Teresa Ranieri

The Epworth Sleepiness Scale: conventional self vs physician administration.

Abstract ABSTRACT BACKGROUND AND AIMS: the Epworth Sleepiness Scale (ESS) is a simple self-administered questionnaire which provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some recent works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores, in a sample of patients with suspicion of OSA. METHODS: patients were randomly divided into 2 groups: group I or the self-administered group (n=113), and group II or the physician-administered group (n=112). Patients in group I were asked to complete the ESS in the traditional way; in group II, the ESS was administered by a sleep medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within a weeks time. RESULTS: the percentage of questionnaires properly completed was significantly different between groups: 77% (87/113) in the group I vs 100% (112/112) in the group II (p=0.00). Scores obtained by the physician-administered questionnaire were higher than those derived by the self-administered ESS (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; p=0.01). The ESSp was more highly correlated with apnea-hypopnea index, and oxygen desaturation index than the ESSs. CONCLUSIONS: our results lead to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.BACKGROUND The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA. METHODS Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 weeks time. RESULTS The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs. CONCLUSIONS Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.

Exhaled breath profiling in patients with COPD and OSA overlap syndrome: A pilot study

The analysis of volatile organic compounds (VOCs) by an electronic nose (e-nose) is a groundbreaking method that provides distinct exhaled molecular patterns in several respiratory and systemic diseases. It has been shown that an e-nose can detect obstructive sleep apnea (OSA) as well as chronic obstructive pulmonary disease (COPD). OSA and COPD are sometimes associated into the so-called overlap syndrome (OVS). In this pilot study we hypothesized that an e-nose could discriminate the exhaled breath of patients with OVS from that of subjects with OSA and COPD alone. Thirteen patients with OSA, 15 patients with COPD and 13 with OVS participated in a cross-sectional study. Exhaled breath was collected by a formerly validated method and sampled by using an electronic nose (Cyranose 320). Raw data were analyzed by canonical discriminant analysis on principal component reduction. Cross-validation accuracy (CVA) and ROC-curves were calculated. External validation in newly recruited patients (6 OSA, 6 OVS and 6 COPD) was tested using the previous training set. Breathprints of patients with OSA clustered distinctly from those with OVS (CVA  =  96.2%) as well as those with COPD (CVA  =  82.1%). Breathprints from OVS were not significantly separated from those of COPD (CVA  =  67.9%). External validation confirmed the above findings. The e-nose can distinguish with high accuracy the exhaled VOC-profile of patients with OSA from those with OVS as well as those with COPD. This warrants future studies to confirm the potential of this technique in the non-invasive detection of sleep apnea.

Titration effectiveness of two autoadjustable continuous positive airway pressure devices driven by different algorithms in patients with obstructive sleep apnoea

Nocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A‐CPAP). The aim of the present study was to compare the titration effectiveness of two A‐CPAP devices using different flow‐based algorithms in patients with OSA.

An electronic nose may sniff out amyotrophic lateral sclerosis

Amyothrophic lateral Sclerosis (ALS) is a neurodegenerative disease characterized by a progressive degeneration of the cortical and spinal motor neuron. Exhaled molecular profiles that have potential in the diagnosis of several respiratory and systemic diseases can be obtained by analyzing human breath with an electronic nose. We hypothesized that exhaled molecular profiling may discriminate well-characterized patients with ALS from controls. 20 ALS patients (age: 63.5±12.3), and 20 healthy controls (age: 58.1±4.4) participated in a cross-sectional study. A Tedlar bag was used to collect exhaled breath by using a validated method. Bags were then sampled by an electronic nose (Cyranose 320). Statistical analysis on sensor responses was performed off-line by principal component analysis, linear discriminant analysis and ROC curves. Breathprints from patients with ALS were discriminated from healthy controls (CVA: 75.0%; p=0.003; AUC 0.795). Based on our results, patients with ALS can be discriminated from healthy controls. This suggests that exhaled breath analysis has potential for screening and/or diagnosis of this neuromuscular disease.

Nocturnal Hypoventilation May Have a Protective Effect on Ischemic Heart Disease in Patients with Obesity Hypoventilation Syndrome

The importance of nocturnal hypoventilation (nHyp) in the development of cardiovascular comorbidity (CVM) in patients with obesity hypoventilation syndrome (OHS) is controversial. We recently hypothesized that nHyp may have a protective effect on CVM in OHS. The aim of this study was to evaluate the link between nHyp and CVM in patients with OHS. We performed a retrospective analysis of the clinical records of 60 patients with OHS. The initial population was divided into two groups: (1) 31 subjects with OHS and nHyp (nhOHS); (2) 29 individuals with OHS without nHyp (wnhOHS). All patients had also obstructive sleep apnea. Anthropometric data, medical history, electrocardiogram, pulmonary function testing, arterial blood gas test, and sleep recordings were collected. Patients with nhOHS, compared with those wnhOHS, showed higher values of PaCO2 (48.75 ± 3.78 vs. 46.91 ± 2.09 mmHg; p = 0.023), lower percentage of ischemic heart disease (3.2% vs. 20.7%; p = 0.042), higher oxygen desaturation index (ODI; 55.10/h ± 28.76 vs. 38.51/h ± 23.21; p = 0.017), and higher total sleep time (TST90) with SpO2 <90% (53.58% ± 26.90 vs. 25.64% ± 21.67; p = 0.000). Moreover, individuals in the nhOHS group showed a significantly different (p = 0.031) distribution of the three ODI tertiles 0-32/h, 33-72/h, >72/h compared with those in wnhOHS group (19.4% vs. 37%, 41.9% vs. 51.7%, 38.7% vs. 10.3%, respectively). Subsequent discriminant analysis correctly classified nhOHS and wnhOHS in 66.7% of the cases. Ours is the first study analyzing the correlation between nHyp and CVM in patients with OHS. We showed that nHyp in OHS may have a protective effect on cardiovascular morbidity, in particular on ischemic cardiac disease.

A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in drivers: A pilot study

Background: Falling asleep behind the wheel is one of the most relevant consequences of obstructive sleep apnea (OSA). We created a new screening questionnaire, named the Driver Sleepiness Score (DSS), aiming to assess sleepiness in drivers with suspected OSA. The primary aim of our study was to evaluate sleepiness in drivers with a suspicion of OSA by the DSS in order to assess its correlation with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and total sleep time with oxyhemoglobin saturation below 90% (TST90). We also aimed to assess the diagnostic accuracy of DSS for three different cutoffs of AHI (AHI = 5, AHI = 15, AHI = 30), which allow stratification of the severity of OSA. Materials and Methods: Seventy-three driving patients at risk for OSA participated in the study. DSS and the Epworth Sleepiness Scale (ESS) were both administered in operator-dependent modality and in randomized sequence. Results: The DSS showed higher accuracy in screening patients with mild OSA [area under curve (AUC): 0.88 vs 0.74] and moderate OSA (AUC: 0.88 vs 0.79), whereas ESS showed higher accuracy in screening patients with severe OSA (AUC: 0.91 vs 0.78). A DSS score ≥ 7 is the optimal cutoff for distinguishing true positives from false positives for the presence of OSA and for its different severity levels. The administration of both questionnaires increases the accuracy for the detection of all OSA severity levels. Conclusions: If validated, DSS may qualify as a new screening tool specifically for drivers with the suspicion of having OSA, in combination with the ESS.

The Epworth sleepiness scale: conventional self-administration versus administration by the physician

Abstract ABSTRACT BACKGROUND AND AIMS: the Epworth Sleepiness Scale (ESS) is a simple self-administered questionnaire which provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some recent works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores, in a sample of patients with suspicion of OSA. METHODS: patients were randomly divided into 2 groups: group I or the self-administered group (n=113), and group II or the physician-administered group (n=112). Patients in group I were asked to complete the ESS in the traditional way; in group II, the ESS was administered by a sleep medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within a weeks time. RESULTS: the percentage of questionnaires properly completed was significantly different between groups: 77% (87/113) in the group I vs 100% (112/112) in the group II (p=0.00). Scores obtained by the physician-administered questionnaire were higher than those derived by the self-administered ESS (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; p=0.01). The ESSp was more highly correlated with apnea-hypopnea index, and oxygen desaturation index than the ESSs. CONCLUSIONS: our results lead to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.BACKGROUND The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA. METHODS Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 weeks time. RESULTS The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs. CONCLUSIONS Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.

The Epworth Sleepiness Scale

Abstract ABSTRACT BACKGROUND AND AIMS: the Epworth Sleepiness Scale (ESS) is a simple self-administered questionnaire which provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some recent works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores, in a sample of patients with suspicion of OSA. METHODS: patients were randomly divided into 2 groups: group I or the self-administered group (n=113), and group II or the physician-administered group (n=112). Patients in group I were asked to complete the ESS in the traditional way; in group II, the ESS was administered by a sleep medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within a weeks time. RESULTS: the percentage of questionnaires properly completed was significantly different between groups: 77% (87/113) in the group I vs 100% (112/112) in the group II (p=0.00). Scores obtained by the physician-administered questionnaire were higher than those derived by the self-administered ESS (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; p=0.01). The ESSp was more highly correlated with apnea-hypopnea index, and oxygen desaturation index than the ESSs. CONCLUSIONS: our results lead to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.BACKGROUND The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subjects level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA. METHODS Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 weeks time. RESULTS The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs. CONCLUSIONS Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.