Im physiologischen Schlaf werden vier Schlafstadien durchlaufen, die zyklisch wiederkehrend in einer bestimmten Abfolge auftreten. Aufgrund charakteristischer Veränderungen der Signale von Elektroenzephalogramm, Elektrookulogramm und Elektromyogramm lassen sich zwei Leichtschlafstadien, ein Tiefschlafstadium und REM-Schlaf differenzieren. In der Kardiorespiratorischen Polysomnographie werden zusätzlich Parameter der Herz-Kreislauf-Funktion registriert, sodass auch charakteristische Veränderungen der autonomen Funktionen erfasst werden. Einschlafen bezeichnet den Übergang zwischen Wachheit und Schlaf. Beim Prozess des Einschlafens geht der Organismus in den meisten Fällen zuerst ins Stadium N1 über, bevor die tieferen Schlafstadien erreicht werden, ein direkter Übergang ins Stadium N2 kommt aber vor. Im Erleben entspricht das Einschlafen dem Verlust des Wachbewusstseins. Der fließende Charakter dieser Veränderung erschwert deren Definition, sowohl subjektiv als auch gemäß den Klassifikationskriterien der einschlägigen Regelwerke.

ZusammenfassungBei Patienten mit Obstruktiver Schlafapnoe (OSA) ist infolge der Schlaffragmentierung die Schlafqualität gestört, der nicht erholsame Schlaf führt zu Tagesschläfrigkeit und die Wahrscheinlichkeit, dass die Betroffenen einen Unfall verursachen, ist erhöht. Dieser Beitrag befasst sich vorwiegend mit Unfällen im Straßenverkehr. Obwohl die Forschung zum Einfluss von Schläfrigkeit auf Leistungsfähigkeit und Fehlerrate ihren Ursprung eher in arbeitsmedizinischen Untersuchungen, z. B. zur Leistungsfähigkeit von Flugbeobachtern an Radarschirmen hat, liegen für den Bereich der Unfälle im Straßenverkehr mehr und bessere Untersuchungen zu dieser Problematik vor. Dieser Themenbereich hat aufgrund der Bedeutung des Individualverkehrs, der Häufigkeit von Unfällen, den damit verbundenen Kosten und der zwar in Deutschland kontinuierlich sinkenden, aber absolut immer noch hohen Anzahl von Verkehrstoten die größte sozioökonomische Bedeutung.

Sleep bruxism (SB) is highly prevalent among patients with obstructive sleep apnea (OSA), yet its etiology remains unclear. This prospective clinical trial aimed to evaluate the diagnostic relevance of occlusion, jaw function, and electromyographic (EMG) muscle tone in OSA patients with and without SB. A total of 105 OSA patients (74 males, 31 females; mean age: 56.1 ± 11.4 years) were assessed, including those with SB and without SB (NSB). Evaluations included occlusal parameters, the Jaw Functional Limitation Scale (JFLS-20), and polysomnography with EMG muscle tone analysis. Descriptive statistics, inter-group comparisons, Spearman’s correlation analyses, and Receiver Operating Characteristic (ROC) curve analyses were performed. No significant differences in occlusal parameters were observed between the SB and NSB groups. However, SB patients exhibited significantly higher JFLS-20 scores compared to NSB patients (P = 0.002; mean global score: 20.79 ± 31.96 vs. 6.52 ± 9.70). EMG muscle tone showed significant correlations with JFLS mobility (P = 0.015) and overall jaw function (P = 0.046). ROC curve analysis for EMG muscle tone revealed an Area Under the Curve (AUC) of 0.911 (P < 0.001). An optimal cutoff value of 9.79 µV for EMG muscle tone demonstrated a sensitivity of 78.6

Yawning is a stereotypical muscular activity observed in most vertebrates. The surrounding pharyngeal muscles undergo complete tension, leading to the dilation of the entire respiratory tract. Frequency of yawning is commonly associated with sleepiness and sleep deprivation with several different hypotheses on primary cause of yawning having been proposed in literature. A literature review was conducted to investigate the primary factors contributing to yawning. In December 2023, an initial set of relevant articles was identified in the electronic database MEDLINE (PubMed) using the Medical Subject Headings (MeSH) for the search term ‘yawning’. In a second step a targeted manual search was conducted for several relevant topics in this research field. Existing literature has demonstrated that “yawning” can be attributed to various factors. However, there is currently no consensus on the primary cause of yawning. While the reflex mechanism has been thoroughly investigated, there are no studies to date that could definitively establish the primary factors for yawning. Due to the heterogeneous and limited data, further studies are needed to examine the diverse hypotheses and the complex muscular mechanisms in both healthy subjects and patients with sleep disorders to address the gaps of knowledge.

Abstract Background The etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography. Methods 106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated. Results OSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea–hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk. Conclusion Increased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients. Trial registration The study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22—2022) and registered at the “German Clinical Trial Register, DRKS” (DRKS0002959).

ZusammenfassungTinnitus hat in Deutschland eine Lebenszeitprävalenz von 25%. Eine häufige Komorbidität bei einem chronischen Verlauf sind Schlafstörungen. Die Ziele dieser Studie waren es, Schlafstörungen zu detektieren und mögliche Zusammenhänge mit Tinnitusparametern aufzuzeigen.Es wurden 50 Patienten mit chronischem Tinnitus rekrutiert. Die Patienten hatten eine Audiometrie, eine nächtliche Polysomnografie und füllten standardisierte Fragebögen zum Tinnitus- und Schlafverhalten aus.Daten lagen bei 30 Männern und 9 Frauen (Alter 50,2±11 J, BMI 28,8±4,4kg/m²) vor. Der Median der Tinnitusdauer lag bei 36 (9; 120) Monaten, der Schweregrad bei 2,00 (1,00; 3,00). Der Mittelwert des Tinnitus-Fragebogens (TF) war 43,6±17,1, der Epworth-Sleepiness-Score (ESS) betrug 8,41±4,27, der Pittsburgh-Schlafqualitätsindex (PSQI) ergab 9,21±4,32 und die Screening-Skala zum chronischen Stress (SSCS) lag bei 58,13±9,58.Somnologische Diagnosen waren 18 Insomnien, 4 RLS und 11 OSA. Der Schweregrad des Tinnitus, der Gesamtscore im PSQI und das Körpergewicht waren bei Patienten mit somnologischer Komorbidität höher als bei Schlafgesunden. Je schlechter die Schlafqualität, desto höher der Tinnitusschweregrad (p=0,038) und desto störender wurde der Tinnitus (p=0,03) bewertet. Patienten mit subjektiv sehr störendem Tinnitus bewerteten den chronischem Stress-Score höher. Die Tinnitusdauer war mit dem OSA-Schweregrad korreliert (p=0,026)Mehr als 2 Drittel aller Tinnituspatienten zeigten eine schlafmedizinische Komorbidität. Ein somnologisches Screening erscheint daher bei einem erhöhten Tinnitusschweregrad sinnvoll. Ob eine CPAP-Therapie bei der Reduktion von Tinnitussymptomen hilfreich ist, konnte nicht abschließend geklärt werden, verdient aber weitere Aufmerksamkeit.

Introduction Nocturnal Continuous Positive Airway Pressure (CPAP) is considered the gold standard treatment for obstructive sleep apnoea (OSA). The CPAP therapy is a long-term treatment but does come with few possible side effects. The adherence to the therapy is frequently suboptimal. In this paper, adherence to therapy was assessed and typical problems were classified.Methods 1078 OSA patients received CPAP therapy after a diagnostic polygraphy (PG) or polysomnography (PSG). Adherence to therapy was followed up three months after treatment induction. The following therapy adherence groups were defined: 1. correctly calibrated CPAP and good adherence, 2. CPAP non-acceptance, after initial use, 3. CPAP intolerance use due to side effects, 4. discontinuation due to lack of motivation/low rates of symptoms. 5. mask intolerance, 6. CPAP failure due to a lack of perceived treatment effect, 7. Change to another non-invasive ventilation method, 8. No control carried out.Results Out of 1078 OSA patients a therapy control was performed in 830 patients (77%). Of these, 450 patients (54.2%) were placed in group 1, 216 patients (26 %) in group 2, 71 patients (8.5 %) in group 3, 35 patients (4.2 %) in group 4, 14 patients (1.7 %) in group 5, 3 patients (0.4 %) in group 6 and 41 patients (4.9%) in group 7. A mild obstructive index, low CPAP pressure and, as a trend, a low Epworth-Sleepiness score were predictors of CPAP failure. No significant predictors could be shown for adherence to therapy.Discussion An effective treatment use of 54% after 3 months is a suboptimal result. Predictors of CPAP failure were parameters that indicated that the patient was less symptomatic prior to therapy. Despite a large patient cohort, neither anthropometric nor PSG-data provided any significant CPAP adherence predictors. Rather, experiences in the first nights of use could be decisive. CPAP devices offer comfort settings that have to be personalised to patients' needs and wants. A large selection of different mask shapes requires experience and training in patient-centred mask fitting. A three-month follow-up appointment seems too long to discuss therapy problems with the patient in a timely manner. Telemedical options or short-term telephone appointments should be considered.

BACKGROUND AND PURPOSE:Infection with COVID-19 can lead to persistent sequelae, such as fatigue, daytime sleepiness or disturbed sleep, that can remain for more than 12 weeks and that are summarized as post-COVID syndrome. The causes remain unclear. The present study investigated the presence of sleep disorders in patients with post-COVID syndrome using polysomnography. METHODS:Thirty-four patients with post-COVID syndrome and new-onset fatigue and sleepiness after a SARS-CoV2 infection underwent polysomnography in accordance with American Association of Sleep Medicine (AASM) standards as part of their clinical workup. Analysis was performed visually based on AASM criteria (scoring manual version 2.6, 2020). RESULTS:Polysomnography revealed a sleep efficiency of <80% in 50% of patients and a mean respiratory disturbance index (RDI) of 9.9 ± 15.4/h. Excluding central apneas, 12 patients (35%) had an RDI of ≥5/h, pointing to obstructive sleep apnea syndrome (OSAS; AASM 2014). Patients with a high RDI were significantly older (p = 0.01) and showed a trend towards a higher body mass index (p = 0.08) than patients with a normal RDI but had no other risk factors for OSAS. Six patients agreed to long-term treatment of their OSAS and all reported discontinuation of daytime symptoms. CONCLUSIONS:Post-COVID symptoms such as daytime sleepiness, fatigue and memory and concentration problems may in part be a result of reduced sleep efficiency and sleep apnea in a relevant percentage of patients. This possibly treatable cause of the symptoms should be kept in mind in patients presenting with post-COVID syndrome.

Einleitung Die schlafmedizinische Diagnostik ist geprägt von Kapazitätsproblemen und längeren Wartezeiten. Daher wurde in dieser Studie untersucht, ob ein rein telemedizinischer Ansatz unter Verwendung von Videosprechstunden und einem Einmal-Diagnostikgerät bei der Abklärung einer schlafbezogenen Atmungsstörung eine Alternative darstellt. Methode Zwischen Januar 2021 und März 2022 wurden von 598 Patienten mit einen Termin für eine ambulante Polygraphie, 172 ausgewählt, um alternativ eine rein telemedizinische Diagnostik bestehend aus Videosprechstunden und einer ambulanten, Tonometrie-basierten Diagnostik mit einem Einmal-Produkt (WatchPAT One), anzubieten. Erfasst wurde die Bereitschaft zur telemedizinischen Diagnostik, die praktische Durchführbarkeit und die Zufriedenheit mit dem Versorgungsweg.

Abstract Introduction Clinical symptoms of Diffuse Parenchymal Lung Disease (DPLD) are dyspnoea and dry cough. On auscultation, crackles can be detected at an early stage. The aim of this study was to analyse whether the extent of abnormal breath sounds (crackles, wheezes and coughs) provides an indication of the disease severity and aetiology. Methodology In 25 patients with DPLD, an in- hospital overnight recording of physiological and abnormal breath sounds was performed with the LEOSound® monitor. The severity of pulmonary fibrosis was assessed by body plethysmography and GAP score. The perceived breathlessness was assessed by King's Brief Interstitial Lung Disease (K-Bild) questionnaire. Results In 16 out of 25 patients, all data were completed in good quality for analysis. Five patients were women (31.3%). The patients’ mean age was 65.8 ± 7.3 years, the mean BMI 28.0 ± 2.4 kg/m2. One patient met GAP I criteria, eight patients GAP II and seven patients met GAP III criteria. The findings of eight patients with idiopathic pulmonary fibrosis (IPF) were compared with those of eight patients with secondary interstitial lung disease (ILD). Both, the number of inspiratory crackles and coughs showed significant correlations with the severity of dyspnoea and ILD-pattern. Wheezing occurred in 15 patients, with a median of 25.7 wheezes/h. Discussion Overnight long-term auscultation in patients with pulmonary fibrosis proved feasible in our study. Regardless of the aetiology and disease severity, crackles were detected in the recordings of all fibrosis patients, but not cough. Wheezing occurred in 15 out of 16 patients, the significance of which for clinical practice must still remain unclear.

Background Postmenopausal women often have chronic cough. Hormonal changes might be affecting lung function and the mucous membrane of the airways, causing hypersensitivity of the cough reflex. Therefore, postmenopausal hormonal changes could play a key role in the association between increased cough and menopause. The aim of this study is to evaluate the relation of chronic cough and postmenopausal symptoms. Methods We performed a questionnaire-based cohort study in generally healthy postmenopausal women (age 45–65 years). Women with cough explained by a pre-existing diagnosis were excluded. Comorbidities, medication and baseline data were collected. The Menopause Rating Scale II (MRS II) was combined with the Leicester Cough Questionnaire. Groups were divided in chronic cough versus non-coughing participants, chronic cough was defined as symptoms over 8 weeks. We performed correlations and logistic regression for predicting cough based on postmenopausal symptoms. Results Sixty-six of 200 women (33%) reported symptoms of chronic cough over 8 weeks. No significant differences in baseline data (age, BMI, onset of menopause, years since menopause, concomitant diseases, and medication) were found between coughing and non-coughing women. The MRS II showed higher menopausal symptoms in patients with cough, with significant differences in 2 of the 3 MRS-domains (urogenital ( p < 0.001) and somato-vegetative ( p < 0.001)). Climacteric symptoms correlated strongly with parameters of cough ( p < 0.001). On the basis of the MRS total score ( p < 0.001) and the somato-vegetative and urogenital domains ( p < 0.05), the prediction for respiratory complaints could be shown. Discussion Chronic cough was significantly associated with menopausal symptoms. Therefore chronic cough as a possible climacteric symptom and its underlying mechanisms should be further explored.

Introduction Diagnostics in sleep medicine is characterized by long waiting times and capacity issues. This study investigates whether a purely telemedical approach using video consultations and a singe-use diagnostic device is feasible in the workup of sleep-related breathing disorders.

Zusammenfassung Einleitung Die nächtliche kontinuierliche positive Überdruckatmung (CPAP) gilt als therapeutischer Goldstandard einer obstruktiven Schlafapnoe (OSA). Die CPAP-Therapie stellt zumeist eine Dauertherapie mit geringen Nebenwirkungen dar. Trotzdem ist die Therapietreue unbefriedigend. In dieser Arbeit wurden die Therapietreue betrachtet und typische Probleme katalogisiert. Methode 1078 OSA-Patienten wurden nach diagnostischer Polygrafie (PG) oder Polysomnografie (PSG) auf eine CPAP-Therapie eingestellt. Die Therapietreue wurde nach 3 Monaten nachverfolgt. Folgende Therapieadhärenz-Gruppen wurden festgelegt: 1. gute CPAP-Einstellung und Nutzung, 2. CPAP-Abbruch nach anfänglicher Nutzung, 3. mangelnde CPAP-Nutzung wegen Nebenwirkungen, 4. Abbruch aufgrund fehlender Motivation/geringem Leidensdruck, 5. Masken-Unverträglichkeit, 6. CPAP-Versagen aufgrund fehlenden Therapieeffekts, 7. Umstellung auf anderes Beatmungsverfahren, 8. keine Kontrolle erfolgt. Ergebnisse Von 1078 CPAP-Patienten erschienen 830 Patienten (77 %) zur Therapiekontrolle. Hiervon waren 450 Patienten (54,2%) in Gruppe 1, 216 Patienten (26%) in Gruppe 2, 71 Patienten (8,5%) in Gruppe 3, 35 Patienten (4,2%) in Gruppe 4, 14 Patienten (1,7%) in Gruppe 5, 3 Patienten (0,4 %) in Gruppe 6 und 41 Patienten (4,9%) in Gruppe 7. Ein geringer obstruktiver Ereignisindex, niedriger CPAP-Druck und tendenziell auch ein geringer Epworth-Sleepiness-Score waren Prädiktoren für CPAP-Versagen. Für die Therapietreue konnten keine signifikanten Prädiktoren dargestellt werden. Diskussion Eine effektive Therapienutzung von 54% nach 3 Monaten ist ein suboptimales Ergebnis. Prädiktoren für CPAP-Versagen waren Parameter, die vor Therapie auf geringen Leidensdruck der Patienten deuteten. Trotz großer Patientenkohorte konnten keine signifikanten CPAP-Adhärenz-Prädiktoren durch anthropometrische oder PSG-Daten dargestellt werden. Vielmehr könnten Erfahrungen in den ersten Therapietagen ausschlaggebend sein. CPAP-Geräte bieten Komforteinstellungen, die kenntnisgerecht auf den Patienten individualisiert werden müssen. Eine große Auswahl an unterschiedlichen Maskenformen erfordert Erfahrung und Training bei der patientenorientierten Maskenanpassung. Eine 3-monatige Wiedervorstellung erscheint zu lang, um Therapieprobleme zeitnah mit dem Patienten zu besprechen. Telemedizinische Möglichkeiten oder kurzfristige telefonische Beratungsoptionen sollten in Betracht gezogen werden.

Background: Augmentation therapy (AT) is the only specific treatment licensed for patients with alpha-1 antitrypsin deficiency (AATD) associated lung disease. Since patients with severe AATD may have a very different prognosis and AT requires intravenous infusions for life, the decision to initiate AT may be challenging. Methods: This survey was conducted on 63 experts in AATD from 13 European countries about their opinions and attitudes regarding AT. Participants were asked to rank the importance of 11 identified factors related with the prescription of AT. In addition, each participant was asked to respond to the indication of AT for 30 out of 500 hypothetical cases developed with the combinations of the 11 factors. Each case was evaluated by 3 experts to check the concordance. Results: The variables that scored higher on preferences for initiating AT were AAT genotype (score 8.6 from a Likert scale 0-10 (SD: 1.7)), AATD serum level (8.2 (SD:2.4)) and FEV1 (%) decline (7.9 (SD:2.4)). Among the 500 different cases, there was an agreement in indication of AT among the 3 experts in 291 (58.2%). Regarding the variables associated with AT, it was indicated to 81.9% of Pi*ZZ, 52.4% of Pi*SZ and 9.8% of Pi*MZ (p < 0.0001). For Pi*ZZ patients, multivariate analysis identified younger age, reduced FEV1 (%), higher FEV1 decline and worse emphysema as significantly associated with prescription (AUC = 0.8114); for Pi*SZ variables were younger age, worse FEV1 (%) and worse emphysema (AUC = 0.7414); and for Pi*MZ younger age, worse DLCO (%), higher DLCO decline and dyspnea (AUC = 0.8387). Conclusion: There is a high variability in the criteria for prescription of AT among European experts. Most cases were recommended AT according to guidelines, but a significant number of patients with genotype Pi*SZ and almost 10% Pi*MZ were recommended to initiate AT despite the lack of evidence of efficacy in these genotypes.

Pregnant women experience profound changes in sleep. The prevalence of sleep disorders such as insomnia, sleep apnoea and restless legs syndrome, which are potentially harmful for the unborn child, rises sharply in pregnancy. Melatonin is a strong marker of our circadian rhythm and promotes sleep. It also exhibits an extremely strong antioxidant potential, which makes it extremely important for the development of new life. Even the intensity and timing of labour and parturition correspond to melatonin levels. Nursing and infant age impact maternal sleep differently and more profoundly than they do paternal sleep. The menopausal transition is preceded by lowered nocturnal melatonin levels and frequently leads to dramatically worsened sleep. Aging females are more affected by the sleep-impairing side effects of modern life like low illumination levels during daytime and increased artificial light in the nocturnal resting period. Integrating sleep medicine into patient care can prevent serious pregnancy complications and lessen sleep disruptions during the nursing period. Sleep, health and quality of life of aging female patients can be improved through the integration of psychological, chronobiological and sleep medical factors into gynecological patient care.

Zusammenfassung Einleitung Die nächtliche kontinuierliche positive Überdruckatmung (CPAP) gilt als therapeutischer Goldstandard einer obstruktiven Schlafapnoe (OSA). Die CPAP-Therapie stellt zumeist eine Dauertherapie mit geringen Nebenwirkungen dar. Trotzdem ist die Therapietreue unbefriedigend. In dieser Arbeit wurden die Therapietreue betrachtet und typische Probleme katalogisiert. Methode 1078 OSA-Patienten wurden nach diagnostischer Polygrafie (PG) oder Polysomnografie (PSG) auf eine CPAP-Therapie eingestellt. Die Therapietreue wurde nach 3 Monaten nachverfolgt. Folgende Therapieadhärenz-Gruppen wurden festgelegt: 1. gute CPAP-Einstellung und Nutzung, 2. CPAP-Abbruch nach anfänglicher Nutzung, 3. mangelnde CPAP-Nutzung wegen Nebenwirkungen, 4. Abbruch aufgrund fehlender Motivation/geringem Leidensdruck, 5. Masken-Unverträglichkeit, 6. CPAP-Versagen aufgrund fehlenden Therapieeffekts, 7. Umstellung auf anderes Beatmungsverfahren, 8. keine Kontrolle erfolgt. Ergebnisse Von 1078 CPAP-Patienten erschienen 830 Patienten (77 %) zur Therapiekontrolle. Hiervon waren 450 Patienten (54,2%) in Gruppe 1, 216 Patienten (26%) in Gruppe 2, 71 Patienten (8,5%) in Gruppe 3, 35 Patienten (4,2%) in Gruppe 4, 14 Patienten (1,7%) in Gruppe 5, 3 Patienten (0,4 %) in Gruppe 6 und 41 Patienten (4,9%) in Gruppe 7. Ein geringer obstruktiver Ereignisindex, niedriger CPAP-Druck und tendenziell auch ein geringer Epworth-Sleepiness-Score waren Prädiktoren für CPAP-Versagen. Für die Therapietreue konnten keine signifikanten Prädiktoren dargestellt werden. Diskussion Eine effektive Therapienutzung von 54% nach 3 Monaten ist ein suboptimales Ergebnis. Prädiktoren für CPAP-Versagen waren Parameter, die vor Therapie auf geringen Leidensdruck der Patienten deuteten. Trotz großer Patientenkohorte konnten keine signifikanten CPAP-Adhärenz-Prädiktoren durch anthropometrische oder PSG-Daten dargestellt werden. Vielmehr könnten Erfahrungen in den ersten Therapietagen ausschlaggebend sein. CPAP-Geräte bieten Komforteinstellungen, die kenntnisgerecht auf den Patienten individualisiert werden müssen. Eine große Auswahl an unterschiedlichen Maskenformen erfordert Erfahrung und Training bei der patientenorientierten Maskenanpassung. Eine 3-monatige Wiedervorstellung erscheint zu lang, um Therapieprobleme zeitnah mit dem Patienten zu besprechen. Telemedizinische Möglichkeiten oder kurzfristige telefonische Beratungsoptionen sollten in Betracht gezogen werden.

Excessive daytime sleepiness is a common symptom in obese patients with obstructive sleep apnea. We investigated predisposing factors of excessive daytime sleepiness by comparing obese non-sleepy with sleepy patients with obstructive sleep apnea. Excessive daytime sleepiness was determined by the Epworth Sleepiness Scale in 43 patients (34 men and 9 women) with obstructive sleep apnea (apnea-hypopnea index >= 15 events per hr) and obesity (body mass index >= 30 kg m(-2)). Two subgroups were formed with (Epworth Sleepiness Scale >= 11) and without (Epworth Sleepiness Scale < 11) excessive daytime sleepiness. The concept of excessive daytime sleepiness was compared with other established daytime performance tests (Stanford Sleepiness Scale, Multiple Sleep Latency Test, Pupillographic Sleepiness Test, Marburger Vigilance test). Associations were calculated between excessive daytime sleepiness and demographic, metabolic and polysomnographic data. We included 19 sleepy patients (mean Epworth Sleepiness Scale score 15.2) and 24 non-sleepy patients (mean Epworth Sleepiness Scale score 5.8). Epworth Sleepiness Scale was negatively correlated with age and morning cortisol. Epworth Sleepiness Scale was positively correlated with body mass index, Stanford Sleepiness Scale, Beck's Depression Inventory and Marburger Vigilance test. Sleepy obese patients were significantly younger (mean 49.1 years), showed lower morning cortisol level (mean 9.41 mu g L-1) and a trend to higher body mass index (mean 37.5 kg m(-)(2)) compared with non-sleepy obese patients (mean: 59.3 years, 5.7 mu g L-1, 34.6 kg m(-)(2), respectively). Many different excessive daytime sleepiness phenotypes are probably enclosed in obese patients with obstructive sleep apnea. Epworth Sleepiness Scale scores were best reflected by the objective Marburger Vigilance test results. The objective test can be particularly useful in cohorts where subjective reports are unreliable and operational readiness is paramount. Sleepy and non-sleepy obese patients with obstructive sleep apnea were similar in all polysomnographic parameters. Sleepy patients were younger, heavier and showed lower morning cortisol levels than non-sleepy patients.

Seit mehr als 60 Jahren wird die Aktigraphie eingesetzt, um den Schlaf-Wach-Rhythmus objektiv zu erfassen. Zunehmend werden verbesserte moderne Geräte angewendet, um schlafmedizinische Erkrankungen im klinischen Rahmen zu diagnostizieren. Aktigraphen sind zwar weniger genau als die Polysomnographie, aber ihr größter Vorteil liegt in der kostengünstigen Sammlung objektiver Daten über längere Zeiträume unter Alltagsbedingungen. Da die Kosten der Handgelenksaktigraphie derzeit nicht erstattet werden, hat dieses Verfahren bisher keine breite Akzeptanz erlangt. In der vorliegenden Arbeit wird ein Überblick über die wesentlichen klinischen Anwendungen der Aktigraphie sowie über die Empfehlungen der Fachgesellschaften gegeben.

Otorhinolaryngologists play a vital role in the management of patients with obstructive sleep apnea (OSA) in Germany, particularly with regards to outpatient diagnostics as well as conservative and surgical treatment of patients with intolerance to ventilation therapy. Although establishment of differential indications for surgical therapy and performance of additional preoperative drug-induced sleep endoscopy in patients with sleep-disordered breathing are among the core competencies of otorhinolaryngologists, differential diagnostic considerations and detection of comorbid sleep disorders can be challenging, particularly for those without extensive sleep medicine training and experience. However, detection of comorbid sleep disorders is of particular importance when permanent surgical treatment is considered. Daytime sleepiness is the typical leading symptom of OSA; nevertheless, other disorders of hypersomnolence need to be considered in these patients and can easily be overlooked. This may lead to inadequate indications for surgical treatment. Based on two case reports, narcolepsy is presented as a comorbid disorder and differential diagnosis in patients with OSA.

Actigraphy has been used for more than 60 years to objectively measure sleep–wake rhythms. Improved modern devices are increasingly employed to diagnose sleep medicine disorders in the clinical setting. Although less accurate than polysomnography, the chief advantage of actigraphs lies in the cost-effective collection of objective data over prolonged periods of time under everyday conditions. Since the cost of wrist actigraphy is not currently reimbursed, this method has not enjoyed wide acceptance to date. The present article provides an overview of the main clinical applications of actigraphy, including the recommendations of specialist societies.