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@article{Þórarinsdóttir2019,
title = {Definition of excessive daytime sleepiness in the general population: Feeling sleepy relates better to sleep‐related symptoms and quality of life than the Epworth Sleepiness Scale score. Results from an epidemiological study},
author = {Elín, H Þórarinsdóttir and Erla, Björnsdóttir and Bryndís, Benediktsdóttir and Christer, Janson and Þórarinn, Gíslason and Thor, Aspelund and Samuel, T Kuna and Allan, I Pack and Erna, Sif Arnardóttir},
url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12852},
year = {2019},
date = {2019-04-10},
abstract = {Many different subjective tools are being used to measure excessive daytime sleepiness (EDS) but the most widely used is the Epworth Sleepiness Scale (ESS). However, it is unclear if using the ESS is adequate on its own when assessing EDS. The aim of this study was to estimate the characteristics and prevalence of EDS using the ESS and the Basic Nordic Sleep Questionnaire (BNSQ) in general population samples. Participants aged 40 years and older answered questions about sleepiness, health, sleep‐related symptoms and quality of life. Two groups were defined as suffering from EDS: those who scored >10 on the ESS (with increased risk of dozing off) and those reporting feeling sleepy during the day ≥3 times per week on the BNSQ. In total, 1,338 subjects (53% male, 74.1% response rate) participated, 13.1% reported an increased risk of dozing off, 23.2% reported feeling sleepy and 6.4% reported both. The prevalence of restless leg syndrome, nocturnal gastroesophageal reflux, difficulties initiating and maintaining sleep and nocturnal sweating was higher among subjects reporting feeling sleepy compared to non‐sleepy subjects. Also, subjects reporting feeling sleepy had poorer quality of life and reported more often feeling unrested during the day than non‐sleepy subjects. However, subjects reporting increased risk of dozing off (ESS > 10) without feeling sleepy had a similar symptom profile as the non‐sleepy subjects. Therefore, reporting only risk of dozing off without feeling sleepy may not reflect problematic sleepiness and more instruments in addition to ESS are needed when evaluating daytime sleepiness.},
keywords = {Daytime sleepiness},
pubstate = {published},
tppubtype = {article}
}

@article{Brendan2018,
title = {Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis},
author = {Brendan, T Keenan and Jinyoung, Kim and Bhajan, Singh and Lia, Bittencourt and Ning-Hung, Chen and Peter, A Cistulli and Ulysses, J Magalang and Nigel, McArdle and Jesse, W Mindel and Bryndís, Benediktsdóttir and Erna, Sif Arnardóttir and Lisa, Kristin Prochnow and Thomas, Penzel and Bernd, Sanner and Richard, J Schwab and Chol, Shin and Kate, Sutherland and Sergio, Tufik and Greg, Maislin and Þórarinn, Gíslason and Allan, I Pack},
url = {https://academic.oup.com/sleep/article/41/3/zsx214/4791307},
year = {2018},
date = {2018-01-05},
abstract = {Study Objectives
A recent study of patients with moderate–severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort.

Methods
Using data on 972 patients with moderate–severe OSA (apnea–hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes.

Results
The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6–54.5 years), obese (30.6–35.9 kg/m2), and had severe OSA (42.0–51.4 events per hour) on average.

Conclusions
Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.},
keywords = {Daytime sleepiness, Insomnia, Sleep Apnea},
pubstate = {published},
tppubtype = {article}
}