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Respiratory-related leg movements and periodic leg movements during sleep
Abstracts / Sleep Medicine 14S (2013) e165–e238
recovery was speed up by 13–15 h. Acceleration was also noted in forced restoration of passive and active wakefulness EEG picture. Significant elevation was noted in CSF OrexinA Concentration. Conclusion: Serial electrical stimulations of hypothalamic Orexincontaining neuronal regions significantly elevates CSF OrexinA concentration, speed up recovery from comatose state, and manifest in accelerated restoration of sleep-wakefulness cycle behavioral states. Acknowledgements: Supported by Shota Rustaveli National Science Foundation, Grant #11/04. http://dx.doi.org/10.1016/j.sleep.2013.11.461
Recognition of sleep-related breathing disorders from HolterECGS¨C a new robust method suitable for clinical screening applications C. Maier 1, H. Wenz 2, H. Dickhaus 1 1 Heidelberg University, Institute of Medical Biometry and Informatics, Department of Medical Informatics, Germany 2 Heidelberg University Hospital, Thoraxklinik, Sleep Medicine Center, Germany Introduction: Detection of sleep-related breathing disorders (SRBD) in an early stage is highly desirable in order to route patients to appropriate diagnostics and therapy before severe consequences become overt. We present a traceable, robust and accurate method for detection and quantification of SRDB from Holter ECGs. It provides an epoch-based (1 min) statement as well as an estimate of the apnea-hypopnea-index (AHI) and appears suitable for screening for SBAS in routine Holter-ECGs. Materials and methods: Time-series of QRS-amplitude (QRSA) and respiratory myogram interference (RMI) were extracted from 140 overnight Holter-ECGs recorded in parallel to polysomnograms (PSGs) in 121 patients. The only exclusion criterion was persistent atrial fibrillation; other co- morbidities such as diabetes, myocardial infarction or periodic limb movements as well as concomitant medication were admitted. The PSG annotations served as reference for ECG-based detection of the presence of respiratory events in epochs of 1 min duration. Detection was based on ROC analysis of a single classification feature that quantifies the joint time-locked occurrence of characteristic modulations in QRSA and RMI using normalized cross-correlation. Two different ROC-thresholds were considered, the first balancing sensitivity and specificity (Tbal), the second maximizing accuracy (Tacc). For AHI assessment, the local period of modulations in the QRSA-series was determined from its zero crossings. Epochs classified as apnea-positive were weighted with a factor 60s/period providing an estimate of the number of respiratory events in that epoch. The sum of these weights, normalized for the duration of the record, served as an AHI estimate. A threshold of AHI ¡Y´ 15 was used for screening. We implemented a ternary strategy where a borderline-class collected all records with conflicting decisions for the two thresholds Tbal and Tacc. Results: For the epoch-based detection, sensitivity was 85.5% and specificity was 86%. In the screening application (AHI ¡Y´ 15), 16% of the recordings were classified as ¡Òborderline¡;= . The sensitivity for the remaining 84% (117 recordings) was 100% with a specificity of 91% and a Kappa coefficient of 0.91. Conclusion: Robust, traceable and accurate detection of SRDB is possible from the Holter-ECG for a very heterogeneous real-world sample including different types of SRDB and typical co- morbidities. Since our approach does not make use of heart rate information, it may be even applicable in patients with severe arrhythmias. http://dx.doi.org/10.1016/j.sleep.2013.11.462
e195
A novel experimental design to avoid rem sleep rebound L. Maisuradze 1, N. Lortkipanidze 2, N. Oniani 2 1 Ilia State University, I. Beritashvili Center of Experimental Biomedicine, Georgia 2 Ilia State University, Georgia
Introduction: Several studies report about the phenomenon of REM sleep rebound which is occurred after cessation of deprivation of this sleep stage conducted by various instrumental techniques. According to our previous works REM sleep replacement by waking episodes does not lead to accumulation of REM sleep need. On the basis of this statement we have elaborated special experimental scheme of to avoid REM sleep rebound appearance. Here we present the results of these experiments. Materials and methods: Eight mature cats weighing 2.8–3.5 kg were implanted with electrodes for standard sleep-wake cycle (SWC) recordings. After establishment of baseline SWC REM sleep deprivation was performed using classic method of short-term awakenings using MRF stimulation during eight hours. Then, the four animals (experimental (E)) were not allowed to fall asleep through the maintenance of active waking state during one hour by using electrical stimulation of the posterior hypothalamus; this procedure was followed by the six- hour post-deprivation period. Another four cats (control (C)) could realize SWC without any interventions. Duration of individual episodes of different SWC phases/ stages, their total amount and percent ratio were calculated and compared with corresponding baseline data. Results: As it was expected, REM sleep propensity increased during deprivation hours with frequent enforced awakenings from this stage, and REM sleep rebound was occurred in the C - group animals with significant decrease of REM sleep latency. However, in E- cats, either total REM sleep amount or the time needed for the transitions of slow- wave sleep to REM sleep did not differ from baseline. No increase of ponto- geniculo-occipital waves or rapid-eye- movements was found in the episodes of E-cat’s REM sleep while the frequency of these indices increased significantly in the C-group. Conclusion: Results provide additional support for our opinion that active waking state is able to satisfy the inner need for REM sleep even in the conditions of substantial increases in the REM sleep propensity and prevents the occurrence of REM sleep rebound. Acknowledgement: We are very thankful to Prof. Tengiz Oniani who was supervisor of the present study.
http://dx.doi.org/10.1016/j.sleep.2013.11.463
Respiratory-related leg movements and periodic leg movements during sleep M. Manconi 1, I. Zavalko 2, C. Bassetti 3, E. Colamartino 1, M. Pons 4, R. Ferri 5 1 Civic Hospital (EOC) of Lugano, Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Switzerland 2 Sechenov First Moscow State Medical University, Laboratory of Autonomic Nervous System Disorders, Switzerland 3 Bern University Hospital, Universitätsklinik für Neurologie, Inselspital, Switzerland 4 Civic Hospital (EOC) of Lugano, Department of Internal Medicine, Switzerland 5 Oasi Institute (IRCCS), Sleep Research Centre, Department of Neurology I.C., Switzerland
Introduction: The aim of the study was to describe the time structure of leg movements (LM) in obstructive sleep apnea syndrome
e196
Abstracts / Sleep Medicine 14S (2013) e165–e238
(OSAS), in order to add new knowledge to the understanding of their clinical significance. Materials and methods: Eighty-four patients (16 females, 68 males, mean age 55.1 years, range 29–74) were recruited. All subjects underwent full-night polysomnography and the leg motor pattern was evaluated by means of advanced tools of analysis particularly able to detect and describe LM time structure (periodicity and distribution). In particular, respiratory-related LM (RRLM) were separated from those not related to respiratory events (NRLM). Results: OSAS patients with RRLM had leg movement parameters generally higher subjects without RRLM; the effect was strong for the periodic LM during sleep (PLMS) index, in particular during NREM sleep. The NRLM intermovement interval distribution histogram of patients with RRLM showed a prominent first peak at 4 s, followed by another at approximately 24 s (corresponding to typical PLMS). In the same group, RRLM showed a single wide lower peak with a maximum at about 42 s. In patients without RRLM, NRLM were evident with a single peak at 2–4 s. Patients with RRLM showed a gradually decreasing number of NRLM, from the first to the last hours of sleep; this pattern was less clear for RRLM. A stepwise linear regression analysis showed that, even when controlling for RLS status and AHI, PLMS were highly significantly associated with RRLM. Conclusion: This study shows that RRLM might be part of the true PLMS because they cluster clearly in the patients who also have typical PLMS not correlated with the respiratory events.
http://dx.doi.org/10.1016/j.sleep.2013.11.464
between patients and controls and patients with PSQI >5 and those with PSQI <5. Results: Neither PSQI total score (5.2 3.6 in patients and 5.33.4 in controls) nor its components differ significantly between patients and controls. PSQI >5 patients (39%) and PSQI <5 patients (61%) do not differ significantly for age (47.115.0 vs. 43.915.0 years), sex (41% vs. 50% males), STAI 1 ( 46.213.2 vs. 37.99.6) and STAI2 scores (44.210.5 vs. 3910.7), BDI (12.88.0 vs. 9.19.0), MEQ chronotype, OSA prevalence (15.8% vs. 7.1%). As for illness-related parameters, PSQI >5 patients proved to have a significantly longer illness duration than PSQI <5 patients (17.518.2 years vs 8.20.3 years; p = 0.035) and a higher rate of seizures recency (54.5% vs. 15.4%; p = 0.04). Conclusion: Our data indicate that subjective sleep quality in adult patients with seizures occurring exclusively or predominantly during sleep is not poorer than in healthy controls. Patients’ sleep quality is influenced by some illness related parameters, with poor sleep quality being associated with longer disease duration and seizure recency. The relatively low frequency of seizures along with a blunting effect of antiepileptic treatment on arousal instability during sleep may explain the finding of a substantially good sleep quality in our patients series. However also epilepsy patients’ life style and their good compliance to sleep hygiene rules may account for a preserved sleep quality. Acknowledgements: The Authors wish to thank the technogists Valter Rustioni, Daniele Marchese, Laura Spelta, Federica Camasso for their technical support.
http://dx.doi.org/10.1016/j.sleep.2013.11.465 Subjective sleep quality in epilepsy patients with sleep-related seizures R. Manni 1, R. Cremascoli 1, C. Sguazzin 2, M. Terzaghi 1 1 National Institute of Neurology IRCCS C, Mondino Foundation, Italy 2 Psychological Unit, Salvatore Maugeri Foundation IRCCS, Scientific Institute, Italy
Introduction: Sleep quality is expected to be poor in epilepsy patients with sleep-related seizures as a consequence of the disruptive effect of seizures themselves on sleep patterns, a potentially heightened pre sleep emotional arousal due to patient’s worries about having seizures during sleep and associated sleep comorbidities. This study is aimed at investigating subjective sleep quality and features in adult patients with seizures occurring exclusively or predominantly during sleep. Patients affected with Nocturnal Frontal Lobe Epilepsy were not included. Materials and methods: Fifty-seven subjects ( 18–72 years of age; 27 males), 27 (47.3%) diagnosed with sleep related undetermined epilepsy and 30 (52.7%) with focal epilepsy based on clinical, awake/sleep EEG and brain MRI findings, were investigated. Most of the patients (94%) had <1 seizure per month, with the seizures being in most cases generalized convulsive seizures during sleep. All the patients were given Pittsburgh questionnaire (PQ), Morningness – Eveningness Questionnaire (MEC), STAI 1 and 2, Beck Depression inventory (BDI). Patients reporting snoring and/or witnessed apneas during sleep underwent a nocturnal polysomnographic screening for obstructive sleep apnea (OSA). At the time of the questionnaire compiling the patients had had at least 1 seizure during the previous month (seizures recency) in 19% of the cases and they all were on antiepileptic drugs at bed time, with valproate, levetiracetam and carbamazepine, alone (89.5%) or in combination (10.5%) being the most frequently used drugs. Fiftyseven healthy subjects matched for age and sex served as controls. Univariate analyses were preliminary performed in comparing categorical (chi square test) and continuous variables (T-test)
ApoE genotype and obstructive sleep apnea syndrome J. Pinzón Martinez 1, J. Díaz 2, J. Ortega 1, C. Martinez 3, M. Latorre 4, P. Ruiz 1 1 Department of Clinical Neurophysiology, Hospital General de Castellón, Spain 2 Sleep Research Unit, Hospital General de Castellón, Spain 3 Genetic Department, Hospital Provincial Castellón, Spain 4 Molecular Biology Laboratory, Hospital Provincial Castellón, Spain
Introduction: The obstructive sleep apnea syndrome (OSAS) is frequently associated with obesity, hypertension, diabetes and dyslipidemia and other cardiovascular risk factors. In addition, patients with untreated of OSAS have an increased cardio-vascular mortality and morbidity Apolipoprotein E (ApoE) plays an important role in the metabolism and transport of lipids. The three main isoforms (E2, E3, and E4) are coded by three common alleles (e2, e3, and e4), resulting in six main genotypes: e2/e2, e2/e3, e2/e4, e3/e3, e3/ e4, and e4/e4. Presence of the APOE e4 allele is also associated with HDL (High Density Lipoprotein). The aim of this study was to determine what is in our population the prevalence of different alleles of the ApoE gene, if there is an association of allele e4 with OSAS and what is their contribution to metabolic syndrome. Materials and methods: Cross-sectional study of 440 men patients. Mean age 54 12 years (range 25–79 years), referred to the sleep unit for study.Written informed consent was obtained from all subjects for the extraction of genetic material, with exclusive analysis of the ApoE gene. Each patient has a clinical history reflecting metabolic and cardiovascular risk and medication in use. nthropometric data were recorded: weight, height, waist circumference and neck circumference. Determination of blood pressure (BP) at baseline. The study protocol included polysomnography (PSG) overnight in our sleep unit. Upon awakening, the BP was measure and simultaneously blood samples were collected, one for biochemical and other
recovery was speed up by 13–15 h. Acceleration was also noted in forced restoration of passive and active wakefulness EEG picture. Significant elevation was noted in CSF OrexinA Concentration. Conclusion: Serial electrical stimulations of hypothalamic Orexincontaining neuronal regions significantly elevates CSF OrexinA concentration, speed up recovery from comatose state, and manifest in accelerated restoration of sleep-wakefulness cycle behavioral states. Acknowledgements: Supported by Shota Rustaveli National Science Foundation, Grant #11/04. http://dx.doi.org/10.1016/j.sleep.2013.11.461
Recognition of sleep-related breathing disorders from HolterECGS¨C a new robust method suitable for clinical screening applications C. Maier 1, H. Wenz 2, H. Dickhaus 1 1 Heidelberg University, Institute of Medical Biometry and Informatics, Department of Medical Informatics, Germany 2 Heidelberg University Hospital, Thoraxklinik, Sleep Medicine Center, Germany Introduction: Detection of sleep-related breathing disorders (SRBD) in an early stage is highly desirable in order to route patients to appropriate diagnostics and therapy before severe consequences become overt. We present a traceable, robust and accurate method for detection and quantification of SRDB from Holter ECGs. It provides an epoch-based (1 min) statement as well as an estimate of the apnea-hypopnea-index (AHI) and appears suitable for screening for SBAS in routine Holter-ECGs. Materials and methods: Time-series of QRS-amplitude (QRSA) and respiratory myogram interference (RMI) were extracted from 140 overnight Holter-ECGs recorded in parallel to polysomnograms (PSGs) in 121 patients. The only exclusion criterion was persistent atrial fibrillation; other co- morbidities such as diabetes, myocardial infarction or periodic limb movements as well as concomitant medication were admitted. The PSG annotations served as reference for ECG-based detection of the presence of respiratory events in epochs of 1 min duration. Detection was based on ROC analysis of a single classification feature that quantifies the joint time-locked occurrence of characteristic modulations in QRSA and RMI using normalized cross-correlation. Two different ROC-thresholds were considered, the first balancing sensitivity and specificity (Tbal), the second maximizing accuracy (Tacc). For AHI assessment, the local period of modulations in the QRSA-series was determined from its zero crossings. Epochs classified as apnea-positive were weighted with a factor 60s/period providing an estimate of the number of respiratory events in that epoch. The sum of these weights, normalized for the duration of the record, served as an AHI estimate. A threshold of AHI ¡Y´ 15 was used for screening. We implemented a ternary strategy where a borderline-class collected all records with conflicting decisions for the two thresholds Tbal and Tacc. Results: For the epoch-based detection, sensitivity was 85.5% and specificity was 86%. In the screening application (AHI ¡Y´ 15), 16% of the recordings were classified as ¡Òborderline¡;= . The sensitivity for the remaining 84% (117 recordings) was 100% with a specificity of 91% and a Kappa coefficient of 0.91. Conclusion: Robust, traceable and accurate detection of SRDB is possible from the Holter-ECG for a very heterogeneous real-world sample including different types of SRDB and typical co- morbidities. Since our approach does not make use of heart rate information, it may be even applicable in patients with severe arrhythmias. http://dx.doi.org/10.1016/j.sleep.2013.11.462
e195
A novel experimental design to avoid rem sleep rebound L. Maisuradze 1, N. Lortkipanidze 2, N. Oniani 2 1 Ilia State University, I. Beritashvili Center of Experimental Biomedicine, Georgia 2 Ilia State University, Georgia
Introduction: Several studies report about the phenomenon of REM sleep rebound which is occurred after cessation of deprivation of this sleep stage conducted by various instrumental techniques. According to our previous works REM sleep replacement by waking episodes does not lead to accumulation of REM sleep need. On the basis of this statement we have elaborated special experimental scheme of to avoid REM sleep rebound appearance. Here we present the results of these experiments. Materials and methods: Eight mature cats weighing 2.8–3.5 kg were implanted with electrodes for standard sleep-wake cycle (SWC) recordings. After establishment of baseline SWC REM sleep deprivation was performed using classic method of short-term awakenings using MRF stimulation during eight hours. Then, the four animals (experimental (E)) were not allowed to fall asleep through the maintenance of active waking state during one hour by using electrical stimulation of the posterior hypothalamus; this procedure was followed by the six- hour post-deprivation period. Another four cats (control (C)) could realize SWC without any interventions. Duration of individual episodes of different SWC phases/ stages, their total amount and percent ratio were calculated and compared with corresponding baseline data. Results: As it was expected, REM sleep propensity increased during deprivation hours with frequent enforced awakenings from this stage, and REM sleep rebound was occurred in the C - group animals with significant decrease of REM sleep latency. However, in E- cats, either total REM sleep amount or the time needed for the transitions of slow- wave sleep to REM sleep did not differ from baseline. No increase of ponto- geniculo-occipital waves or rapid-eye- movements was found in the episodes of E-cat’s REM sleep while the frequency of these indices increased significantly in the C-group. Conclusion: Results provide additional support for our opinion that active waking state is able to satisfy the inner need for REM sleep even in the conditions of substantial increases in the REM sleep propensity and prevents the occurrence of REM sleep rebound. Acknowledgement: We are very thankful to Prof. Tengiz Oniani who was supervisor of the present study.
http://dx.doi.org/10.1016/j.sleep.2013.11.463
Respiratory-related leg movements and periodic leg movements during sleep M. Manconi 1, I. Zavalko 2, C. Bassetti 3, E. Colamartino 1, M. Pons 4, R. Ferri 5 1 Civic Hospital (EOC) of Lugano, Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Switzerland 2 Sechenov First Moscow State Medical University, Laboratory of Autonomic Nervous System Disorders, Switzerland 3 Bern University Hospital, Universitätsklinik für Neurologie, Inselspital, Switzerland 4 Civic Hospital (EOC) of Lugano, Department of Internal Medicine, Switzerland 5 Oasi Institute (IRCCS), Sleep Research Centre, Department of Neurology I.C., Switzerland
Introduction: The aim of the study was to describe the time structure of leg movements (LM) in obstructive sleep apnea syndrome
e196
Abstracts / Sleep Medicine 14S (2013) e165–e238
(OSAS), in order to add new knowledge to the understanding of their clinical significance. Materials and methods: Eighty-four patients (16 females, 68 males, mean age 55.1 years, range 29–74) were recruited. All subjects underwent full-night polysomnography and the leg motor pattern was evaluated by means of advanced tools of analysis particularly able to detect and describe LM time structure (periodicity and distribution). In particular, respiratory-related LM (RRLM) were separated from those not related to respiratory events (NRLM). Results: OSAS patients with RRLM had leg movement parameters generally higher subjects without RRLM; the effect was strong for the periodic LM during sleep (PLMS) index, in particular during NREM sleep. The NRLM intermovement interval distribution histogram of patients with RRLM showed a prominent first peak at 4 s, followed by another at approximately 24 s (corresponding to typical PLMS). In the same group, RRLM showed a single wide lower peak with a maximum at about 42 s. In patients without RRLM, NRLM were evident with a single peak at 2–4 s. Patients with RRLM showed a gradually decreasing number of NRLM, from the first to the last hours of sleep; this pattern was less clear for RRLM. A stepwise linear regression analysis showed that, even when controlling for RLS status and AHI, PLMS were highly significantly associated with RRLM. Conclusion: This study shows that RRLM might be part of the true PLMS because they cluster clearly in the patients who also have typical PLMS not correlated with the respiratory events.
http://dx.doi.org/10.1016/j.sleep.2013.11.464
between patients and controls and patients with PSQI >5 and those with PSQI <5. Results: Neither PSQI total score (5.2 3.6 in patients and 5.33.4 in controls) nor its components differ significantly between patients and controls. PSQI >5 patients (39%) and PSQI <5 patients (61%) do not differ significantly for age (47.115.0 vs. 43.915.0 years), sex (41% vs. 50% males), STAI 1 ( 46.213.2 vs. 37.99.6) and STAI2 scores (44.210.5 vs. 3910.7), BDI (12.88.0 vs. 9.19.0), MEQ chronotype, OSA prevalence (15.8% vs. 7.1%). As for illness-related parameters, PSQI >5 patients proved to have a significantly longer illness duration than PSQI <5 patients (17.518.2 years vs 8.20.3 years; p = 0.035) and a higher rate of seizures recency (54.5% vs. 15.4%; p = 0.04). Conclusion: Our data indicate that subjective sleep quality in adult patients with seizures occurring exclusively or predominantly during sleep is not poorer than in healthy controls. Patients’ sleep quality is influenced by some illness related parameters, with poor sleep quality being associated with longer disease duration and seizure recency. The relatively low frequency of seizures along with a blunting effect of antiepileptic treatment on arousal instability during sleep may explain the finding of a substantially good sleep quality in our patients series. However also epilepsy patients’ life style and their good compliance to sleep hygiene rules may account for a preserved sleep quality. Acknowledgements: The Authors wish to thank the technogists Valter Rustioni, Daniele Marchese, Laura Spelta, Federica Camasso for their technical support.
http://dx.doi.org/10.1016/j.sleep.2013.11.465 Subjective sleep quality in epilepsy patients with sleep-related seizures R. Manni 1, R. Cremascoli 1, C. Sguazzin 2, M. Terzaghi 1 1 National Institute of Neurology IRCCS C, Mondino Foundation, Italy 2 Psychological Unit, Salvatore Maugeri Foundation IRCCS, Scientific Institute, Italy
Introduction: Sleep quality is expected to be poor in epilepsy patients with sleep-related seizures as a consequence of the disruptive effect of seizures themselves on sleep patterns, a potentially heightened pre sleep emotional arousal due to patient’s worries about having seizures during sleep and associated sleep comorbidities. This study is aimed at investigating subjective sleep quality and features in adult patients with seizures occurring exclusively or predominantly during sleep. Patients affected with Nocturnal Frontal Lobe Epilepsy were not included. Materials and methods: Fifty-seven subjects ( 18–72 years of age; 27 males), 27 (47.3%) diagnosed with sleep related undetermined epilepsy and 30 (52.7%) with focal epilepsy based on clinical, awake/sleep EEG and brain MRI findings, were investigated. Most of the patients (94%) had <1 seizure per month, with the seizures being in most cases generalized convulsive seizures during sleep. All the patients were given Pittsburgh questionnaire (PQ), Morningness – Eveningness Questionnaire (MEC), STAI 1 and 2, Beck Depression inventory (BDI). Patients reporting snoring and/or witnessed apneas during sleep underwent a nocturnal polysomnographic screening for obstructive sleep apnea (OSA). At the time of the questionnaire compiling the patients had had at least 1 seizure during the previous month (seizures recency) in 19% of the cases and they all were on antiepileptic drugs at bed time, with valproate, levetiracetam and carbamazepine, alone (89.5%) or in combination (10.5%) being the most frequently used drugs. Fiftyseven healthy subjects matched for age and sex served as controls. Univariate analyses were preliminary performed in comparing categorical (chi square test) and continuous variables (T-test)
ApoE genotype and obstructive sleep apnea syndrome J. Pinzón Martinez 1, J. Díaz 2, J. Ortega 1, C. Martinez 3, M. Latorre 4, P. Ruiz 1 1 Department of Clinical Neurophysiology, Hospital General de Castellón, Spain 2 Sleep Research Unit, Hospital General de Castellón, Spain 3 Genetic Department, Hospital Provincial Castellón, Spain 4 Molecular Biology Laboratory, Hospital Provincial Castellón, Spain
Introduction: The obstructive sleep apnea syndrome (OSAS) is frequently associated with obesity, hypertension, diabetes and dyslipidemia and other cardiovascular risk factors. In addition, patients with untreated of OSAS have an increased cardio-vascular mortality and morbidity Apolipoprotein E (ApoE) plays an important role in the metabolism and transport of lipids. The three main isoforms (E2, E3, and E4) are coded by three common alleles (e2, e3, and e4), resulting in six main genotypes: e2/e2, e2/e3, e2/e4, e3/e3, e3/ e4, and e4/e4. Presence of the APOE e4 allele is also associated with HDL (High Density Lipoprotein). The aim of this study was to determine what is in our population the prevalence of different alleles of the ApoE gene, if there is an association of allele e4 with OSAS and what is their contribution to metabolic syndrome. Materials and methods: Cross-sectional study of 440 men patients. Mean age 54 12 years (range 25–79 years), referred to the sleep unit for study.Written informed consent was obtained from all subjects for the extraction of genetic material, with exclusive analysis of the ApoE gene. Each patient has a clinical history reflecting metabolic and cardiovascular risk and medication in use. nthropometric data were recorded: weight, height, waist circumference and neck circumference. Determination of blood pressure (BP) at baseline. The study protocol included polysomnography (PSG) overnight in our sleep unit. Upon awakening, the BP was measure and simultaneously blood samples were collected, one for biochemical and other