV, Sleep Unit, BioAraba, CIBERES, Spain
Introduction: Over 50% of patients suffering from obstructive sleep apnea (OSA) meet criteria for postural OSA. Postural OSA is defined by an apnea-hypopnea index (AHI) doubling in supine position vs. not supine. Different devices for postural OSA has been used but most of them are uncomfortable and their results for treating postural OSA are controversial. Our group in collaboration with the company SIBEL SA, have developed a patented postural device (PCT/ES2010707108 and P26018USPC). This is a vibratory device of 4 4 cm and a weight of about 50 grams integrating an accelerometer, a vibrator and other sensors. The device is placed on the patient’s forehead and when the device detects that the patient is in the supine position for 30 s or more, it starts a vibration, with
e111
increasing intensity, which ceases when the patient moves to lateral. The aim was to demonstrate a significant reduction in the AHI and that this reduction was maintained over time. We also want to assess the quality and quantity of sleep using the device. Materials and methods: We present the results of a pilot study in patients with postural OSA. All patients were studied by standard polysomnography (PSG) three times; at baseline, and at 1 and 4 weeks of using the device. Results: We studied 12 patients (75% male), body mass index of 25.7 kg/m2 (SD 3.3). The baseline AHI was 33.5 (SD 14.7) and was reduced after 1 and 4 weeks using the device to 22.8 (SD 10.6; p = 0.004) and 19.7 (SD 7.4; p = 0.002), respectively. The percentage of total sleep time (TST) in supine changed from 51.5% (SD 14.8%) at baseline to 16.4% (SD 16.0%; p = 0.002) and 25.2% (SD 21.0%; p = 0.005) at 1 and 4 weeks of using the device, respectively. The device did not significantly modify the TST and significantly reduced the arousal index. Conclusion: The results of this study suggest that this device is safe and could be useful as a treatment for postural OSA in a significant number of patients and its effect is mantained over the time. Acknowledgements: Device designed and produced by Sibel Group SL with the collaboration and participation in all phases by the Sleep Units of Vitoria (Spain) and Lleida (Spain) The sponsorship of the different prototypes and this pilot study has been made possible by the Basque Institute of Research and by Sibel Group SL All Rights reserved by Sibel Group SL and the Basque Institute of Research. http://dx.doi.org/10.1016/j.sleep.2013.11.244
REM sleep behavioral disorder in Parkinson’s disease: preliminary results A. Eckeli, M. Sobreira Neto, E. Sobreira, M. Chagas, V. Tumas, R. Francßa Fernandes Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Brazil
Introduction: REM Sleep Behavioral Disorder (RBD) is a parasomnia characterized by acting out during REM sleep, with a higher prevalence in Parkinson‘s Disease (PD), which changes from 46% to 58%. Moreover, PD patients with RBD show motor and non-motor characteristics distinct from other PD patients without RBD. Objetives: to estimate the prevalence and characteristics of RBD among patients with PD. Materials and methods: Methods and patients: Patients were consecutively evaluated at a third level Outpatient Clinics for Movement Disorders, through the following clinical scales: PD sleep Scale validated for the Brazilian population (PDSS-Br), Epworth’s daytime sleepiness scale, quality of life questionnaire in PD (PDQ- 39), unified PD rating scale (UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England’s functional evaluation scale. All patients were submitted to polysomnography and diagnose of RBD was defined according to the 2nd International Classification of Sleep Disorders. Results: seventy third (73) patients have been included so far, among whom we have found a prevalence of 61.6% of RBD (45 patients). There was a lower respiratory disorder index (RDI) among patients with RBD (10.53 ± 11.07) as compared to those without RBD (20.58 ± 17.89) (p = 0.020). We also found history of self inflicted injury or wounding someone else during sleep acting out periods in 15 patients (33.3%) with RBD. Somniloquy was reported in 97.7% of RBD patients and it was the most frequently reported behavior. We did not find statistically significant differences between groups of patients with or without RBD related to age, time
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Abstracts / Sleep Medicine 14S (2013) e93–e164
duration of PD, as well as in regard to PD Sleep Scale validated for the Brazilian population (PDSS-Br), Epworth’s daytime sleepiness scale, quality of life questionnaire in PD (PDQ-39), unified PD rating scale (UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England’s functional evaluation scale. Conclusion: RBD is a very prevalent condition among PD patients, being associated to a lower RDI and higher risk of wounding during sleep. We found no association between RBD and reduced quality of life in PD patients. Acknowledgements: FAEPA (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo) CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). http://dx.doi.org/10.1016/j.sleep.2013.11.245
Obstructive sleep apnea syndrome in Parkinson’s disease: preliminary results M. Sobreira Neto, M. Pereira, E. Sobreira, R. França Fernandes, V. Tumas, A. Eckeli Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Brazil
Introduction: the prevalence of Obstructive Sleep Apnea Syndrome (OSAS) among patients with Parkinson’s Disease (PD) changes from 20% to 66%. OSAS also shows different characteristics in those patients as compared to general population. Objectives: to estimate the prevalence and characteristics of OSAS in patients with PD. Materials and methods: Methods and patients: Patients were consecutively evaluated at a third level Outpatient Clinics for Movement Disorders, through the following clinical scales: PD Sleep Scale validated for the Brazilian population (PDSS-Br), Epworth‘s daytime sleepiness scale, quality of life questionnaire in PD (PDQ-39), unified PD rating scale (UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England‘s functional evaluation scale. All patients were submitted to polysomnography and diagnose of OSAS was defined according to the 2nd International Classification of Sleep Disorders. Results: Seventy third (73) patients have been included so far, among whom we have found a prevalence of 61.6% of OSAS (45 patients), of mild or moderate severity in 86.6%. OSAS patients had higher age than those without OSAS (p = 0.004). The mean score in Epworth‘s scale was higher among OSAS patients (p = 0.05). Snore was the prevalent symptom in the group of OSAS patients (74.5%), showing a sensitivity of 80%. Apneas witnessed by partners were the most specific symptom, ranking 92%. We did not find significant differences between the groups with and without OSAS in regard to PDSS-Br, PDQ-39, UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England’s functional evaluation scale. Conclusion: OSAS is a prevalent sleep disorder among PD patients, in whom it is found in higher aging people and is associated to greater daytime sleepiness, in comparison to non-OSAS PD patients. Snore is the most sensitive symptom and apneas witnessed by the partner the most specific symptom in PD patients with OSAS. Acknowledgements: FAEPA (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo) CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). http://dx.doi.org/10.1016/j.sleep.2013.11.246
A collaborative care model for improving sleep disorders management in primary care J. Edinger 1, J. Grubber 2, C. Ulmer 2, J. Zervakis 2, M. Olsen 2 1 National Jewish Health, United States 2 VA Medical Center, United States
Introduction: Sleep disorders often are not adequately addressed in the primary care setting. The current study was conducted to determine the effects of a one-time consultation with a sleep specialist on sleep management patterns and outcomes in a primary care setting. Materials and methods: The study entailed a prospective, randomized, clinical intervention trial. Participants were 137 veterans (Mage = 55.4 years; 29 women) enrolled in the primary care clinics of the Durham VA Medical Center. Eligible participants had a sleep complaint > 1 month duration, P6 on the Pittsburgh Sleep Quality Index-PSQI, P24 on the Folstein exam, no unstable medical or psychiatric disorders, and no previous sleep specialist treatment. Participants were randomized to an intervention (INT; N = 68) or wait-list control (WLC; N = 69). INT consisted of one meeting with a sleep specialist who administered structured interviews assessing sleep and psychiatric disorders, and then provided manualized treatment recommendations to patients and their respective healthcare providers. Providers’ referral patterns and patient outcomes (sleep diaries, PSQI, Epworth Sleepiness) were then monitored for a subsequent 10month period. Results: Provider-initiated sleep-focused interventions were significantly more frequent for the INT group than for the WLC group including PSG referrals (p < .0001), and mental health clinic referrals (p < .02). INT recipients showed greater improvements in diary total wake time (p < .05) and sleep efficiency (p < .03) than did WLC recipients at 10-month follow-up. In addition, larger proportions of the INT group showed >one standard deviation decline on the PSQI (41% vs. 21%; p = 0.02) and achieved normal (<10) Epworth Sleepiness Scale scores (69% vs. 50%; p = 0.03) by the 10-month followup than did those in the WLC group. Conclusion: A one-time sleep consultation significantly increased healthcare providers’ attention to sleep problems and resulted in benefits to patients’ sleep/wake symptoms. Acknowledgements: Funded by US Department of Veterans Affairs Health Services Research and Development Grant # IIR 05–213. http://dx.doi.org/10.1016/j.sleep.2013.11.247
Association between subjective sleepiness and severity of sleep-disordered breathing among truck drivers in Japan E. Eguchi 1, T. Tanigawa 1, M. Takahashi 2, S. Sakurai 3, K. Maruyama 4 1 Ehime University Graduate School of Medicine, Public Health, Japan 2 National Institute of Occupational Safety and Health, Japan 3 Tenri Health Care University, Japan 4 Ehime University Graduate School of Medicine, Japan
Introduction: The purpose of this study is to investigate the association of subjective sleepiness and severity of sleep-disordered breathing among truck drivers in Japan. Materials and methods: Age adjusted subjective daytime sleepiness was not significantly related to the severity of sleep-disordered breathing in this population (p = 0.36). Among the subjects who had severe sleep-disordered breathing (RDI P 20), ESS score of nonsleepiness and moderate sleepiness was 56.3% and 34.4% respectively. For the BMI stratified analysis, prevalence of non-sleepiness
Acknowledgements: Research funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de recherche du Québec – Santé (FRQS). http://dx.doi.org/10.1016/j.sleep.2013.11.242
Sleep problems in patients with parkinson’s disease in a hospital setting from Romania M. Dumitru University Hospital of Psychiatry ‘‘Socola’’, Romania
Introduction: Sleep dysfunction is common among patients with Parkinson’s disease and occurs in approximately two thirds of patients. The objective of this study was to examine the prevalence of sleep problems in patients with Parkinson’s disease in Romania, and their associated factors. Materials and methods: 44 consecutive PD inpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS). Results: The mean age was 67.8 years (range 35–74); the mean Hoehn and Yahr stage was 2.13 (SD 0.89), and the mean UPDRS part III was 22.6 (SD 11.5). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. Conclusion: The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS. Physicians and patients must be educated so that sleep problems can be appropriately recognized and treated. Acknowledgement: I thank Proffesor Cornel Dinu Popescu for his skillfull assistance during the study. http://dx.doi.org/10.1016/j.sleep.2013.11.243
A new vibratory postural device for the treatment of positional obstructive sleep apnea (OSA). A pilot study J. Duran-Cantolla 1, F. Barbe 2, J. Rigau 3, D. Oreja 1,2,3,4, C. Martinez-Null 4, C. Egea Santaolalla 4 1 Araba University Hospital, UPV, BioAraba Institute, CIBERES, Spain 2 IRB Lleida, CIBERES, Spain 3 SibelMed SA, Spain 4 Araba University Hospital, UPV, Sleep Unit, BioAraba, CIBERES, Spain
Introduction: Over 50% of patients suffering from obstructive sleep apnea (OSA) meet criteria for postural OSA. Postural OSA is defined by an apnea-hypopnea index (AHI) doubling in supine position vs. not supine. Different devices for postural OSA has been used but most of them are uncomfortable and their results for treating postural OSA are controversial. Our group in collaboration with the company SIBEL SA, have developed a patented postural device (PCT/ES2010707108 and P26018USPC). This is a vibratory device of 4 4 cm and a weight of about 50 grams integrating an accelerometer, a vibrator and other sensors. The device is placed on the patient’s forehead and when the device detects that the patient is in the supine position for 30 s or more, it starts a vibration, with
e111
increasing intensity, which ceases when the patient moves to lateral. The aim was to demonstrate a significant reduction in the AHI and that this reduction was maintained over time. We also want to assess the quality and quantity of sleep using the device. Materials and methods: We present the results of a pilot study in patients with postural OSA. All patients were studied by standard polysomnography (PSG) three times; at baseline, and at 1 and 4 weeks of using the device. Results: We studied 12 patients (75% male), body mass index of 25.7 kg/m2 (SD 3.3). The baseline AHI was 33.5 (SD 14.7) and was reduced after 1 and 4 weeks using the device to 22.8 (SD 10.6; p = 0.004) and 19.7 (SD 7.4; p = 0.002), respectively. The percentage of total sleep time (TST) in supine changed from 51.5% (SD 14.8%) at baseline to 16.4% (SD 16.0%; p = 0.002) and 25.2% (SD 21.0%; p = 0.005) at 1 and 4 weeks of using the device, respectively. The device did not significantly modify the TST and significantly reduced the arousal index. Conclusion: The results of this study suggest that this device is safe and could be useful as a treatment for postural OSA in a significant number of patients and its effect is mantained over the time. Acknowledgements: Device designed and produced by Sibel Group SL with the collaboration and participation in all phases by the Sleep Units of Vitoria (Spain) and Lleida (Spain) The sponsorship of the different prototypes and this pilot study has been made possible by the Basque Institute of Research and by Sibel Group SL All Rights reserved by Sibel Group SL and the Basque Institute of Research. http://dx.doi.org/10.1016/j.sleep.2013.11.244
REM sleep behavioral disorder in Parkinson’s disease: preliminary results A. Eckeli, M. Sobreira Neto, E. Sobreira, M. Chagas, V. Tumas, R. Francßa Fernandes Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Brazil
Introduction: REM Sleep Behavioral Disorder (RBD) is a parasomnia characterized by acting out during REM sleep, with a higher prevalence in Parkinson‘s Disease (PD), which changes from 46% to 58%. Moreover, PD patients with RBD show motor and non-motor characteristics distinct from other PD patients without RBD. Objetives: to estimate the prevalence and characteristics of RBD among patients with PD. Materials and methods: Methods and patients: Patients were consecutively evaluated at a third level Outpatient Clinics for Movement Disorders, through the following clinical scales: PD sleep Scale validated for the Brazilian population (PDSS-Br), Epworth’s daytime sleepiness scale, quality of life questionnaire in PD (PDQ- 39), unified PD rating scale (UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England’s functional evaluation scale. All patients were submitted to polysomnography and diagnose of RBD was defined according to the 2nd International Classification of Sleep Disorders. Results: seventy third (73) patients have been included so far, among whom we have found a prevalence of 61.6% of RBD (45 patients). There was a lower respiratory disorder index (RDI) among patients with RBD (10.53 ± 11.07) as compared to those without RBD (20.58 ± 17.89) (p = 0.020). We also found history of self inflicted injury or wounding someone else during sleep acting out periods in 15 patients (33.3%) with RBD. Somniloquy was reported in 97.7% of RBD patients and it was the most frequently reported behavior. We did not find statistically significant differences between groups of patients with or without RBD related to age, time
e112
Abstracts / Sleep Medicine 14S (2013) e93–e164
duration of PD, as well as in regard to PD Sleep Scale validated for the Brazilian population (PDSS-Br), Epworth’s daytime sleepiness scale, quality of life questionnaire in PD (PDQ-39), unified PD rating scale (UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England’s functional evaluation scale. Conclusion: RBD is a very prevalent condition among PD patients, being associated to a lower RDI and higher risk of wounding during sleep. We found no association between RBD and reduced quality of life in PD patients. Acknowledgements: FAEPA (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo) CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). http://dx.doi.org/10.1016/j.sleep.2013.11.245
Obstructive sleep apnea syndrome in Parkinson’s disease: preliminary results M. Sobreira Neto, M. Pereira, E. Sobreira, R. França Fernandes, V. Tumas, A. Eckeli Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Brazil
Introduction: the prevalence of Obstructive Sleep Apnea Syndrome (OSAS) among patients with Parkinson’s Disease (PD) changes from 20% to 66%. OSAS also shows different characteristics in those patients as compared to general population. Objectives: to estimate the prevalence and characteristics of OSAS in patients with PD. Materials and methods: Methods and patients: Patients were consecutively evaluated at a third level Outpatient Clinics for Movement Disorders, through the following clinical scales: PD Sleep Scale validated for the Brazilian population (PDSS-Br), Epworth‘s daytime sleepiness scale, quality of life questionnaire in PD (PDQ-39), unified PD rating scale (UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England‘s functional evaluation scale. All patients were submitted to polysomnography and diagnose of OSAS was defined according to the 2nd International Classification of Sleep Disorders. Results: Seventy third (73) patients have been included so far, among whom we have found a prevalence of 61.6% of OSAS (45 patients), of mild or moderate severity in 86.6%. OSAS patients had higher age than those without OSAS (p = 0.004). The mean score in Epworth‘s scale was higher among OSAS patients (p = 0.05). Snore was the prevalent symptom in the group of OSAS patients (74.5%), showing a sensitivity of 80%. Apneas witnessed by partners were the most specific symptom, ranking 92%. We did not find significant differences between the groups with and without OSAS in regard to PDSS-Br, PDQ-39, UPDRS), Hoehn & Yahr’s modified evaluation scale and Schwab & England’s functional evaluation scale. Conclusion: OSAS is a prevalent sleep disorder among PD patients, in whom it is found in higher aging people and is associated to greater daytime sleepiness, in comparison to non-OSAS PD patients. Snore is the most sensitive symptom and apneas witnessed by the partner the most specific symptom in PD patients with OSAS. Acknowledgements: FAEPA (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo) CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior). http://dx.doi.org/10.1016/j.sleep.2013.11.246
A collaborative care model for improving sleep disorders management in primary care J. Edinger 1, J. Grubber 2, C. Ulmer 2, J. Zervakis 2, M. Olsen 2 1 National Jewish Health, United States 2 VA Medical Center, United States
Introduction: Sleep disorders often are not adequately addressed in the primary care setting. The current study was conducted to determine the effects of a one-time consultation with a sleep specialist on sleep management patterns and outcomes in a primary care setting. Materials and methods: The study entailed a prospective, randomized, clinical intervention trial. Participants were 137 veterans (Mage = 55.4 years; 29 women) enrolled in the primary care clinics of the Durham VA Medical Center. Eligible participants had a sleep complaint > 1 month duration, P6 on the Pittsburgh Sleep Quality Index-PSQI, P24 on the Folstein exam, no unstable medical or psychiatric disorders, and no previous sleep specialist treatment. Participants were randomized to an intervention (INT; N = 68) or wait-list control (WLC; N = 69). INT consisted of one meeting with a sleep specialist who administered structured interviews assessing sleep and psychiatric disorders, and then provided manualized treatment recommendations to patients and their respective healthcare providers. Providers’ referral patterns and patient outcomes (sleep diaries, PSQI, Epworth Sleepiness) were then monitored for a subsequent 10month period. Results: Provider-initiated sleep-focused interventions were significantly more frequent for the INT group than for the WLC group including PSG referrals (p < .0001), and mental health clinic referrals (p < .02). INT recipients showed greater improvements in diary total wake time (p < .05) and sleep efficiency (p < .03) than did WLC recipients at 10-month follow-up. In addition, larger proportions of the INT group showed >one standard deviation decline on the PSQI (41% vs. 21%; p = 0.02) and achieved normal (<10) Epworth Sleepiness Scale scores (69% vs. 50%; p = 0.03) by the 10-month followup than did those in the WLC group. Conclusion: A one-time sleep consultation significantly increased healthcare providers’ attention to sleep problems and resulted in benefits to patients’ sleep/wake symptoms. Acknowledgements: Funded by US Department of Veterans Affairs Health Services Research and Development Grant # IIR 05–213. http://dx.doi.org/10.1016/j.sleep.2013.11.247
Association between subjective sleepiness and severity of sleep-disordered breathing among truck drivers in Japan E. Eguchi 1, T. Tanigawa 1, M. Takahashi 2, S. Sakurai 3, K. Maruyama 4 1 Ehime University Graduate School of Medicine, Public Health, Japan 2 National Institute of Occupational Safety and Health, Japan 3 Tenri Health Care University, Japan 4 Ehime University Graduate School of Medicine, Japan
Introduction: The purpose of this study is to investigate the association of subjective sleepiness and severity of sleep-disordered breathing among truck drivers in Japan. Materials and methods: Age adjusted subjective daytime sleepiness was not significantly related to the severity of sleep-disordered breathing in this population (p = 0.36). Among the subjects who had severe sleep-disordered breathing (RDI P 20), ESS score of nonsleepiness and moderate sleepiness was 56.3% and 34.4% respectively. For the BMI stratified analysis, prevalence of non-sleepiness