pISSN: 2476-2938
eISSN: 2476-2946
Editor-in-Chief:
Khosro Sadeghniiat Haghighi, MD.
Iranian Sleep Medicine Society
Vol 2 No 1-2 (2017): Winter-Spring
Original Article(s)
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Background and Objective: Obstructive sleep apnea (OSA) has been associated with metabolic syndrome, diabe-tes mellitus, and cardiovascular diseases. Insulin resistance and increased leptin levels could explain the impaired meta-bolic conditions in patients with OSA. This study aimed to assess the association of OSA severity with insulin re-sistance and leptin levels in a group of patients referred to a sleep disorders’ clinic.
Materials and Methods: Seventeen patients without OSA and 28, 33, and 30 patients with mild, moderate, and se-vere OSA; respectively, were included in this study. All participants underwent full night polysomnography (PSG), and blood samples were collected in the morning after PSG. The insulin resistance index was estimated by homeostasis model assessment (HOMA).
Results: HOMA values were not significantly different among the study groups. Significant difference in leptin lev-el was found between patients with severe and mild OSA. Leptin level was significantly correlated with age (r = 33, P = 0.020), apnea–hypopnea index (AHI) (r = 0.41, P = 0.004), and oxygen desaturation index (r = 46, P = 0.030). HOMA was insignificant positive correlation only with triglyceride level (P = 0.010). Stepwise multiple regression analysis showed that AHI, body mass index, and gender were determinants of leptin levels, however, no variable was found for predicting HOMA.
Conclusions: Present findings suggest that leptin levels might be independently associated with severity of OSA. Other factors other than insulin resistance should be considered for increasing vascular diseases in patients with OSA. -
Background and Objective: Obstructive sleep apnea syndrome (OSAS) is a breathing disorder during sleep and de-fined as unexplained sleepiness during the day, with a minimum of five obstructive respiratory events per hour of sleep. This study aimed to evaluate the compliance to continuous positive airway pressure (CPAP) in patients with OSAS.
Materials and Methods: This cross-sectional study was conducted on OSAS patients whose polysomnography test was performed at least 1 year before, and CPAP was prescribed for them. Apnea–hypopnea index (AHI) and patients’ demographic information were recorded.
Results: This study included 105 patients with OSAS. The mean AHI score was 40. Patients were distributed into three groups according to their AHI: Mild (5 ≤ AHI < 15): 20 patients (19%), moderate (15 ≤ AHI < 30): 25 patients (23.8%), and severe (AHI ≥ 30): 60 patients (57.1%). Patients were divided into three groups based on their use of CPAP: 27 (25.7%) patients were regular users of CPAP, their time average use was 5.4 hours a day; 11 (10.4%) patients were in the group who stop using their CPAP, their average of time use was 6.4 hours a day; and 67 (63.8%) patients were in the group who did not use the CPAP.
Conclusion:The long-term adherence to CPAP in patients with OSAS was 25%, which correlated significantly with their financial situation, while there was no significant association between the use of CPAP with age, sex, educational status, and the severity of sleep apnea. -
Background and Objective: Sleep disturbances are common in women, especially during pregnancy. This can re-sult in emotional and psychological consequences in pregnant women. The aim of this study was to assess the preva-lence and identify the relationship between sleep quality, anxiety, and depression during pregnancy.
Materials & Methods: This cohort study included 283 pregnant women. Participants completed Beck Depression Inventory, State-Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index at first, second, and third gestational tri-mesters. Data were analyzed by descriptive statistics and Cramer’s V correlation technique.
Results: The findings indicated that nearly 30% of participants suffered from depression. Mild depression reported from the first, second, and third trimesters was 18%, 11%, and 4.9%, respectively, while severe depression frequency was found to be 4.9% in the third trimester. Moreover, the highest proportion of mild anxiety was 28.3% in the first trimester, and moderate and severe anxiety had a prevalence of 4.9 and 14.1% in the third trimester, respectively. In the third trimester, sleep quality was lower and the prevalence of sleep problems was 75.26%. The findings also showed that there is a significant association between sleep problems and depression and anxiety (P < 0.0500).
Conclusion: Psychological problems such as anxiety and depression were prevalent among the studied population of pregnant women. Thus, psychological counseling before pregnancy or early pregnancy in this population may pro-vide safer pregnancy, convenient delivery, and healthier newborns. -
Background and Objective: Sleep condition of nurses is important because it may affect providing healthcare services by them. The aim of this study was to determine the effect of a sleep hygiene course in nurses suffering from sleep disorders.
Materials and Methods: This study was conducted among nurses with clinical insomnia. The nurses were randomly divided into intervention (50 nurses) and control (50 nurses) groups. For nurses in the intervention group, a 2-hour training session was held about sleep hygiene practices. 1 month after the intervention, the Persian versions of Insomnia Severity Index (ISI), Epworth sleepiness scale (ESS), and Pittsburg sleep quality index (PSQI) questionnaire were completed by all participants. Data were analyzed using t test.
Results: All nurses were female, and their mean age was 29.8 ± 3.2 years. After the intervention, sleep latency was 15.5 ± 8.8 and 35.7 ± 19.7 minute in the intervention and control groups, respectively (P < 0.001). Total sleep duration per day was 462.6 ± 21.4 and 436.8 ± 18.8 minute in the intervention and control groups, respectively (P < 0.001). Total PSQI score (5.4 ± 0.9 vs. 7.0 ± 1.2, P = 0.003), ISI (9.3 ± 1.2 vs. 15.3 ± 2.7, P < 0.001), and ESS (7.6 ± 1.3 vs. 10.6 ± 1.6, P < 0.001) in the intervention group were significantly lower than control group.
Conclusion: Sleep hygiene education consisted of a 2-hour session, and an educational brochure improved sleep problems in shift work nurses. -
Background and Objective: The main aim of the current research was to compare sleep problems in two groups of patients with addiction treated with preservatives substances (i.e., methadone and buprenorphine).
Materials and Methods: Two groups of addicts (30 patients treated with methadone and 30 patients treated with buprenorphine) were voluntarily selected using an available sampling method and were asked to complete Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), Insomnia Severity Index (ISI), and STOP-BANG question-naires. Data analysis was performed using independent t-test and descriptive indicators at the significant level of 5%.
Results:The average age was 39.16 ± 5.07 in the methadone group and 40.30 ± 6.17 years in the buprenorphine group (P < 0.050). All participants were male. Current findings indicated that significant difference existed between the two studied groups in the PSQI (P < 0.001) and ESS (P < 0.010) with the higher mean score for the methadone group. However, buprenorphine group showed higher mean score than methadone group on the ISI and STOP-BANG and the-se differences were found statistically significant (P < 0.010).
Conclusion: Sleep problems may be one of the reasons for the failure in the treatment of addiction among patients with addiction. -
Background and Objective: Night work causes disorder in the sleep-wake cycle followed by physiological and psychological consequences. This study aimed to investigate the effects of shift work on mental health and sleep prob-lems among workers of one gas refinery in Iran.
Materials and Methods: This study was a descriptive, type ex post facto study. The sample consisted of shift and day workers of one gas refinery in Iran. A total of 255 workers were selected from the refinery by purposive sampling (126 day workers and 125 shift workers) and were evaluated using scl-90-R, Pittsburgh Sleep Quality Index, and demo-graphic questionnaires. Data were analyzed through SPSS using t-test, one-way ANOVA, and regression methods.
Results:The findings suggested that there is no significant difference between shift workers and day workers in terms of mental health (M = 0.38 in day workers vs. M = 0.40 in day workers). There was a non-significant difference between shift workers and day workers in terms of sleep problems (M = 5.43 in day workers vs. M = 6.33 in shift work-ers); however, the differences between two groups in sleep latency and sleep efficacy were significant. The findings also suggested that marital status and place of residence of workers have no significant effect on sleep problems or their mental health.
Conclusions: It seems that although sleep problems are more common in shift workers than in day workers, there were no significant psychological problems between these groups in our sample. -
Background and Objective: People’s perceptions toward insomnia are influenced by the socio-cultural context of their lives. Therefore, the purpose of this study was to investigate beliefs, attitudes, and practices of the participants about causes of insomnia and its management.
Materials and Methods: Nineteen participants with a self-reported history of insomnia from the community were recruited in this study. Semi-structured qualitative interviews were conducted. The interviews were recorded and tran-scribed verbatim. The transcriptions were analyzed using thematic analysis.
Results: Four themes were identified: underlying causes of insomnia, help-seeking barriers, my coping strategies, and good food - bad drugs. Participant’s reactions to insomnia depended on their broader socio-cultural beliefs.
Conclusion: Studying these perceptions and responses in our sample would contribute to better understanding of patients’ therapeutic preferences. It would also help to identify effective socio-cultural beliefs on insomnia self-management methods. Identification of these beliefs and practices also can contribute to adaptation of common insom-nia treatments. -
Background and Objective: Previous studies have reported abnormal changes in spirometric parameters and flow-volume curves in patients with obstructive sleep apnea syndrome (OSAS) during sleep. This study aimed to evaluate the lung function capacities and flow-volume curves in these patients.
Materials and Methods:This was a cross-sectional study. A total of 120 adults aged 18-65 years with suspected OSAS were selected. A full record of demographic characteristics and history of chronic diseases, as well as the results of spirometry and polysomnography were obtained. Spirometric indices and flow-volume curves in OSAS patients and normal subjects were compared.
Results:The mean body mass index was 30.85 ± 6.18 kg/m2. Average neck and abdominal circumferences were 41.68 ± 3.53 and 108.56 ± 14.34 (cm); respectively. The subjects were divided into three groups based on their AHI. The sawtooth signal was observed in a flow-volume curve in 20.2% and 2.8% of patients with and without OSAS; respectively. Significant differences were seen in sawtooth appearance signs and forced expiratory flow (FEF) 50/forced inspiratory flow (FIF) 50 (P > 0.001), but these parameters were not significantly different in AHI subgroups of sleep apnea.
Conclusion:Sawtooth sign and FEF50/FIF50 ≥ 1 could be useful in diagnosis of OSAS, although it cannot be used to predict the severity. Despite a significant difference in a sawtooth sign and FEF50/FIF50 between OSAS patients and nor-mal subjects, no significant differences in lung functions were observed between OSAS patients and normal subjects.
