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Sung H Jang - One of the best experts on this subject based on the ideXlab platform.
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Excessive Daytime Sleepiness and injury of the ascending reticular activating system following whiplash injury
Frontiers in Neuroscience, 2018Co-Authors: Sung H Jang, Young Hoon KwonAbstract:Abstract Objectives: This study investigated injuries of the ascending reticular activating system (ARAS) following whiplash injury, in patients with Excessive Daytime Sleepiness (EDS). Methods: Twenty-three patients with whiplash injury and 26 healthy control subjects were recruited for this study. Epworth Sleepiness Scale (ESS) was used for evaluating Sleepiness. According to the ESS score, the patients were classified into two groups: subgroup A ESS score 0.05). Conclusions: We found significant injury of the lower ventral ARAS in EDS patients with whiplash injury. These results suggest that diffusion tensor tractography (DTT) could provide useful information for detecting injuries of the ARAS following whiplash injury, in patients with EDS. Key words: Excessive Daytime Sleepiness, ascending reticular activating system, hypersomnia, Whiplash injury, diffusion tensor tractography
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aggravation of Excessive Daytime Sleepiness concurrent with aggravation of an injured ascending reticular activating system in a patient with mild traumatic brain injury a case report
Medicine, 2017Co-Authors: Sung H Jang, Hyeok Gyu KwonAbstract:AbstractBackground:We report on a patient who developed aggravation of Excessive Daytime Sleepiness (EDS) concurrent with aggravation of an injured ascending reticular activating system (ARAS) following mild traumatic brain injury (TBI), demonstrated by follow-up diffusion tensor tractographies (DTT
Alexandros N Vgontzas - One of the best experts on this subject based on the ideXlab platform.
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natural history of Excessive Daytime Sleepiness role of obesity weight loss depression and sleep propensity
Sleep, 2015Co-Authors: Julio Fernandezmendoza, Alexandros N Vgontzas, Susan L Calhoun, Ilia Kritikou, Duanping Liao, Edward O BixlerAbstract:STUDY OBJECTIVES: Excessive Daytime Sleepiness (EDS) is highly prevalent in the general population and is associated with occupational and public safety hazards. However, no study has examined the clinical and polysomnographic (PSG) predictors of the natural history of EDS. DESIGN: Representative longitudinal study. SETTING: Sleep laboratory. PARTICIPANTS: From a random, general population sample of 1,741 individuals of the Penn State Adult Cohort, 1,395 were followed up after 7.5 years. MEASUREMENTS AND RESULTS: Full medical evaluation and 1-night PSG at baseline and standardized telephone interview at follow-up. The incidence of EDS was 8.2%, while its persistence and remission were 38% and 62%, respectively. Obesity and weight gain were associated with the incidence and persistence of EDS, while weight loss was associated with its remission. Significant interactions between depression and PSG parameters on incident EDS showed that, in depressed individuals, incident EDS was associated with sleep disturbances, while in non-depressed individuals, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy/ asthma, anemia, and sleep complaints also predicted the natural history of EDS. CONCLUSIONS: Obesity, a disorder of epidemic proportions, is a major risk factor for the incidence and chronicity of EDS, while weight loss is associated with its remission. Interestingly, objective sleep disturbances predict incident EDS in depressed individuals, whereas physiologic sleep propensity predicts incident EDS in those without depression. Weight management and treatment of depression and sleep disorders should be part of our public health policies.
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sleep disordered breathing in obese children is associated with prevalent Excessive Daytime Sleepiness inflammation and metabolic abnormalities
The Journal of Clinical Endocrinology and Metabolism, 2010Co-Authors: Edward O Bixler, George P Chrousos, Marina Tsaoussoglou, Susan L Calhoun, Katherine A Sauder, Alexandros N VgontzasAbstract:Background: In obese adults, sleep apnea is associated with Excessive Daytime Sleepiness (EDS) and cardiometabolic risk factors. In children, on the other hand, sleep-disordered breathing (SDB) is primarily associated with anatomic abnormalities and neurocognitive impairment, whereas studies on potential concurrent metabolic aberrations and EDS have been limited and inconsistent. In this study, we examined the joint effect of SDB and obesity in EDS as well as proinflammatory and metabolic markers. Methods: One hundred fifty children, aged 5–17 yr, were consecutively recruited from our sleep disorders clinic and a subset of the Penn State Children’s Cohort. Every child had a thorough history and physical examination, 9-h polysomnographic study, and a single blood draw for the assessment of IL-6, TNFα, soluble IL-6 receptor, TNF receptor-1, hypersensitive C-reactive protein, leptin, and adiponectin. In addition, parents completed a subjective questionnaire to assess EDS. Analysis of covariance was performed...
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Excessive Daytime Sleepiness in sleep apnea it is not just apnea hypopnea index
Sleep Medicine, 2008Co-Authors: Alexandros N VgontzasAbstract:Excessive Daytime Sleepiness (EDS) and fatigue (tiredness without increased sleep propensity) are the most common complaints of patients referred to a sleep disorders clinic. In the general population, the prevalence of EDS is estimated to range from 5–20% based on the question asked [1–4]. From published epidemiologic studies, it is clear that there has been a significant increase of Sleepiness over the last two decades. For example, Bixler et al. reported a prevalence of 4% of “hypersomnia” in Los Angeles in 1979 [1], whereas moderate to severe EDS was present in about 10% of the general population in central Pennsylvania in 2005 [4]. In the sleep field, it has been assumed that sleep factors, such as sleep fragmentation due to sleep apnea or self-induced sleep restriction, are the major determinants of this “epidemic” of Sleepiness and fatigue. In this issue of Sleep Medicine, Roure and his colleagues [5], in a large multicenter cohort of patients with obstructive sleep apnea (OSA) from Spain, examine the role of sleep fragmentation as a result of apnea on EDS. Surprisingly and contrary to the common belief, sleepy patients showed longer sleep duration and increased slow wave sleep compared to the nonsleepy patients with apnea. The authors concluded that sleep apnea and sleep disruption are not the primary determinants of EDS in patients with sleep apnea. Ten years ago, we published a study indicating that obese patients without sleep apnea are sleepier than nonobese controls using objective Daytime sleep tests [6]. Also, in this study and other studies [6,7], morbidly obese patients slept poorly during the night. We were surprised when we found that their Daytime Sleepiness was not a result of the poor sleep of the preceding night. In fact, analysis showed that those obese patients who were sleepier during the day had higher sleep efficiency at night, whereas those who were less sleepy during the day also had shorter nighttime sleep duration. At that time, we speculated that Sleepiness in obese patients most likely reflects metabolic/circadian disturbances. Consequently, and similarly to our study, two more studies showed that in patients with sleep apnea, objective Daytime Sleepiness is associated with longer nighttime sleep duration [8] or that in obese patients, subjective EDS could not be explained by objective polysomnographic measures of the previous night [9]. Although EDS is considered the cardinal symptom of sleep apnea, their association is rather weak. For example, in clinical practice, frequently patients are examined with a high number of apneas but without significant EDS. This is more common in apneics identified in general population samples [10–12]. Conversely, patients with a small number of apneas or arousals related to breathing alterations complain of significant EDS not readily explained from the degree of sleep disturbance or any other comorbid conditions. In the Wisconsin cohort of subjects found to have SDB, only 22% of the women and 17% of men reported EDS [10]. In the Penn State cohort, a complaint of EDS was reported by only 17% of those with an apnea hypopnea index (AHI) ≥ 15 [11,12], whereas in the Sleep Heart Health Study, EDS was reported by 16% of those with an AHI > 5 [13]. Also, Bixler and his colleagues in a recent analysis of a large cohort of 1,741 individuals showed that EDS is independently but weakly associated with AHI [4]. In addition, correction of SDB with continuous positive airway pressure (CPAP) does not lead to complete restoration of Daytime energy and/or significant improvement of objective measures of Sleepiness in many patients [14], and additional administration of stimulants is recommended [15]. These data suggest that Sleepiness, in part, is independent of the number of apneas and that other factors may play a significant role. In subsequent studies we have attempted to explore other possible factors contributing to Sleepiness and fatigue. We and others have shown that age, obesity, diabetes, insulin resistance, physical activity, and depression/emotional stress are strong determinants of Excessive Daytime Sleepiness and fatigue in humans [4,16–20], whereas the association of diet-induced obesity and Excessive sleep has been demonstrated in animals as well [21]. Furthermore, combining data from clinical and physiological studies, we have suggested that metabolic factors are associated with objective Sleepiness, whereas the presence of emotional stress is associated with subjective fatigue but not objective Sleepiness [22]. These studies do not refute the role of sleep apnea per se or sleep loss in Sleepiness; in fact, sleep apnea/sleep disruption is one but not the only or primary determinant of Sleepiness in clinical and population samples. The data by Roure et al. [5] strengthen these previous findings and call for further investigation into the possible factors determining EDS and fatigue. From a practical standpoint, there is evidence to support that the evaluation of a sleepy apneic patient should include an assessment of metabolic status, level of exercise, as well as presence of depression or emotional stress. This direction enriches the field of sleep medicine and does not detract from its significance in modern medicine. The study by Roure et al. [5] does not provide data on patients’ metabolic status (e.g.., insulin resistance/visceral adiposity), levels of physical activity, or emotional stress. Body mass index does not provide enough information in regard to the metabolic status of their relatively mild obese population. Waist circumference or simple metabolic indices of glycemic control or hyperlipidemia are more accurate indices of the metabolic syndrome and are potentially useful to confirm or reject the importance of metabolic factors in EDS. Also, from this study we cannot exclude the possibility that sleepy apneic patients may suffer from chronic self-induced sleep restriction (which is rather unlikely), that they are more vulnerable to the effects of chronic sleep disruption due to endogenous trait characteristics [23,24], or that their Sleepiness is driven partly by genetics [25]. There are many challenges that we need to address in order to understand what makes some apneic patients sleepy and some others not: inconsistencies between subjective vs. objective measures; validity of current instruments; the demarcation of the phenomenology and pathophysiology of objective Daytime Sleepiness vs. subjective fatigue; detection, definition, and validation of the various subtypes of Sleepiness; and, of course, the role of inherited individual predisposition to Sleepiness. However, from Roure’s study [5] and those preceding their study, there is an important message. In order to understand EDS in clinical and general population samples, we should look beyond the apnea/hypopnea index. If in 1998 these views were “paradoxical” and not “mainstream,” in 2008, a stubborn exclusive adherence to AHI (neglecting other factors) in understanding EDS may potentially be harmful to the scientific credibility of the field of sleep medicine.
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Excessive Daytime Sleepiness in a general population sample the role of sleep apnea age obesity diabetes and depression
The Journal of Clinical Endocrinology and Metabolism, 2005Co-Authors: Edward O Bixler, Alexandros N Vgontzas, Susan L Calhoun, Antonio Velabueno, Anthony KalesAbstract:CONTEXT: Excessive Daytime Sleepiness (EDS) is commonly considered a cardinal sign of sleep apnea; however, the mechanism underlying the association is unclear. OBJECTIVE: The purpose of this study was to assess the association between the complaint of EDS and sleep apnea, considering a wide range of possible risk factors in a population sample. DESIGN AND SETTING: We examined this question in the Penn State cohort (a random sample of 16,583 men and women from central Pennsylvania, ranging in age from 20 to 100 yr). A random subset of this cohort (n = 1,741) was further evaluated for one night in the sleep laboratory. MAIN OUTCOME MEASURE: The main measure was a complaint of EDS. RESULTS: The final logistic regression model indicated depression was the most significant risk factor for EDS followed by body mass index, age, typical sleep duration, diabetes, smoking, and finally sleep apnea. The strength of the association with EDS decreased with increasing age, whereas the association of depression with EDS was stronger in the young. EDS is more prevalent in the young ( 75 yr), suggesting increasing medical illness and health problems. EDS was associated with a reduced report of typical sleep duration without any association with objective polysomnographic measures. CONCLUSIONS: It appears that the presence of EDS is more strongly associated with depression and metabolic factors than with sleep-disordered breathing or sleep disruption per se. Our findings suggest that patients with a complaint of EDS should be thoroughly assessed for depression and obesity/diabetes independent of whether sleep-disordered breathing is present.
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elevation of plasma cytokines in disorders of Excessive Daytime Sleepiness role of sleep disturbance and obesity
The Journal of Clinical Endocrinology and Metabolism, 1997Co-Authors: Alexandros N Vgontzas, Dimitris A Papanicolaou, Edward O Bixler, Anthony Kales, Kathy Tyson, George P ChrousosAbstract:Excessive Daytime Sleepiness (EDS) and fatigue are frequent symptoms in the general population and the chief complaint of the majority of patients at Sleep Disorders Centers. There is evidence that the inflammatory cytokines tumor necrosis factor-α (TNFα), interleukin-1β (IL-1β), and IL-6 are involved in physiological sleep regulation and that their administration to humans is associated with Sleepiness and fatigue. To explore whether plasma levels of TNFα, IL-1β, and IL-6 are elevated in patients with EDS, we measured morning plasma levels of TNFα, IL-1β, and IL-6 in 12 sleep apneics, 11 narcoleptics, 8 idiopathic hypersomniacs, and 10 normal controls. TNFα was significantly elevated in sleep apneics and narcoleptics compared to that in normal controls (P< 0.001 and P = 0.001, respectively). Plasma IL-1β concentrations were not different between sleep disorder patients and controls, whereas IL-6 was markedly and significantly elevated in sleep apneics compared to that in normal controls (P = 0.028). The ...
Edward O Bixler - One of the best experts on this subject based on the ideXlab platform.
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natural history of Excessive Daytime Sleepiness role of obesity weight loss depression and sleep propensity
Sleep, 2015Co-Authors: Julio Fernandezmendoza, Alexandros N Vgontzas, Susan L Calhoun, Ilia Kritikou, Duanping Liao, Edward O BixlerAbstract:STUDY OBJECTIVES: Excessive Daytime Sleepiness (EDS) is highly prevalent in the general population and is associated with occupational and public safety hazards. However, no study has examined the clinical and polysomnographic (PSG) predictors of the natural history of EDS. DESIGN: Representative longitudinal study. SETTING: Sleep laboratory. PARTICIPANTS: From a random, general population sample of 1,741 individuals of the Penn State Adult Cohort, 1,395 were followed up after 7.5 years. MEASUREMENTS AND RESULTS: Full medical evaluation and 1-night PSG at baseline and standardized telephone interview at follow-up. The incidence of EDS was 8.2%, while its persistence and remission were 38% and 62%, respectively. Obesity and weight gain were associated with the incidence and persistence of EDS, while weight loss was associated with its remission. Significant interactions between depression and PSG parameters on incident EDS showed that, in depressed individuals, incident EDS was associated with sleep disturbances, while in non-depressed individuals, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy/ asthma, anemia, and sleep complaints also predicted the natural history of EDS. CONCLUSIONS: Obesity, a disorder of epidemic proportions, is a major risk factor for the incidence and chronicity of EDS, while weight loss is associated with its remission. Interestingly, objective sleep disturbances predict incident EDS in depressed individuals, whereas physiologic sleep propensity predicts incident EDS in those without depression. Weight management and treatment of depression and sleep disorders should be part of our public health policies.
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sleep disordered breathing in obese children is associated with prevalent Excessive Daytime Sleepiness inflammation and metabolic abnormalities
The Journal of Clinical Endocrinology and Metabolism, 2010Co-Authors: Edward O Bixler, George P Chrousos, Marina Tsaoussoglou, Susan L Calhoun, Katherine A Sauder, Alexandros N VgontzasAbstract:Background: In obese adults, sleep apnea is associated with Excessive Daytime Sleepiness (EDS) and cardiometabolic risk factors. In children, on the other hand, sleep-disordered breathing (SDB) is primarily associated with anatomic abnormalities and neurocognitive impairment, whereas studies on potential concurrent metabolic aberrations and EDS have been limited and inconsistent. In this study, we examined the joint effect of SDB and obesity in EDS as well as proinflammatory and metabolic markers. Methods: One hundred fifty children, aged 5–17 yr, were consecutively recruited from our sleep disorders clinic and a subset of the Penn State Children’s Cohort. Every child had a thorough history and physical examination, 9-h polysomnographic study, and a single blood draw for the assessment of IL-6, TNFα, soluble IL-6 receptor, TNF receptor-1, hypersensitive C-reactive protein, leptin, and adiponectin. In addition, parents completed a subjective questionnaire to assess EDS. Analysis of covariance was performed...
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Excessive Daytime Sleepiness in a general population sample the role of sleep apnea age obesity diabetes and depression
The Journal of Clinical Endocrinology and Metabolism, 2005Co-Authors: Edward O Bixler, Alexandros N Vgontzas, Susan L Calhoun, Antonio Velabueno, Anthony KalesAbstract:CONTEXT: Excessive Daytime Sleepiness (EDS) is commonly considered a cardinal sign of sleep apnea; however, the mechanism underlying the association is unclear. OBJECTIVE: The purpose of this study was to assess the association between the complaint of EDS and sleep apnea, considering a wide range of possible risk factors in a population sample. DESIGN AND SETTING: We examined this question in the Penn State cohort (a random sample of 16,583 men and women from central Pennsylvania, ranging in age from 20 to 100 yr). A random subset of this cohort (n = 1,741) was further evaluated for one night in the sleep laboratory. MAIN OUTCOME MEASURE: The main measure was a complaint of EDS. RESULTS: The final logistic regression model indicated depression was the most significant risk factor for EDS followed by body mass index, age, typical sleep duration, diabetes, smoking, and finally sleep apnea. The strength of the association with EDS decreased with increasing age, whereas the association of depression with EDS was stronger in the young. EDS is more prevalent in the young ( 75 yr), suggesting increasing medical illness and health problems. EDS was associated with a reduced report of typical sleep duration without any association with objective polysomnographic measures. CONCLUSIONS: It appears that the presence of EDS is more strongly associated with depression and metabolic factors than with sleep-disordered breathing or sleep disruption per se. Our findings suggest that patients with a complaint of EDS should be thoroughly assessed for depression and obesity/diabetes independent of whether sleep-disordered breathing is present.
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elevation of plasma cytokines in disorders of Excessive Daytime Sleepiness role of sleep disturbance and obesity
The Journal of Clinical Endocrinology and Metabolism, 1997Co-Authors: Alexandros N Vgontzas, Dimitris A Papanicolaou, Edward O Bixler, Anthony Kales, Kathy Tyson, George P ChrousosAbstract:Excessive Daytime Sleepiness (EDS) and fatigue are frequent symptoms in the general population and the chief complaint of the majority of patients at Sleep Disorders Centers. There is evidence that the inflammatory cytokines tumor necrosis factor-α (TNFα), interleukin-1β (IL-1β), and IL-6 are involved in physiological sleep regulation and that their administration to humans is associated with Sleepiness and fatigue. To explore whether plasma levels of TNFα, IL-1β, and IL-6 are elevated in patients with EDS, we measured morning plasma levels of TNFα, IL-1β, and IL-6 in 12 sleep apneics, 11 narcoleptics, 8 idiopathic hypersomniacs, and 10 normal controls. TNFα was significantly elevated in sleep apneics and narcoleptics compared to that in normal controls (P< 0.001 and P = 0.001, respectively). Plasma IL-1β concentrations were not different between sleep disorder patients and controls, whereas IL-6 was markedly and significantly elevated in sleep apneics compared to that in normal controls (P = 0.028). The ...
Hyeok Gyu Kwon - One of the best experts on this subject based on the ideXlab platform.
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aggravation of Excessive Daytime Sleepiness concurrent with aggravation of an injured ascending reticular activating system in a patient with mild traumatic brain injury a case report
Medicine, 2017Co-Authors: Sung H Jang, Hyeok Gyu KwonAbstract:AbstractBackground:We report on a patient who developed aggravation of Excessive Daytime Sleepiness (EDS) concurrent with aggravation of an injured ascending reticular activating system (ARAS) following mild traumatic brain injury (TBI), demonstrated by follow-up diffusion tensor tractographies (DTT
Young Hoon Kwon - One of the best experts on this subject based on the ideXlab platform.
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Excessive Daytime Sleepiness and injury of the ascending reticular activating system following whiplash injury
Frontiers in Neuroscience, 2018Co-Authors: Sung H Jang, Young Hoon KwonAbstract:Abstract Objectives: This study investigated injuries of the ascending reticular activating system (ARAS) following whiplash injury, in patients with Excessive Daytime Sleepiness (EDS). Methods: Twenty-three patients with whiplash injury and 26 healthy control subjects were recruited for this study. Epworth Sleepiness Scale (ESS) was used for evaluating Sleepiness. According to the ESS score, the patients were classified into two groups: subgroup A ESS score 0.05). Conclusions: We found significant injury of the lower ventral ARAS in EDS patients with whiplash injury. These results suggest that diffusion tensor tractography (DTT) could provide useful information for detecting injuries of the ARAS following whiplash injury, in patients with EDS. Key words: Excessive Daytime Sleepiness, ascending reticular activating system, hypersomnia, Whiplash injury, diffusion tensor tractography
