What do objective measures of daytime sleepiness measure?
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ABSTRACT: The purpose of this review is to identify which aspects of allergic rhinitis limit the quality of life in patients, to present information on how rhinitis affects sleep, and to review instruments available to assess the impact that rhinitis has on sleep. Subjective and objective instruments reveal patients with allergic rhinitis frequently suffer from sleep-disordered breathing, poor sleep quality, daytime somnolence, and fatigue. Sleep disturbances associated with allergic rhinitis can lead to decreased cognitive and psychomotor abilities, impaired work performance, decreased productivity, impaired learning, difficulty concentrating, and memory deficits. Objective and subjective instruments are available to measure the extent of compromise in quality of life in affected patients. Subjective measurements available to evaluate allergic rhinitis include general and disease specific quality of life questionnaires, including rhinitis specific and sleep specific questionnaires. Objective measurements available include evaluation of nasal patency and physiology in rhinitis, nasal inspiratory peak flow, acoustic rhinometry, rhinomanometry, polysomnography, the Multiple Sleep Latency Test, the Maintenance of Wakefulness Test, and learning and performance testing. The continued utilization of these and other available instruments is vital for further assessment on the effect of allergic rhinitis on sleep.
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ABSTRACT: The present investigation was designed to explore the role and implications of both daytime sleepiness and fatigue in obstructive sleep apnea syndrome with respect to sleep, perceived health quality, and psychological functioning. Our participants consisted of two groups: 124 older community volunteers who completed a polysomnographic sleep study and were diagnosed with sleep apnea, and 19 healthy controls. All participants completed self-report measures of sleepiness, fatigue, sleep quality, health quality, and psychological functioning. The apnea sample was divided according to clinically relevant cut-offs on sleepiness and fatigue. When those with mid-range scores were ruled out, the following groups remained: low sleepiness/low fatigue (LL, n=23), high sleepiness/high fatigue (HH, n=28), high sleepiness/low fatigue (HS, n=10) and low sleepiness/high fatigue (HF, n=13). The respiratory disturbance index did not differ significantly among these groups and only the two highly fatigued groups (HH and HF) experienced significantly lower average oxygen saturation than the control group. Analyses revealed that the HH group was significantly worse than the LL and control groups on most sleep, health quality, and psychological measures. On these same measures, the groups for whom fatigue was low (LL and HS), regardless of sleepiness, were similar to controls. When patients with sleep apnea are classified into different sleepiness/fatigue categories, the results show that high fatigue is associated with more severe dysfunction than high sleepiness. The current debate on whether to treat apnea patients with low sleepiness needs to consider the impact of fatigue.
Article: Dangerous Driver
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