Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Comparative Study
Comparison of Commonly Used Questionnaires to Identify Obstructive Sleep Apnea in a High-Risk Population.
Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools. ⋯ There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.
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Comparative Study
Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke.
Sleep-disordered breathing (SDB) is highly prevalent in patients with acute stroke. SDB is often underdiagnosed and associated with neurological deterioration and stroke recurrence. Polysomnography or home sleep apnea testing (HSAT) is typically used as the diagnostic modality; however, it may not be feasible to use regularly in patients with acute stroke. We investigated the predictive performance of pulse oximetry, a simpler alternative, to identify SDB. ⋯ Nocturnal pulse oximetry has a high diagnostic accuracy in predicting moderate to severe SDB in patients with acute stroke. Oximetry can be a simple modality to rapidly recognize patients with more severe SDB and facilitate the referral to the confirmation sleep study.
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Comparative Study
Risk of Cardiovascular Disease Related to Smoking Is Greater Among Women With Sleep-Disordered Breathing.
Although both sleep-disordered breathing (SDB) and smoking are associated with cardiovascular disease (CVD), the potential for an interactive effect on CVD risk has not been explored. Our objective was to determine if smoking-related risk for CVD rises with greater SDB severity. ⋯ In women, smoking-related risk for CVD is significantly higher among individuals with moderate to severe SDB.
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Comparative Study
Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder.
Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. ⋯ These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population.
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Individuals with primary insomnia often have poorer self-reported sleep than objectively measured sleep, a phenomenon termed negative sleep discrepancy. Recent studies suggest that this phenomenon might differ depending on comorbidities. This study examined sleep discrepancy, its night-to-night variability, and its correlates in comorbid insomnia and fibromyalgia. ⋯ Unlike patients with primary insomnia, patients with comorbid fibromyalgia do not exhibit consistent negative sleep discrepancy; however, there are both substantial positive and negative discrepancies in all sleep parameters at the daily level. Future research is needed to investigate the clinical significance and implications of high night-to-night variability of sleep discrepancy, and the role of prescribed opioid medications in sleep perception.