Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 139 142 EN Hoda Parsa Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mahdieh Faghihi Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Alireza Imani Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2016 06 29 2016 08 27 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. https://jss.tums.ac.ir/index.php/jss/article/view/33 https://jss.tums.ac.ir/index.php/jss/article/download/33/49

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 176 181 EN Hassan Talebi Department of Medical Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran Mohammad Ali Heydari-Gorji Department of Medical Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran Zoya Hadinejad Department of Emergency Medical Service, Mazandaran University of Medical Sciences, Sari, Iran 2016 08 26 2016 11 14 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.     https://jss.tums.ac.ir/index.php/jss/article/view/39 https://jss.tums.ac.ir/index.php/jss/article/download/39/54

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 143 147 EN Fariborz Rezaeetalab Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Hadi Asadpour Department of Psychiatry, School of Medicine, Sleep Clinic of Ebn-e-Sina Hospital AND Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Mohammadreza Ahmadi Mousavi Department of Pulmonary and Sleep Medicine, School of Medicine AND Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mitra Safa Department of Pulmonary and Sleep Medicine, School of Medicine AND Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ali Panahi Department of Pulmonary and Sleep Medicine, School of Medicine AND Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Parisa Adimi Department of Pulmonary and Sleep Medicine, School of Medicine AND Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2016 09 10 2016 12 10 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. https://jss.tums.ac.ir/index.php/jss/article/view/43 https://jss.tums.ac.ir/index.php/jss/article/download/43/50

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 148 150 EN Amin Amali Otorhinolaryngology Research Center AND Department of Otolaryngology, Head and Neck Surgery, School of Medicine AND Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Behrooz Amirzargar Otorhinolaryngology Research Center AND Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mohammad Sadeghi Otorhinolaryngology Research Center AND Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Babak Saedi Otorhinolaryngology Research Center AND Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2016 09 16 2016 11 15 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. https://jss.tums.ac.ir/index.php/jss/article/view/44 https://jss.tums.ac.ir/index.php/jss/article/download/44/51

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 151 155 EN Zahra Banafsheh Alemohammad Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Ahmad Khajeh-Mehrizi Department of Internal Medicine, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Khosro Sadeghniiat-Haghighi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Ania Rahimi-Golkhandan Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran 2016 10 04 2016 12 10 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. https://jss.tums.ac.ir/index.php/jss/article/view/50 https://jss.tums.ac.ir/index.php/jss/article/download/50/56

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 156 163 EN Omid Aminian Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Narges Sadat Shams-Hosseini Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran Khosro Sadeghniiat-Haghighi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran 2016 07 09 2016 09 03 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. https://jss.tums.ac.ir/index.php/jss/article/view/36 https://jss.tums.ac.ir/index.php/jss/article/download/36/53

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 4 2017 04 09 164 168 EN Hadiseh Hosseiny Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Nafiseh Naeimabadi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Arezu Najafi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Reihaneh Heidari Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Khosro Sadeghniiat-Haghighi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran ame>Zahra Banafsheh Alemohammad Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical sciences, Tehran, Iran Seyed Mohammad Esmaeil Taghavi Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical sciences, Tehran, Iran Akbar Sharifian Occupational Medicine Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2015 11 14 2016 02 29 Background and Objective: Restless legs syndrome (RLS) is a sleep disorder with an association to sleep quality. We investigated the sleep quality in patients with RLS among health-care workers with or without shift work. Materials and Methods: All female health-care workers (n = 540) in four educational hospitals were enrolled in this cross-sectional study. International RLS Study Group (IRLSSG) questionnaire, IRLSSG Rating Scale, Pittsburgh Sleep Quality Index (PSQI), and a data collection sheet including demographic characteristics and disorders related to secondary RLS were completed by study participants. Results: The mean ± standard deviation (SD) age of the participants was 32.0 ± 6.8 years. The mean ± SD PSQI scores were 9.03 ± 3.29 and 7.30 ± 3.67 in RLS-positive and RLS-negative shift workers (P = 0.002), respectively. The mean ± SD PSQI scores were 7.76 ± 3.66 and 6.10 ± 3.15 in RLS-positive and RLS-negative non-shift workers (P = 0.005), respectively. Conclusion: Health-care workers have poor sleep quality aggravated with both RLS and shift work. RLS-positive female patients are at increased risk of poor sleep quality in both shift workers and non-shift workers with the worst score of PSQI questionnaire in shift workers. https://jss.tums.ac.ir/index.php/jss/article/view/14 https://jss.tums.ac.ir/index.php/jss/article/download/14/28

Tehran University of Medical Sciences Journal of Sleep Sciences 2476-2938 1 2 2016 07 27 80 86 EN Zohreh Yazdi Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Ziba Loukzadeh Industrial Disease Research Center, Assistant Professor of Shahid Sadoughi University of Medical Sciences, Yazd, Iran Shabnam Jalilolghadr Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Shima Rezaian Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran 2016 06 18 2016 06 18 Background and Objective: Sleep disorders are common medical problems in most of the communities. However, medical students and general practitioners (GPs) do not have enough information about sleep disorders. The aim of this study was to assess the level of knowledge, attitude, and practice of GPs in the field of sleep disorders in Iran. Materials and Methods: In this cross-sectional questionnaire-based study, all physicians working in the private sector of Qazvin were invited to participate in this study. A comprehensive questionnaire was used including questions about knowledge, attitude, and practice of GPs about sleep disorders. Univariate logistic regression was used for calculation of odds ratio and 95% confidence intervals for demographic factors. Results: A total of 243 GPs participated including 123 (50.6%) females. A mean age of participants was 39.5 ± 8.2 years. The prevalence of sleep disorders among their patients was 25.2% and they believed that nearly 30% of cases of sleep disorders have been occurred following somatic disease. The average of knowledge, attitude, and practice in GPs was 63.8%, 49.4%, and 56.5%, respectively. There were lower levels of knowledge with increasing years after graduation. Conclusion: Attitud