No Abstract

Background and Objective: Obstructive sleep apnea (OSA) is a disease with serious consequences. Many portable devices have been developed to overwhelm some of limitations in the accessibility of the gold standard test for OSA, polysomnography (PSG). This study aimed to determine diagnostic accuracy of a portable sleep apnea screener against PSG in patients of a sleep clinic.
Materials and Methods: Patients admitted to a sleep lab were recruited during a three-month period. Study participants underwent one night simultaneous recording of PSG and a double channel portable sleep apnea screener in the laboratory. A sleep physician scored the PSGs manually according to standard criteria. Portable sleep apnea screener data were analyzed automatically with the manufacturer’s proprietary software. We com- pared the apnea–hypopnea indices (AHI) from the PSG and the portable sleep apnea screener to assess the spec- ificity and sensitivity of the device.
Results: A total of 120 patients completed the study. Mean AHI recorded from PSG and portable device were 31.7 and 30.8, respectively. Using a variety of AHI cutoff values (5, 10, 15, 20, 30 and 40), sensitivities of the portable device were 96.9, 88.6, 87.2, 84.1, 79.6, and 83.9 percent and specificities were 45.5, 71.9, 69.0,74.5, 90.1, and 88.8 percent, respectively. The LRs+ were 1.77, 3.15, 2.81, 3.29, 8.04 and 7.49 and the LRs- were 0.06, 0.15, 0.18, 0.21, 0.22 and 0.18. The AUCs were 0.90, 0.88, 0.86, 0.89, 0.90, and 0.92, respectively.
Conclusions: In studied participants, portable device showed acceptable sensitivity and specificity in the lab when compared to the standard PSG.

Background and Objective: Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing. Multivariable apnea prediction (MAP) index consists of three questions about the frequency of OSA symptoms plus body mass index (BMI), age and sex that categorizes the patients to low and high risk for OSA using a formula. Objective MAP index was calculated by discounting the questions from formula. In this study, we evaluated the utility of the MAP index and objective MAP index in screening of the OSA.
Materials and Methods: In a cross-sectional study, we enrolled 609 patients of three sleep clinics suspected of having OSA who underwent polysomnography (PSG) as a gold standard test for OSA diagnosis. The apnea-hypopnea index (AHI) of the PSG was used to classify the severity of OSA.
Results: A significant strong correlation was observed between MAP index and objective MAP index using Spearman’s coefficient (r=0.801, P<0.001). Spearman’s correlation coefficient showed a stronger correlation between AHI and MAP index (r=0.586, P<0.001) than between AHI and objective MAP index (r=0.467, P<0.001). The area under the curve of the MAP index and objective MAP index were found to be 0.810 and 0.766, respectively, at AHI≥5; 0.792 and 0.728, respectively, at AHI≥15, and 0.767 and 0.684, respectively, at AHI≥30. The predictive parameters of the MAP index and objective MAP index for identifying OSA were satis- factory.
Conclusions: This study showed that MAP index and especially objective MAP index might have a consid- erable utility in the screening of OSA.

Background and Objective: Depression is commonly reported in patients with Obstructive Sleep Ap- nea/Hypopnea Syndrome (OSAS). We aimed to assess the association between OSAS severity and depressive symptoms in patients with OSAS.
Materials and Methods: A total of 337 patients with symptoms of OSAS were visited for psychological testing prior to beginning diagnosis for the syndrome between 2012 -2014 in Baharloo Hospital. Participants completed the Beck Depression Inventory-II (BDI-II) and Epworth Sleepiness Scale (ESS) questionnaires. Res- piratory Disturbance Index (RDI), mean of arterial oxygen saturation, sleep efficiency, and number of awaken- ings were measured by polysomnography (PSG).
Results: Correlation between RDI index and ESS score was statistically significant (r: 0.215, P<0.001), but correlation between RDI and BDI-II score was not statistically significant (P= 0.59). Also mean of BDI-II score between male and female was statistically different (male: 12.08 ± 10.6, female: 17.26 ± 12.56, P<0.001).
Conclusions: OSAS severity was not related to symptoms of depression measured by BDI-II questionnaire.It seems that the method of scoring for depression severity may affect the association between obstructive sleep apnea and depression.

Background and Objective: Adult lead poisoning commonly occurs due to workplace exposures. Neuro- psychological symptoms such as insomnia are reported as the early symptoms of chronic lead intoxication. This study aimed to evaluate association between blood lead level (BLL) of workers from lead-zinc factories and their sleep quality.
Materials and Methods: A cross-sectional study was performed and 425 workers were enrolled with eligi- bility criteria of the study. BLL of workers were measured using atomic absorption spectrophotometry. Clinical assessment of workers was performed regarding their sleep problems through a self-administered questionnaire consisting of demographic characteristics, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburg Sleep Quality Index (PSQI).  Multiple linear regression and ANOVA tests were used for analysis of data.
Results: Among 425 workers studied, mean (±SD) BLL was 34.7(± 16.7) µg/dl. BLL was significantly asso- ciated with total scores of ISI, ESS, and PSQI questionnaires adjusted for age, sex, job experience, shift work, and body mass index (Adjusted R2 was 0.19, 0.08, and 0.18, respectively; P<0.001). Difficulty with falling asleep, difficulty of staying asleep and waking up too early were more prevalent among workers with increased BLL (P<0.001).
Conclusions: Workers exposed to lead and with increased BLL may have more sleep problems including in- somnia, excessive daytime sleepiness, and poor sleep quality. This warrants further attention toward different types of sleep problems in workers with lead exposure especially those with increased BLL.

Background and Objective: Obstructive sleep apnea (OSA) is the most common respiratory disorder during sleep and a risk factor for myocardial ischemia. In this study, we evaluated the proportion of subjects at high risk for OSA and prevalence of its predictors among patients admitted for acute myocardial infarction (MI).
Materials and Methods: A total of 210 patients with MI admitted at the cardiac care unit of Baharloo Hospital, Tehran, Iran were enrolled in this study. The STOP-BANG questionnaire was used for diagnosing high- risk patients of OSA. Anthropometric and demographic characteristics, family and personal history, results of biochemical tests, and the time of the onset of MI in patients were recorded.
Results: Based on the STOP-BANG questionnaire, 112 patients (53.3%) were at high risk for OSA. The lev- el of fasting blood sugar (FBS) was significantly higher in high-risk patients for OSA. Regression analysis showed that FBS could be a predictor of OSA in patients with MI (P value: 0.005). From midnight to 5:59, the frequency of the onset of MI was significantly higher in patients at high risk for OSA compared with those at low risk (42% vs. 16.3%, P <0.001).
Conclusions: OSA is a prevalent disorder in patients with MI. Looking for signs and symptoms of OSA should be considered in clinical assessment of MI patients.

Background and Objective: Obstructive sleep apnea (OSA) is frequent and in some degree it affects about 24% of male and 9% of female in middle age adults. This study aimed to assess the association between risk of OSA and CAD.
Materials and Methods: This case-control study was performed among 184 patients with a history of coro- nary angiography in two catheter labs at hospitals in Qom, Iran. Control group had normal or minimal coronary stenosis (<50%) and case group had 1, 2 or 3 coronary vessel disease. All the patients completed demographic and Berlin questionnaires and then data were analyzed using SPSS version 16.
Results: Mean (±SD) age of participants was 55.36 ± 10 years. A total of 119 (61.4%) patients were female. This study showed significant difference between risk of OSA in patients with CAD and those without CAD (OR=1.25), hypertension (OR=10.4) and non-insulin dependent diabetes mellitus (OR=2.12), but there were no correlation between risk of OSA and ejection fraction less than 45% (P value=0.582).
Conclusions: OSA can be considered as one of the important risk factors for CAD.

Background and Objective: Sleep-Disordered Breathing (SDB) is associated with increased morbidity and mortality in patients with heart failure (HF). We assessed the prevalence and the pattern of SDB in HF patients who were candidates for heart transplantation.
Materials and Methods: Twenty heart transplantation patients with ventricular ejection-fraction < 25% were recruited consecutively in a cross-sectional study in Iran during 2009-2010. Full-night polysomnography was performed for them.
Results: The participants consisted of 14 males and 6 females with the mean ± SD age of 45.6 ±13.3 and the mean ± SD Body Mass Index (BMI) of 24.1±5.5. Seventeen patients (85%) were diagnosed with sleep breathing disorder, among which, four had central sleep apnea.
Conclusions: Sleep apnea is prevalent in heart transplantation candidates.