Journal of sleep research
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Journal of sleep research · Mar 2011
Comparative StudySleep efficiency during sleep studies: results of a prospective study comparing home-based and in-hospital polysomnography.
To date, the clinical use of unattended home-based polysomnography (PSG) is not recommended. To assess whether sleep efficiency is better at home, we have performed a prospective, crossover, single-blind study comparing unattended home- versus attended in-hospital PSG in a population referred for high clinical suspicion of obstructive sleep apnoea syndrome (OSA). Within 2 weeks, all the patients underwent both PSG performed by the same sleep technician, which were analysed by another blinded technician. ⋯ We conclude that home-based PSG is associated with a better sleep efficiency. It also appears as feasible and reliable in patients with high preclinical suspicion for OSA. It is also more comfortable for the patients whose sleep efficiency is better and allows cost saving related to the absence of hospitalization.
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Journal of sleep research · Mar 2011
Randomized Controlled TrialRandomised controlled trial of auto-adjusting positive airway pressure in morbidly obese patients requiring high therapeutic pressure delivery.
Auto-adjusting positive airway pressure (APAP) devices are being increasingly used to treat obstructive sleep apnoea (OSA). Anecdotal encounters of obese patients requiring high therapeutic pressure whose OSA was inadequately controlled by APAP led to this study aiming to compare the effectiveness of continuous positive airway pressure (CPAP) and APAP (S8 Autoset II(®) , ResMed, NSW, Australia) in a randomised, single-blinded crossover trial. Twelve morbidly obese patients with severe OSA [mean±SD apnoea-hypopnoea index (AHI) 75.8±32.7, body mass index 49.9±5.2 kg m(-2) , mean pressure 16.4 cmH(2)O] were consecutively recruited, and received CPAP or APAP in random order for six nights at home, separated by a four-night washout. ⋯ The machine-scored AHI significantly overestimated the level of residual disease compared with the laboratory-scored AHI (using Chicago criteria); however, when the machine-scored AHI was ≤5 and ≤10 this was always confirmed by the PSG data. In morbidly obese OSA patients without significant co-morbid disease requiring high therapeutic pressure, our data provide support for the use of either APAP or manually titrated CPAP. We recommend objective assessment by sleep study if the S8 Autoset II indicates a high level of residual disease.
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Journal of sleep research · Mar 2011
Evidence of dysregulated affect indicated by high alexithymia in obstructive sleep apnea.
Alexithymia refers to dysregulation of affect characterized by difficulty in identifying and expressing emotions. Obstructive sleep apnea (OSA) is characterized by increased medical/psychiatric comorbidity and possibly by affect dysregulation. In the present case-control study, we examined alexithymia levels with the Toronto Alexithymia Scale (TAS-20) in 23 psychiatrically uncomplicated OSA outpatients and 23 same gender controls one-to-one matched for age, education and subjective depressive symptomatology. ⋯ Finally, 'difficulty describing feelings' and 'externally oriented thinking' significantly predicted risk for OSA. Alexithymia is higher in non-psychiatrically ill patients with OSA compared with carefully matched controls even after adjustment for subjective depressive symptoms and demographic confounders. Total alexithymia is associated with greater subjective depression and poor general health/quality of life, while 'externally oriented thinking' is associated with disease severity and together with 'difficulty describing feelings' may be vulnerability factors for OSA, although reverse causality cannot be excluded.
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Journal of sleep research · Mar 2011
A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. The Akershus Sleep Apnea Project (ASAP).
The Berlin Questionnaire (BQ) is a widely used screening tool for obstructive sleep apnea (OSA), but its performance in the general population setting is unknown. The prevalence of OSA in middle-aged adults is not known in Norway. Accordingly, the aims of the current study were to evaluate the utility of the BQ for OSA screening in the general population and to estimate the prevalence of OSA in Norway. ⋯ Estimated prevalences of OSA were 16% for AHI≥5 and 8% for AHI≥15. In conclusion, the BQ classified one out of four middle-aged Norwegians to be at high-risk of having OSA, but the screening properties of the BQ were suboptimal. The estimated prevalence of OSA was comparable to previous estimates from general populations in the USA, Australia and Europe.
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Journal of sleep research · Mar 2011
Home set-up polysomnography in the assessment of suspected obstructive sleep apnea.
Home set-up polysomnography (PSG) has advantages over other portable monitoring devices, but remains unendorsed by professional bodies despite excellent utility in the Sleep Heart Health Study (SHHS). The study aims to determine technical reliability and diagnostic accuracy of unattended, home set-up versus attended laboratory-based PSG in patients with suspected obstructive sleep apnea (OSA). Thirty patients with suspected OSA without significant co-morbidity were recruited. ⋯ Signal loss was higher at home but mitigated by multi-channel redundancy. Success rate was similar to SHHS and superior to laboratory set-up home studies. Home set-up PSG is a valid alternative to laboratory-based PSG for suspected OSA.