Search

Summary Obstructive sleep apnea (OSA) has been associated with incident type 2 diabetes mellitus (T2DM); however, few prospective epidemiological studies have accounted for important T2DM predictors including pre‐diabetes status and testosterone. Participants in the longitudinal Men Androgens Inflammation Lifestyles Environment and Stress (MAILES) study, who underwent eight‐channel home‐based polysomnography (PSG) in 2010–2011 (n = 824) and were free of diabetes at baseline were included in the analysis (n = 682). From 2015 to 2021, 78.6% (n = 536) completed at least one follow‐up assessment. Incident T2DM was determined by self‐reported doctor diagnosis, diabetes medications, plasma glucose (fasting ≥7.0 mmol/L or random ≥11.0 mmol/L) or glycated haemoglobin ≥6.5%. Conservative hierarchical Poisson regression models adjusted associations of PSG metrics (categorical and continuous) for age, waist circumference, baseline fasting glucose and testosterone concentrations. In all, 52 men (9.7%) developed T2DM over a mean (range) of 8.3 (3.5–10.5) years. Significant age‐ and waist circumference‐adjusted association of incident T2DM with rapid eye movement (REM) sleep apnea–hypopnea index (AHI) ≥20 events/h (incidence rate ratio [IRR] 1.5, 95% confidence interval [CI] 0.8–2.8; p = 0.23] and highest quartile of delta index (IRR 2.1, 95% CI 0.95–4.6; p = 0.066) were attenuated after adjustment for baseline glucose and testosterone, and the association with the lowest quartile of mean oxygen saturation persisted (IRR 4.2, 95% CI 1.7–10.3; p = 0.029). Categorical measures of AHI severity, oxygen desaturation index, and hypoxia burden index (HBI) were not independently associated with incident T2DM. Associations with T2DM were similar when continuous PSG variables were used; however, HBI was significant (IRR 1.015, 95% CI 1.006–1.024; p = 0.007). In a sub‐sample with OSA treatment data (n = 479), these significant associations persisted after excluding adequately treated OSA (n = 32). Understanding underlying OSA endotypes generating hypoxaemia may identify opportunities for diabetes prevention. [ABSTRACT FROM AUTHOR]

Summary: We assessed: (1) the independent and joint association of obstructive sleep apnea risk and healthy lifestyle with common consequences (excessive daytime sleepiness, depression, cardiovascular disease and stroke) of obstructive sleep apnea; and (2) the effect of healthy lifestyle on survival in people with increased obstructive sleep apnea risk. Data from 13,694 adults (median age 46 years; 50% men) were used for cross‐sectional and survival analyses (mortality over 15 years). A healthy lifestyle score with values from 0 (most unhealthy) to 5 (most healthy) was determined based on diet, alcohol intake, physical activity, smoking and body mass index. In the cross‐sectional analysis, obstructive sleep apnea risk was positively associated with all chronic conditions and excessive daytime sleepiness in a dose–response manner (p for trend < 0.001). The healthy lifestyle was inversely associated with all chronic conditions (p for trend < 0.001) but not with excessive daytime sleepiness (p for trend = 0.379). Higher healthy lifestyle score was also associated with reduced odds of depression and cardiovascular disease. We found an inverse relationship between healthy lifestyle score with depression (p for trend < 0.001), cardiovascular disease (p for trend = 0.003) and stroke (p for trend = 0.025) among those who had high obstructive sleep apnea risk. In the survival analysis, we found an inverse association between healthy lifestyle and all‐cause mortality for all categories of obstructive sleep apnea risk (moderate/high‐ and high‐risk groups [p for trend < 0.001]). This study emphasises the crucial role of a healthy lifestyle in mitigating the effects of obstructive sleep apnea risk in individuals with an elevated obstructive sleep apnea risk. [ABSTRACT FROM AUTHOR]

Summary: Obstructive sleep apnea (OSA) has been linked to cancer in several clinical and community‐based cohorts. The effect in community‐based studies free of clinical referral bias needs to be replicated. In this observational prospective cohort study, we pooled data from three community‐based prospective cohorts (Uppsala Sleep and Health in Men cohort [UMEN]; Sleep and health in women [SHE]; Men Androgen Inflammation Lifestyle Environment and Stress Cohort [MAILES]; nTotal = 1467). All cohorts had objective data on obstructive sleep apnea and registry linkage data on cancer and cancer mortality. Analyses for different obstructive sleep apnea measures (apnea–hypopnea index [AHI], oxygen desaturation index [ODI], and minimal saturation) as risk factors for cancer incidence (all cancers) were performed using Cox proportional hazards models (follow‐up 5–16 years). We did not find an overall increased risk of cancer after adjustment for age, sex, and BMI (HRAHI [95% CI] = 1.00 [0.98; 1.01] and HRODI [95% CI] = 0.99 [0.97; 1.01]). Stratifying by daytime sleepiness did not influence the association. Cancer mortality was not significantly associated with obstructive sleep apnea. Taken together, we did not observe an overall increased risk of cancer or cancer mortality in relation to obstructive sleep apnea, however, our confidence limits remain wide for important diagnostic categories of sleep apnea severity. The relationship between obstructive sleep apnea and cancer needs further investigation in a comprehensive multi‐cohort approach with greater statistical precision. For future studies we may need to find and then combine every community‐based cohort study that can provide a definitive answer to the question on the risk of cancer from obstructive sleep apnea in the general population. [ABSTRACT FROM AUTHOR]

Summary: Previous prospective studies examining associations of obstructive sleep apnea and sleep macroarchitecture with future cognitive function recruited older participants, many demonstrating baseline cognitive impairment. This study examined obstructive sleep apnea and sleep macroarchitecture predictors of visual attention, processing speed, and executive function after 8 years among younger community‐dwelling men. Florey Adelaide Male Ageing Study participants (n = 477) underwent home‐based polysomnography, with 157 completing Trail‐Making Tests A and B and the Mini‐Mental State Examination. Associations of obstructive sleep apnea (apnea–hypopnea index, oxygen desaturation index, and hypoxic burden index) and sleep macroarchitecture (sleep stage percentages and total sleep time) parameters with future cognitive function were examined using regression models adjusted for baseline demographic, biomedical, and behavioural factors, and cognitive task performance. The mean (standard deviation) age of the men at baseline was 58.9 (8.9) years, with severe obstructive sleep apnea (apnea–hypopnea index ≥30 events/h) in 9.6%. The median (interquartile range) follow‐up was 8.3 (7.9–8.6) years. A minority of men (14.6%) were cognitively impaired at baseline (Mini‐Mental State Examination score <28/30). A higher percentage of light sleep was associated with better Trail‐Making Test A performance (B = −0.04, 95% confidence interval [CI] −0.06, −0.01; p = 0.003), whereas higher mean oxygen saturation was associated with worse performance (B = 0.11, 95% CI 0.02, 0.19; p = 0.012). While obstructive sleep apnea and sleep macroarchitecture might predict cognitive decline, future studies should consider arousal events and non‐routine hypoxaemia measures, which may show associations with cognitive decline. [ABSTRACT FROM AUTHOR]

Summary: Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale‐15 items (GSS‐15). Data were derived from a population‐based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut‐off scores and test associations with sleep, daytime functioning, health, and quality‐of‐life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS‐15 global scores and outcomes, including 'a good night′s sleep' (r = 0.7), 'feeling un‐refreshed' (r = −0.59), and 'experienced sleepiness' (r = −0.51), p < 0.001. Cut‐off scores were derived to categorise individuals likely to be a good sleeper (GSS‐15 score ≥40) and those very likely to be a good sleeper (GSS‐15 score ≥45). The GSS‐15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples. [ABSTRACT FROM AUTHOR]

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence‐based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are:Weight loss, and reduced alcohol consumption should be recommended, where appropriateIf clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advisedPositional therapy should be considered in supine dominant snorersIn dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physicianContinuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to trySurgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non‐surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association. [ABSTRACT FROM AUTHOR]

Summary: Insomnia and obstructive sleep apnea commonly co‐occur (co‐morbid insomnia and sleep apnea), and their co‐occurrence has been associated with worse cardiometabolic and mental health. However, it remains unknown if people with co‐morbid insomnia and sleep apnea are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study (N = 5803) to investigate potential associations between co‐morbid insomnia and sleep apnea and cardiovascular disease prevalence at baseline and cardiovascular event incidence over ~11 years follow‐up. Insomnia was defined as self‐reported difficulties initiating and/or maintaining sleep AND daytime impairment. Obstructive sleep apnea was defined as an apnea–hypopnea index ≥ 15 events per hr sleep. Co‐morbid insomnia and sleep apnea was defined if both conditions were present. Data from 4160 participants were used for this analysis. The prevalence of no insomnia/obstructive sleep apnea, insomnia only, obstructive sleep apnea only and co‐morbid insomnia and sleep apnea was 53.2%, 3.1%, 39.9% and 1.9%, respectively. Co‐morbid insomnia and sleep apnea was associated with a 75% (odd ratios [95% confidence interval]; 1.75 [1.14, 2.67]) increase in likelihood of having cardiovascular disease at baseline after adjusting for pre‐specified confounders. In the unadjusted model, co‐morbid insomnia and sleep apnea was associated with a twofold increase (hazard ratio, 95% confidence interval: 2.00 [1.33, 2.99]) in risk of cardiovascular event incidence. However, after adjusting for pre‐specified covariates, co‐morbid insomnia and sleep apnea was not significantly associated with incident cardiovascular events (hazard ratio 1.38 [0.92, 2.07]). Comparable findings were obtained when an alternative definition of insomnia (difficulties initiating and/or maintaining sleep without daytime impairment) was used. [ABSTRACT FROM AUTHOR]

Summary: The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well‐being in Australian adults. A cross‐sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18–90 years. Composite scores of self‐reported healthy sleep were based on Ru‐SATED (R‐SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well‐being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ‐5D‐5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well‐being with sleep dimensions, and total R‐SATED (range 0–11) and SATED scores (0–10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well‐being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ‐5D‐5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08–1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17–1.23). These estimates did not differ when the total R‐SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well‐being. [ABSTRACT FROM AUTHOR]

Summary: Evidence linking obstructive sleep apnea with cognitive dysfunction predominantly comes from clinical or select community samples. We investigated the independent cross‐sectional association of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function in unselected community‐dwelling middle‐aged and older men. Four hundred and seventy‐seven Florey Adelaide Male Ageing Study participants underwent successful home‐based polysomnography. They also completed cognitive testing, including the inspection time task, Fuld object memory evaluation, trail‐making test A and B, and mini‐mental state examination. Multivariable regression models examined independent cross‐sectional associations of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function. In univariable analyses, a higher apnea–hypopnea index and percentage of total sleep time with oxygen saturation <90% were associated with worse trail‐making test A performance (both p <.05). A higher apnea–hypopnea index was also associated with worse trail‐making test B performance and slower inspection time (both p <.05). In adjusted analyses, obstructive sleep apnea and sleep macroarchitecture parameters were not associated with cognitive function (all p >.05). In age‐stratified analysis in men ≥65 years, greater stage 1 sleep was independently associated with worse trail‐making test A performance, whereas greater stage 3 sleep was independently associated with better trail‐making test A performance (both p <.05). Our findings suggest that obstructive sleep apnea is not independently associated with cognitive function. In older, but not younger, men, light sleep was associated with worse attention, whereas deep sleep was associated with better attention. Longitudinal population‐based cohort studies are needed to determine if obstructive sleep apnea and disrupted sleep macroarchitecture independently predict prospective cognitive dysfunction and decline. [ABSTRACT FROM AUTHOR]

See relatedLetter [ABSTRACT FROM AUTHOR]

Objective: To determine the suitability of using the International Prostate Symptom Score (IPSS), a condition‐specific instrument, within economic evaluation of lower urinary tract symptom (LUTS) interventions. Methods: Data were obtained from a cohort of 2236 community‐dwelling Australian men. Using correlations and a modified Bland–Altman plot, we investigated the convergent validity of the IPSS with two generic quality of life (GQol) instruments: the Assessment of Quality of Life 4 Dimensions (AQoL‐4D) and the Short‐Form 36 (SF‐36). Discriminant validity was investigated using Wilcoxon–Mann–Whitney and Kruskal–Wallis tests, comparing instrument scores and utilities between subgroups varying in age, marital status, history of illness, smoking status and self‐assessed general health. Results: Discriminant validity was confirmed for all instruments by finding statistically significant differences in summary scores and utilities between nearly all subgroups. Convergent validity between the summary scores/utilities of the IPSS and the GQoL instruments was weak (absolute correlation value range, 0.11–0.23) but differed considerably between dimensions of the instruments (absolute correlation value range, 0.01–0.24). Weak to moderate correlation between the GQoL instruments was seen (absolute correlation value range, 0.01–0.49). Conclusion: Our findings suggest that the IPSS has comparable discriminant validity to the GQoL instruments and therefore useful for assessing subgroup differences related to urinary symptoms. The weak convergence between the IPSS and the GQoL instruments however suggests that, within economic evaluation, the IPSS should be viewed as a complement rather than a substitute to the GQoL instruments because it captures different quality of life constructs. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective Obstructive sleep apnoea ( OSA) and insomnia coexist in clinical populations but prevalence in the community and risk factors remain largely unknown. We examined the prevalence and profile of previously undiagnosed co-morbid OSA and insomnia symptoms ( COMISA) in community-dwelling men. Methods Men ( n = 700, aged 58.5 ± 11.0 (mean ± SD) years) without a prior diagnosis of OSA completed full at-home unattended polysomnography, the Pittsburgh Sleep Quality Index and 36-item short form ( SF-36) survey (2007-2012). Insomnia symptoms included difficulty initiating/maintaining sleep in the presence of daytime fatigue ( DIMS-F). Depressive symptoms were assessed using the Beck Depression Inventory- 1A, Centre for Epidemiological Studies Depression Scale and Patient Health Questionnaire-9 ( PHQ-9) (2007-2010). Univariate ( χ2 and analysis of variance ( ANOVA)) and multiple linear regressions were used to compare data from four groups of individuals: neither disorder; previously undiagnosed OSA (apnoea-hypopnoea index ≥ 10) or DIMS-F alone; and COMISA. Results COMISA prevalence was 6.7%. Depression prevalence ( COMISA, 42.6%; DIMS-F, 21.6%; OSA, 8.4%, χ2 = 71.6, P < 0.00) and symptom scale scores (e.g. PHQ-9 mean ± SD: 16.1 ± 5.5 c.f. DIMS-F: 14.0 ± 4.9, P < 0.01 and OSA: 11.4 ± 3.0, P = 0.01) were highest in men with COMISA. In COMISA, respiratory and arousal indices were similar to those observed in OSA whilst reductions in subjective sleep and day dysfunction scores were similar to DIMS-F. After adjustment, predicted mean depression scores were all higher in DIMS-F and COMISA using linear regression (e.g. PHQ-9 β (95% CI): DIMS-F: 2.3 (1.2, 3.5); COMISA: 4.1 (3.0, 5.1)). Conclusion Men with COMISA have a greater prevalence, and severity, of depression than men with only one disorder. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of musculoskeletal pain with objectively determined obstructive sleep apnea (OSA) and subjective sleep measures in a population-based sample.Methods: Participants were community-dwelling men (n = 360) age ≥35 years from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. Shoulder, back, hip, knee, hand, and foot pain were assessed by computer-assisted telephone interview or self-completed questionnaire. OSA was determined with full in-home unattended polysomnography (Embletta X100) scored by 2007 American Academy of Sleep Medicine alternative criteria. The Epworth Sleepiness Scale assessed daytime sleepiness and the Pittsburgh Sleep Quality Index assessed sleep quality.Results: OSA was not associated with the presence of any joint pain (adjusted odds ratio [OR] 1.03 [95% confidence interval (95% CI) 0.61-1.76]). There was no association between OSA and pain in any specific joint (shoulder, back, hip, knee, hand, or foot), nor was the number of joints in pain associated with OSA. There was, similarly, no association between pain variables and excessive daytime sleepiness, except for hand pain (OR 3.10 [95% CI 1.50-6.39]). However, pain was associated with poor sleep quality: any pain (OR 2.19 [95% CI 1.25-3.82]), shoulder pain (OR 2.16 [95% CI 1.25-3.75]), back pain (OR 2.24 [95% CI 1.41-3.55]), and foot pain (OR 2.47 [95% CI 1.43-4.26]). The number of painful joints was also associated with poor sleep quality (5-6 joints versus no joints OR 7.34 [95% CI 2.30-23.42]).Conclusion: No association between OSA and pain or between daytime sleepiness and pain was found. Consistent with previous reports, poor sleep quality was associated with musculoskeletal pain in this population sample. The etiologic differences between OSA-related sleep disruption and poor subjective sleep quality require further investigation. [ABSTRACT FROM AUTHOR]

We examine a newly designed, interdisciplinary education program and clinical rotation for the first-year obstetrics and gynecology resident, implemented at the University of Colorado, Denver, Colorado, between the College of Nursing midwifery faculty and the School of Medicine Department of Obstetrics and Gynecology. The barriers to program development, along with the advantages and disadvantages of collaboration between nursing and medical schools, are reviewed. The clinical experience, consisting of 5 clinical shifts, was designed using the conceptual model of collaborative intelligence. A formal rotation with the midwife was constructed for the first-year resident on the labor and delivery unit, providing care to intrapartum and postpartum women and families. The program included didactic and clinical teaching, with an emphasis on the normal physiologic process of birth and introduction to the midwifery scope of practice and philosophy of care. Formative evaluation of the clinical rotation demonstrated strong interest for continuation of the program and an ability to appreciate midwifery components of care in a limited exposure. Moreover, program development was successful without requiring large curricular changes for the resident. Future planning includes expansion of the program with increased emphasis on the postpartum and breastfeeding woman and continued program evaluation. The long-term success of such collaborations will depend on the continued support of the American College of Nurse-Midwives and the American Congress of Obstetricians and Gynecologists in developing and improving interdisciplinary educational teams. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. [ABSTRACT FROM AUTHOR]

The article discusses a study that aims to measure the level of functional health literacy (FHL) among 2,824 South Australian adults from September to October 2008, using instruments such as the Newest Vital Sign (NVS), self-reported general health status, and use of health services. The study's results showed that 24% of the respondents were at risk of limited FHL, as well as corroborated research done in the U.S. suggesting that people with at-risk FHL were more likely to report having chronic conditions like diabetes or heart disease.

The article discusses a study which explored the incidence of self-reported harmful adverse events in the health care of community-dwelling adults in Australia. The study also examined public attitudes about health system safety. It included 3,522 adults who are participating in Stage 2 of the North West Adelaide Health Study in South Australia. Study authors have found that better communication could help improve risk perception and reduce self-reported harm. They added that communication could enhance public advocacy for health system improvement.

Recent studies have reported no association between elevated glycated hemoglobin (HbA1c) and incident cardiovascular disease (CVD) among women without diabetes. This study describes associations between HbA1c and new onset CVD in a representative adult population cohort. Assessment of participants in The North West Adelaide Health Study (NWAHS), a population study of randomly selected adults (age ≥18 years, n = 4,060), included measurement of height, weight, blood pressure, fasting lipids, glucose, and HbA1c. A self-completed questionnaire assessed doctor-diagnosed diabetes, CVD and stroke, smoking status, and demographics. The cohort was followed for an average 3.5 years. Of the 2,913 adults free of diabetes at baseline and follow-up, 94 (3.5%) reported new onset coronary heart disease (CHD) and/or stroke. Compared with those with an HbA1c ≤5.0%, risk of new onset CVD was increased in those with HbA1c 5.4–5.6% (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.4, 4.6), and ≥5.7% (OR 1.9, 95% CI 1.1, 3.4), after adjustment for other risk factors. The association was stronger in women than men (P = 0.03), and attenuated to only a small degree by addition of impaired fasting glucose (IFG), hypertension, hypercholesterolemia, BMI, waist circumference, or smoking to the model. Elevated HbA1c is related to new onset CVD over a relatively short follow-up period in both men and women without diabetes and who do not develop diabetes, after adjustment for other major risk factors. Unlike previous studies, this relationship was not substantially attenuated by other traditional risk factors.Obesity (2009) 17 3, 559–563. doi:10.1038/oby.2008.592 [ABSTRACT FROM AUTHOR]

The article presents a study which assessed the prevalence, interactions and relationships of asthma, obesity and depression. Respondents include 3175 adults wherein data about asthma, psychological morbidity, physical functioning, and body mass index were collected. Results revealed that psychological morbidity and obesity are common among asthmatics and that future studies of psychological morbidity of asthmatics should consider sex-specific controls.

Background and objective To determine correlates of excessive daytime sleepiness (EDS) identified with the Epworth Sleepiness Scale (ESS) and a more broad definition, while accounting for obstructive sleep apnoea (OSA) in community dwelling men. Methods Participants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) Study ( n = 837, ≥ 40 years) without a prior OSA diagnosis, underwent in-home full unattended polysomnography (PSG, Embletta X100), completed the ESS, STOP questionnaire and Pittsburgh Sleep Quality Index in 2010-2011. In 2007-2010, questionnaires and biomedical assessment (in South Australian public hospital-based clinics) identified medical conditions. An alternate EDS definition (EDSAlt) consisted of ≥ 2 of 3 problems (feeling sleepy sitting quietly; feeling tired/fatigued/sleepy; trouble staying awake). Results EDSAlt (30.4%, n = 253), but not ESS ≥ 11 (EDSESS, 12.6%, n = 104), increased significantly across OSA severity and body mass index categories. In adjusted analyses, EDSESS was significantly associated with depression: odds ratio (OR), 95%CI: 2.2 (1.3-3.8) and nocturia: 2.0 (1.3-3.2). EDSAlt was associated with depression, financial stress, relationship, work-life balance problems and associations with nocturia and diabetes were borderline. After excluding men with EDSESS, EDSAlt was associated with oxygen desaturation index (3%) ≥ 16 and the highest arousal index quartile but not with comorbidities. Conclusion Sleepiness not necessarily leading to dozing, but not ESS ≥ 11, was related to sleep disordered breathing. Clinicians should be alert to (1) differing perspectives of sleepiness for investigation and treatment of OSA, and (2) the presence of depression and nocturia in men presenting with significant Epworth sleepiness regardless of the presence of OSA. [ABSTRACT FROM AUTHOR]

The title compound, [Pb(C(6)F(5)S)(2)(C(5)H(5)N)(2)](n), shows the Pb(II) atom in a ψ-trigonal bipyramidal S(2)N(2) bonding environment. Pyridine N atoms occupy axial sites, while thiol-ate S atoms and a stereochemically active lone pair occupy equatorial sites. Very long inter-molecular Pb⋯S inter-actions [3.618 (4) and 3.614 (4) Å] yield a weakly associated one-dimensional polymeric structure extending parallel to [010].