Background and Objective: Obstructive sleep apnea (OSA) is an important health problem, which is commonly under-diagnosed especially in workplace settings. We tried to obtain a model with more objective variables due to the greater reliability in occupational settings.
Materials and Methods: A total of 374 suspected patients with OSA who underwent their first olysomnography (PSG) at Baharloo Sleep Clinic in Tehran, Iran, were enrolled in the study. Before PSG, all patients completed a ques-tionnaire including demographic characteristics. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured for all participants. Furthermore, a blood sample was collected for measuring fasting blood sugar (FBS) and hemoglobin A1c (HbA1c). All the patients underwent full PSG. Respiratory Disturbance Index (RDI) was calculated and recorded for all patients. Different multiple adjusted logistic regression models were constructed to find the best model for prediction of OSA.
Results: A total of 271 (72.5%) participants were men. The mean age and body mass index (BMI) were 48.58 ± 13.04 years and 30.4 ± 5.0 kg/m2, respectively. The prevalence of RDI ≥ 15 was 78.87% (n = 295). Using regression analysis, several models were obtained, where the best one yielded sensitivity and specificity of 77.29% and 67.09%, respectively. Area under the curve (AUC) of this model was 82%. The variables of this model included SBP, age, neck circumference-height ratio (NHR), FBS, BMI, and gender (PAN apnea index) with a cutoff point ≥ 8 for high-risk individuals.
Conclusion: In this study, we considered only objective parameters to predict OSA which enhances reliability for diag-nosis especially in occupational settings.

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder and an important risk factor for cardiovascular diseases (CVDs). This study aimed to compare abnormal heart rate and arrhythmias among patients with OSA and normal subjects.
Materials and Methods: This case-control study was conducted on patients with OSA who were attending Imam Khomeini Hospital Sleep Lab, Tehran, Iran, to undergo a full-night polysomnography (PSG). Apnea-Hypopnea Index (AHI) was measured for study participants. Those with AHI < 5/h were considered as control (normal) and those with AHI > 15/h were considered as case (OSA) group. We compared abnormal heart rate and nocturnal arrhythmia during PSG between the two study groups.
Results: A total of 60 patients (30 cases and 30 controls) were included in this study. Abnormal heart rate (bradycardia and tachycardia) and nocturnal arrhythmia were compared between the two study groups. Twenty-eight percent of patients with moderate to severe OSA developed arrhythmia including sinus arrest, premature atrial contraction (PAC), atrial fibrillation (AF), and bigeminy premature ventricular contraction (PVC). Multiple PVC episodes were observed in 6.7% of subjects without OSA. Nocturnal arrhythmia was more common in cases; however, there was no significant difference. Mean heart rate in cases was 45 beat/minute in comparison with 68/minute in controls (P = 0.0001).
Conclusion: Different arrhythmias are observed in patients with OSA due to autonomic disorders. Bradycardia was more prevalent among patients with OSA. Regarding the association between OSA and nocturnal arrhythmias, treatment of OSA is important to prevent cardiac mortality.

Background and Objective: Sleep health can be defined as a multidimensional pattern of sleep-awakening that is consistent with individual, social, and environmental needs and its absence endangers physical and mental wellbeing. The objective of the present study was to validate the Sleep Health Scale (SHS).
Materials and Methods: The population for this study consisted of all nurses in Arak Province, Iran, including 130 participants who were selected using the available sampling method (simple sampling). Data collection was based on the SHS by Buysse, which resulted in 120 completed questionnaires. SPSS software was used for exploratory factor analysis (EFA), reliability, and correlation between questions, and AMOS was used for confirmatory factor analysis (CFA). This scale was translated from English to Persian and then was back-translated from Persian to English. The questionnaire was examined in terms of cultural sensitivities, clarity of questions, conflicts, and errors in meaningful-ness by a panel of experts.
Results: Cronbach’s alpha coefficient for the questionnaire was 0.89; hence, the questionnaire was reliable. Factor loadings’ examination using EFA and CFA showed 0.77 and 0.80 for the questions and this confirmed an acceptable construct validity. All items showed acceptable correlation (0.82 to 0.84). The results of test-retest reliability showed stability over time (r = 0.83) for sleep health assessment.
Conclusion: The Persian version of the questionnaire has acceptable validity and reliability and can be used for sleep health assessment, along with other questionnaires.

Background and Objective: Language disorders are common in children with autism spectrum disorder (ASD). It seems that children who suffer from sleep problems usually suffer from more severe disturbances in other linguistic areas, as well. Accordingly, the aim of this study was to compare language disorders in children with autism with sleep problems to children with autism with no sleep problems.
Materials and Methods: This was a cross-sectional study. The statistical population for this study included all children with autism aged between 7 and 12 years. Purposeful sampling through Children's Sleep Habits Questionnaire (CSHQ) test was applied to select a sample of 38 subjects, which was divided into two groups of 19 according to presence of sleep problems. The subjects were then evaluated through continuous speech quality testing.
Results: Higher mean and standard deviation (SD) of scores of mean length utterance (2.93 ± 2.01), speech rate (74.13 ± 1.58), number of verbs (11.72 ± 2.61), lexical enrichment (16.00 ± 1.55), and echolalia (2.81 ± 1.10) was ob-served among children with autism with sleep problems as compared to children with autism without sleep problems (P < 0.05) The findings also showed that the difference in mean scores in subscale of the number of lexical words was not significant.
Conclusion: According to the findings of this study, it seems that sleep disorders may be one of the factors affecting language learning and continuous speech quality in children with autism.

Background and Objective: Previous studies had examined the effect of learning in young adults with generally worse results in cases with the delayed sleep-wake phase disorder. In this study, the relationship between circadian rhythm preferences and objective structured clinical examination (OSCE) results was examined in medical students.
Materials and Methods: This study was conducted during the OSCE for clinical license in medical students who were graduation candidates. The reduced form of the Horne and Ostberg Morningness-Eveningness Questionnaire was used to estimate their circadian chronotype. The OSCE consisted of 12 stations, which evaluated different clinical skills, as well as participant’s medical knowledge. The effect of morningness-eveningness preference of each participant on score was evaluated within each station of OSCE.
Results: In total, 78 students participated out of a total of 114 clinically competent candidates (aged 25-34 years) were evaluated. In terms of sex, 56% of the students were girl, who obtained significantly higher grades in three stations (P < 0.05). The grades of students with delayed sleep-wake chronotypes were higher in most of the stations; however, the difference was statistically significant in only one station (P = 0.045), which was the most difficult station of the exam. Nevertheless, the delayed sleep-wake chronotype was associated with excessive daytime sleepiness (P = 0.002).
Conclusion: Contrary to other similar studies in medical students, normal circadian chronotype was associated with poorer outcome in the OSCE; which may be explained by unusual student training hours during shifts, and the resultant available time for undisturbed study .

Background and Objective: Sleep disorder is highly prevalent among students and can cause neurological, behavioral, and physiological changes and academic decline. Current study aimed to evaluate the association between depression, anxiety, and stress with sleep quality in nursing students of Kurdistan University of Medical Sciences, Sanandaj, Iran.
Materials and Methods: This cross-sectional study was performed on 204 nursing students selected by convenience sampling method. Data were collected using demographic characteristics form, Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety, and Stress Scale (DASS-21). Data analysis was performed by SPSS software.
Results: In this study, 115 participants (56.4%) were female and 84 students (41.2%) had poor sleep quality. The results indicated a significant and positive correlation between sleep quality score and depression (r = 0.492), anxiety (r = 0.391), and stress (r = 0.414). Moreover, there was a relationship between the mean score of sleep quality with de-pression and part-time job of students (P < 0.05).
Conclusion: The results of multivariate regression demonstrated that by increasing one unit in depression score and part-time job in students, sleep quality score increased by 0.238 and 1.850 units, respectively. According to the results of the study and concerning the relationship between students' part-time job and depression with sleep disorders, provi-sion of special interventions to enhance sleep quality in students seems necessary.

Background and Objective: Idiopathic hypersomnia (IH) manifests with excessive daytime sleepiness (EDS), cogni-tive and autonomic symptoms, debilitating sleep inertia, difficulty awakening, prolonged sleep duration, and non-restorative sleep. Here, we present a case with IH who was a shift worker in an automobile factory. Workplace implications and fitness for work in safety-sensitive jobs are especially important for patients with hypersomnolence, be cause rates of accidents increase in these situations.
Case Report: The patient was a 34-year-old man referred to Baharloo Sleep Clinic, Tehran, Iran, because of EDS. He was a shift worker in an automobile factory. The subject underwent multiple sleep latency test (MSLT) after overnight polysomnography (PSG). He had no sleep onset rapid eye movement (REM) periods in MSLT and the mean sleep la-tency (MSL) was 5.75 minutes. According to PSG and MSLT report, the diagnosis of narcolepsy was ruled out. According to his sleep log, the patient slept more than 11 hours per 24 hours and had MSL lower than eight minutes. Our patient used modafinil for improvement of his symptoms and he was unfit for working in night shifts.
Conclusion: Here, we reported a case of IH. Attention to past medical history, occupational history, sleep log or actigraphy, PSG, and MSLT findings is very helpful for diagnosis and confirmation of IH. Pre-employment and periodic evaluation of sleepiness, accident analysis, and tracking in an integrative sleepiness or fatigue management system would be very useful.

"In its simplest and most positive terms, sleep is a desired state of unconsciousness". Anesthesia in the contrary is another type of “desired unconsciousness”. However, they are actually like the two unequal twins sharing some features but different in others. Sleep and anesthesia are different in several aspects making them unique neu-rophysiologic states with complex mechanisms of action. Here, we aimed to compare these two states concisely, that may be a source of more interesting scientific pearls for whom working in this field especially sleep medicine specialists.