Background and Objective: Amygdala contains central nucleus which is the region rich of γ-aminobutyric acid (GABA-A) receptors and plays a key role in modulating behavior and sleep homeostasis. Furthermore, dysfunction of amygdala probably contributes to anxiety and mood disorders. In this study, we evaluated the association between acute sleep deprivation (ASD) and anxiety through GABA-A receptor in the central nucleus of the amygdala (CeA).
Materials and Methods: A total of 35 male rats were bilaterally cannulated in CeA, randomly divided into four groups (n = 7); control (CON), ASD, bicuculline (BIC) (as a GABA-A receptor blocker), BIC + ASD. Saline was in-jected intra-CeA for the first three groups and others received intra-CeA BIC (0.1 nmol/0.5 μl in volume of 0.5 μl same at each side).
Results: Intra-CeA injection of BIC increased the level of anxiety compared to control group. Induction of 24 hours ASD immediately after BIC injection, led to decrease in the anxiety level when compared to BIC group, and we found no statistically difference between control and ASD groups.
Conclusion: Intra-CeA injection of BIC increased anxiety level while induction of ASD decreased BIC-induced anxiety.

Background and Objective: The main causes of nocturnal hypoxemia are pulmonary diseases or sleep related breathing disorders. In overlap syndrome, the co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), blood oxygen alteration, and hypercapnia may be more severe. We aimed to study hypoxemia markers in OSA patients with or without COPD.
Materials and Methods: This cross-sectional study evaluated clinical data and polysomnographic findings of 210 patients with apnea hypopnea index (AHI) > 5 among whom 35 patients had COPD.
Results: A total of 210 patients with mean age of 57 years were enrolled in this study. 140 patients (66.7%) had severe OSA (AHI ≥ 30). At wake stage, the mean oxygen saturation (SpO2) was 89.7 ± 5.1 mmHg for those with severe apnea, 91.0 ± 5.7 mmHg for non-severe apnea patients (AHI < 30), 82.7 ± 10.1 mmHg for COPD patients with severe apneas, and 89.3 ± 7.5 mmHg for COPD patients with non-severe OSA (P < 0.0001). Mean pressure of carbon dioxide was 52.9 ± 7.6 mmHg for COPD patients with severe apneas, and 50.2 ± 10.1 mmHg among those with not-severe OSA (P < 0.0001). In average, blood SpO2 dropped to 68.0 ± 12.6 mmHg in severe OSA group, to 57.0 ± 13.6 mmHg in COPD patients with severe OSA (P < 0.0001).
Conclusion: Hypoxemia is significantly prominent in overlap syndrome. The presence of diurnal hypoxemia and hypercapnia may predict nocturnal hypoxemia in these patients.

Background and Objective: Numerous anatomical abnormalities or pathological conditions can cause upper airway obstruction in obstructive sleep apnea syndrome (OSAS). Muller’s maneuver (MM) is one of diagnostic modalities investigating the obstruction site in patients with OSAS. This study aimed to investigate the obstruction sites of patients with OSAS based on MM.
Materials and Methods: This was a case-series study. A total of 145 patients were enrolled in this study. The awake MM (a flexible fiberoptic endoscopy of the upper airway while patients perform forced inspiration against a closed oral and nasal airway) was performed by a single surgeon with the patient in a supine position. Endoscopic findings were classified using the modified velum, oropharyngeal lateral walls, tongue base, and epiglottis (VOTE) classification criteria.
Results: Mean ± standard deviation age of patients was 41.5 ± 10.1 years old. Mean respiratory disturbance index was 29.7 ± 24.3/hours. The most common site of obstruction in all patients was velum. About 72% of the patients had more than 75% obstruction in the velum area while most patients had < 50% obstruction in oropharyngeal lateral walls (41.4%) and tongue base (55.2%). 69% of the patients had no obstruction in epiglottis according to the modified VOTE classification.
Conclusion: Simple awake diagnostic test before surgery would help physicians to identify obstruction sites of OSAS patients.

Background and Objective: STOP-BANG questionnaire is a well-known obstructive sleep apnea (OSA) screening tool. This study aimed to evaluate that patients with high probability of OSA in STOP-BANG questionnaire meet the criteria for assessment by split-night polysomnography (PSG).
Materials and Methods: Patients who were admitted to three sleep clinics and underwent full-night PSG entered into the study. The patients filled in the STOP questionnaire at their first clinic visit. Weight, height, and neck circumference were measured by technicians for computing STOP-BANG score. The apnea–hypopnea index (AHI) was used for diagnosis of OSA for which 5 ≤ AHI < 15, 15 ≤ AHI < 30, and AHI ≥ 30 were considered as mild, moderate, and severe OSA, respectively. AHI cutoff levels of 20 and 40 were used to evaluate split-night PSG criteria. Sensitivity analysis was performed for identifying predictive parameters.
Results: In assessment of 990 patients, the sensitivity of the STOP-BANG ≥ 3 for OSA diagnosis at AHI thresholds of 5, 15 and 30 were 93, 96 and 97.8, and the specificity were 39, 24.5 and 20, respectively. The specificities of the STOP-BANG score ≥ 7 for OSA diagnosis at AHI thresholds of 20 and 40 were 99.2 and 97.9, and the positive predictive values were 90.5 and 64.3, respectively.
Conclusion: We found that the STOP-BANG could be considered not only as an OSA screening test, but also as a test to determine proper patients for split-night PSG, the benefit of which is a cost reduction in OSA management.

Background and Objective: Obstructive sleep apnea syndrome (OSAS) is a prevalent disease in adults. Limited evidence regarding the effect of severity of sleep apnea and depression on heart rate variability (HRV) indices exists. Hence, we decided to focus on the association between HRV and severity of OSAS based on depression score.
Materials and Methods: A total of 193 patients with confirmed OSAS were selected from a sleep clinic setting. A checklist for demographic data and self-administered questionnaires including the Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Beck Depression Inventory; Snoring, Tiredness, Observed apnea, Blood pressure, Body mass index, Age, Neck circumference (STOP-BANG), and Gender questionnaire were filled in. We used two domains of HRV (e.g., frequency and time) estimation.
Results: The mean number of pairs of adjacent RR intervals (time between QRS complexes) differing by more than 50 ms in the entire analysis interval (NN50 count) was significantly different among various severity OSAS groups (μ = 2639.12 ± 478.98 for mild and moderate, and 2313.81 ± 670.54 in severe OSAS; P = 0.0200). In frequency do-main, the indices were higher in severe OSAS patients. Statistically significant association was between HRV parame-ters (standard deviation of all RR intervals, mean of the standard deviation of all RR intervals for all 5-minutes segments, NN50 count, the NN50 count divided by the total number of all RR intervals, average total power, low frequency power) and OSAS severity.
Conclusion: There are some statistically significant differences between OSAS severity and parameters of HRV.

Background and Objective: Obstructive sleep apnea (OSA) is defined as a sleep disordered breathing due to partial or complete obstruction of upper airways. This study aimed to investigate treatment outcomes and clinical complications among patients with OSA who underwent upper airway surgery in clinical settings.
Materials and Methods: All patients undergone upper airway surgery for OSA were called upon to enroll in this follow-up study. Demographic characteristics, Epworth sleepiness scale (ESS), snoring, dry mouth, nocturia, improvement of high blood pressure, and complications of surgery including bleeding, infection, pain, and temporary voice change were recorded at median of 8 months after the surgery. 12 patients accepted to undergo follow-up polysomnography (PSG).
Results: Among 41 participants, mean age was 44.2 ± 11.6 years, and 33 (78.6%) were male. In three patients (25%) with follow-up PSG, mean respiratory disturbance index (RDI) was decreased by 50%. The baseline and post-surgery RDI was 34.0 ± 26.2 and 24.8 ± 13.2/hours, respectively. Mean ESS pre-surgery was 9.0 ± 4.5 with a decrease of 3.9 ± 4.2 post-surgery. Most of the participants reported improved snoring. More than half of the patients reported improvement of hypertension, dry mouth, nocturia, and sleep quality. The most common reported complications were temporary changes in voice and pain.
Conclusion: Surgery improved snoring, daytime sleepiness, and OSA-related problems. RDI improvement in a small subset of patients indicates importance of follow-up PSG after upper airway surgery and warrants further studies. Moreover, evaluation of the reasons of non-participation for undergoing follow-up PSG requires more investigation.

Background and Objective: Breast cancer is the most common cancer among women. Many of the women with breast cancer suffer from sleep disorders. This study aimed to investigate the quality of sleep and its related issues in women with breast cancer referred to the Hematology and Oncology Research Center affiliated with Tabriz University of Medical Sciences, Tabriz, Iran.
Materials and Methods: In this cross-sectional study, 103 women with breast cancer were chosen using the census method. Data were collected using the Pittsburgh Sleep Quality Index. Descriptive and analytic statistics and linear re-gression test were used for data analysis.
Results: The mean age of the sample was 42.59 years [standard deviation (SD): 11.72 years] and the average length of diagnosis was 19.90 months (SD: 12.67 months). The mean score of sleep quality was 11.50 (SD: 3.71) in a range from 0 to 21. Except the history of mastectomy, age, smoking status, the remaining demographic data could predict 39.5% of the variance of sleep quality.
Conclusion: The results of this study are a wakeup call for officials. To prevent the negative impact of poor quality of sleep, there is a need to design holistic and appropriate interventions. The findings provide valuable information with scheduling for these interventions.

Background and Objective: Lack of sleep (insomnia) is a common problem involving society members and inpatients causing different physiological effects. Treatment includes a variety of several pharmacologic or other techniques. One of the non-pharmacologic methods is local heating of terminal organs (passive body heating). Manipulation of body temperature is a potential therapeutic intervention. The purpose of this study was to review the impact of passive body heating on the sleep quality.
Materials and Methods: After searching in available databases with proper keywords in both Persian and English language and with no time limits, 114 articles were collected. Of these, 31 were selected as the most relevant and were reviewed.
Results: Based on the previous researches, the warm footbath was selected for implementation of passive body heating which was the most common and safest method. In some studies, the warm footbath also improved mental sleep and polysomnography findings.
Conclusion: Although the impact of passive body heating on sleep has not been proved in all studies, it increases patient comfort and relaxation and the parasympathetic stimulation. Hence, this method can be used as a non-complicated nursing procedure in patients with insomnia.