Abstracts / Sleep Medicine 14S (2013) e93e164

leptic patients, both sexes and various ages, diagnosed according to

standard criteria, made up the patient group. The control group was
made up of 22 healthy volunteer without sleep disorders, both sexes
and various ages. The same samples were analyzed using Head
Space-Solid Phase MicroExtraction and Gas Cromatography-Mass
Spectrometry (HS-SPMEGCMS) and with proper statistical techniques to distinguish the aroma prole between the two groups.
Results: 11 narcoleptic were detected positive by the dogs while
only three controls. HS-SPMEGCMS results showed that the disease
can be discarded with a classication rate of 75%. HS-SPMEGCMS
technique can be proposed as screening method in a rst diagnosis
approach.
Conclusion: It seems that narcoleptic patients have a distinct typical odour that trained dogs and analytical techniques can detect.
The development of olfactory test for the diagnosis of narcolepsy
opens a new research area.
Acknowledgements: This was not an industry supported study. The
authors would like to thanks the Civil Guard for his contribution
regarding the dogs training and completion of the detection test
for all the samples submitted. They have made this study possible.

http://dx.doi.org/10.1016/j.sleep.2013.11.237

Risk factors associated with sleep disturbance following

traumatic brain injury
Y. Dong 1, P. Sheng 1, W. Tong 2, Z. Li 3, D. Xu 3, L. Hou 1
1
Department of Neurosurgery, Changzheng Hospital, Second Military
Medical University, China
2
Department of Neurosurgery, Pudong New Area Peoples Hospital, China
3
Department of Neurosurgery, Fengxian Central Hospital, China

Introduction: Sleep disturbance is very common following traumatic brain injury (TBI), which may initiate or exacerbate a variety
of co-morbidities and negatively impact rehabilitative treatments.
To date, there are paradoxical reports regarding the associations
between inherent characteristics of TBI and sleep disturbance in
TBI population. The current study was designed to explore the relationship between the presence of sleep disturbance and characteristics of TBI and identify the factors which are closely related to the
presence of sleep disturbance in TBI population.
Materials and methods: 98 TBI patients (72 males, mean age SD, 47
13 years, range 1870) were recruited. Severity of TBI was evaluated
based on Glasgow Coma Scale (GCS). All participants were performed cranial computed tomography and examined on selfreported sleep quality, anxiety, and depression.
Results: 37 of 98 patients (38%) reported sleep disturbance following TBI. Insomnia was diagnosed in 28 patients (29%) and post-traumatic hypersomnia in 9 patients (9%). In TBI with insomnia group, 5
patients (18%) complained difculty falling asleep only, 8 patients
(29%) had difculty maintaining sleep without difculty in initial
sleep and 15 patients (53%) presented both difculty falling asleep
and difculty maintaining sleep. Risk factors associated with insomnia were headache and/or dizziness and more symptoms of anxiety
and depression rather than GCS. In contrast, GCS was independently
associated with the presence of hypersomnia following TBI. Furthermore, there was no evidence of an association between locations of
brain injury and the presence of sleep disturbance after TBI.
Conclusion: Our data demonstrate that TBI patients with insomnia
are prone to suffer from concomitant headache and/or dizziness and
report more symptoms of anxiety and depression. Severe TBI
patients are likely to experience hypersomnia.
Acknowledgements: We would like to express our appreciation to
all the patients who have participated in this study and Drs. Zhong-

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xin Zhao, Liuqing Huang and You Yin for their valuable comments on
this manuscript.
http://dx.doi.org/10.1016/j.sleep.2013.11.238

Energy expenditure in narcolepsy patients and controls

C. Donjacour 1, P. Schoffelen 2, S. Overeem 3, G. Lammers 1, H. Pijl 4,
K. Westerterp 2
1
Leiden University Medical Centre, Department of Neurology, The
Netherlands
2
Maastricht University Medical Centre, Human Biology, The
Netherlands
3
Radboud University Medical Centre, Neurology, The Netherlands
4
Leiden University Medical Centre, Department of Endocrinology, The
Netherlands

Introduction: Hypocretin deciency causes narcolepsy, a condition

characterized by excessive daytime sleepiness, cataplexy, and fragmented nocturnal sleep. Co-morbid overweight is present in two
thirds of narcolepsy patients. Moreover one third of them is obese.
Why narcolepsy patients gain weight is not known. They do not
seem to eat and/or sleep more during 24 h than controls. This study
was performed to detect a possible decrease in energy expenditure
that could be the cause for the overweight in narcolepsy. This is
the rst study using a respiration chamber to measure Energy
Expenditure in narcolepsy.
Materials and methods: Nine hypocretin decient male patients
with narcolepsy-cataplexy, and nine sex, age and body mass index
(BMI) matched controls were enrolled. Energy Expenditure was
measured for 24 h in a respiration chamber. Spontaneous physical
activity was measured by a radar system based on Doppler principle.
Subjects were given a diet to maintain energy balance based on the
HarrisBenedict equation. Total Energy Expenditure (TEE), Overnight
Metabolic Rate (OMR) and lowest Sleeping Metabolic Rate (SMRmin)
were calculated. In addition, measured SMR was compared with
SMR calculated with a prediction equation based on body
composition.
Results: Narcolepsy patients did not differ from controls in BMI
(27.4 3.9 vs. 27.5 4.2; P = 9.4) or age (38.1 16.0 vs. 36.8 15.2;
P = .86) respectively. There were no differences in TEE (10.6 1.2
vs. 10.6 .80 MJ/d; P = .99) OMR (5.7 .73 vs. 6.0 .55 MJ/d;
P = .35), SMRmin (5.4 .76 vs. 5.4 .51 MJ/d; P = .99) and spontaneous activity between narcolepsy patients and matched controls
(2862 514 vs. 2732 245 counts/d; P = .50). For both groups, measured SMR was closely related to SMR predicted from body
composition.
Conclusion: Energy expenditure in narcolepsy patients is similar to
matched controls. It is conceivable that we were not close enough to
onset of the disease, when patients usually gain weight, to detect a
possible difference before a new metabolic set point establishes.
Acknowledgement: This study was supported by a grant from UCB
Pharma.
http://dx.doi.org/10.1016/j.sleep.2013.11.239

Prevalence of central sleep apnea among heart failure patients

with preserved ejection fraction
K. Terziyski 1, A. Draganova 1, O. Aliman 2, I. Ilchev 3, A. Hristova 1,
S. Kostianev 1
1
Medical University Plovdiv, Pathophysiology Dept, Bulgaria
2
MHAT St. Caridad, Cardiology Dept, Bulgaria
3
MHAT St Ivan Rilski, Cardiology Dept, Bulgaria

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Abstracts / Sleep Medicine 14S (2013) e93e164

Introduction: Central sleep apnea (CSA) is common among

patients with chronic heart failure (CHF) and has been associated
with increased morbidity and mortality. However, scarce data about
CSA prevalence in heart failure patients with preserved ejection fraction (EF) are available. The aim of the study was to determine the
prevalence of CSA among ambulatory heart failure patients with preserved ejection fraction (HFPEF).
Materials and methods: Thirty-three ambulatory patients with
HFPEF were recruited and subjected to full-night polysomnography.
The presence of sleep-disordered breathing (SDB) was based on
apnea-hypopnea index (AHI) 515 mild, 1530 moderate,
>30 severe. Preserved ejection fraction was dened as EF > 45%.
All patients received drug treatment in concordance with the latest
guidelines.
Results: The mean age was 65.8 8.5 years and the mean left ventricular ejection fraction was 55.4 6.4%. Among the 33 patients, 27
(81.8%) had SDB 11 (33.3%) CSA, 4 (12.1%) obstructive sleep apnea
and 12 (36.4%) mixed sleep apnea. Moderate or severe SDB was present in 24 of them (72.3%). No statistically signicant differences
between CHF patients with CSA and CHF patients without SDB were
found regarding main anthropometric parameters (body-mass index
(BMI) = 28.5 6.9 vs 25.6 8.7, NS, age = 70.2 9.9 vs 63.3 8.1, NS)
and excessive daytime sleepiness (Epworth score = 8.7 6.1 vs
7.2 2.6).
Conclusion: CSA demonstrates very high prevalence in patients
with HFPEF. Those patients should also be considered for screening
for SDB and consequent therapy.
Acknowledgement: The study was nanced by the Bulgarian Ministry of Youth and Science.
http://dx.doi.org/10.1016/j.sleep.2013.11.240

A study on association between obstructive sleep apnea syndrome (OSAS) and epworth sleepiness score (ESS), physical and
mental components related with quality of life (QOL)
A. Dubey 1, S. Dixit 2, S. Kant 1, S. Tiwari 1
1
KGMU, India
2
Department of Nutrition, IT College, India

Introduction: Obstructive sleep apnea syndrome (OSAS) put

adverse impacts on the quality of life (QOL). Excessive sleepiness
and other associated symptoms may negatively affect ability to
learn, employment, and interpersonal relations, and directly degrade
QOL. The objective of the present study was to evaluate the impact of
OSAS on Epworth Sleepiness Score (ESS), Physical and Mental components related with QOL.
Materials and methods: Design: Observational, Hospital based
study Setting: Study was carried out in 190 index subjects in polysomnography unit of Department of Pulmonary Medicine, KGMU,
India. Method: Overnight sleep study was carried out in all subjects
on polysomnography unit. Hindi version of HRQOL tool SF-36 was
used to evaluate Physical Functioning (PF), Role Physical (RP), Bodily
Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF),
Role Emotional (RE), Mental Health (MH), Physical Component Summary (PCS) and Mental Component Summary (MCS) in these
subjects.
Results: PCS was found to be associated with BMI, Neck Circumference, Blood Pressure, Hypopnea, and number of total Desaturation
fall events below 5% while MCS was found to be associated with
BMI and Hypopnea events in these subjects. In males, severity of disease was found associated with BP, RP and MCS (p = 0.05, 0.03 and
0.01 respectively) whereas in females, severity of disease was signif-

icant association with parameters such as BP (p = 0.02), GH

(p = 0.01), VT (p = 0.01), SF (p = 0.02), PF (p = 0.04), RP (p = 0.001)
and PCS (p = 0.000).
Conclusion: Physical Component Summary (PCS) and Mental Component Summary (MCS) are related with sleep related events in
these subjects thus improvement in these parameters through various treatment modalities can be used to improve QOL in this
population.
Acknowledgements: I would like to thank my guide and my coguides who help me to walk in a right direction. I would also like
to thank all the subjects who respond me so patiently. I would also
like to thank to God for being with me throughout my work.
http://dx.doi.org/10.1016/j.sleep.2013.11.241

Association between the consolidation of the rest-activity cycle

and brain recovery in the acute phase of traumatic brain injury
C. Duclos 1, M. Dumont 1, L. De Beaumont 1, C. Wiseman-Hakes 1,
F. Bernard 2, N. Gosselin 1
1
Center for Advanced Research in Sleep Medicine, Hpital du
Sacr-Coeur de Montral, Department of Psychiatry, Universit de
Montral, Canada
2
Traumatology program, Hpital du Sacr-Coeur de Montral,
Department of Medicine, Universit de Montral, Canada

Introduction: Based on clinical observations, sleepwake cycle disturbances, arise in the days following traumatic brain injury (TBI),
and remain among the most persistent and debilitating symptoms.
The aim of this study was to document the evolution of rest-activity
cycle consolidation in the acute phase of moderate/severe TBI, and
its association with injury severity and outcome, using actigraphy.
Materials and methods: Sixteen hospitalised patients (13 men;
27.1 11.3 years) with moderate/severe TBI wore actigraphs for
10 days. Recordings began in the intensive care unit (ICU) when continuous sedation was discontinued and patients had reached medical
stability. The ratio of daytime (7:0021:59) activity to total 24-h
activity was used to quantify the level of consolidation of a day-night
rest-activity cycle, and a ratio P80% was considered to reect adequate consolidation. The Galveston Orientation and Amnesia Test
and the Disability Rating Scale were used to assess posttraumatic
amnesia (PTA) and functionality at discharge. An analysis of variance
was used to characterize the evolution of the daytime activity ratio
over the recording period. Pearsons correlations were carried out
to measure associations between actigraphy and injury severity
and outcome. T-tests for independent samples were used to compare
the rest-activity cycle of patients with and without PTA at discharge.
Results: Most patients showed a very low daytime activity ratio
during the rst 48-h of recording (mean SD = 70.8 10.1%), with
only 4 patients having a ratio P80%. Although this consolidation
threshold was reached in only 46.6% of all recording days, there
was a signicant linear trend of improvement over the 10 days of
recording (p < 0.05). Greater TBI severity, and longer duration of
ICU and hospital stay were associated with poorer rest-activity cycle
consolidation and evolution (p-values < 0.05). A greater improvement of rest-activity cycle consolidation was associated with better
physical and cognitive state at hospital discharge (p < 0.05).
Conclusion: TBI patients have severe rest-activity cycle disturbances during their hospital stay, but these disturbances globally
improve over time. The absence of rest-activity cycle consolidation
reects severe fragmentation of sleepwake patterns. A faster return
to rest-activity cycle consolidation may predict enhanced brain
recovery.