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OBJECTIVES To evaluate the short-term repeatability of Epworth Sleepiness Scale (ESS) in patients with suspected obstructive sleep apnoea (OSA), and whether transitory sleepiness of the patient influenced ESS-results. METHODS Adult subjects with suspected OSA taking part in a study on the diagnostic accuracy of repeated sleep studies were eligible. For assessment of repeatability, the agreement between two sequential ESS-scores obtained within one day (same-day group) or on different days within one week (same-week group) was evaluated. By analysing the within-day repeatability, a possible influence of situational sleepiness on ESS-results was assessed. By comparing correlations of sequential scores between both groups, a potential influence of test-day-specific sleepiness on ESS-results was evaluated. check details Data were analysed using Bland-Altman plots, intraclass-correlation coefficients (ICC), Standard error of measurement analysis, and relative amounts of ESS discrepancies beyond 2, 3, 5, and 7 points. RESULTS 40 participants (mean age 47.7 ± 15.4 years, 67.5% men) were included in this study, 20 in each group. Bland-Altman analysis demonstrated considerable variability of repeated scores (mean (±1.96xSD) 1.93 (-3.81 to 7.66)). Discrepancies of at least 3 points between sequential ESS-scores were found in 48% of all participants. Comparison of ESS-repeatability between both groups showed no evidence for a difference. CONCLUSIONS A clinically relevant variability of ESS-scores was found, even when repeated on the same day, possibly due to situational sleepiness influencing ESS-results. Changes in ESS in response to interventions should be interpreted with caution due to its low test-retest-reliability. © 2020 American Academy of Sleep Medicine.STUDY OBJECTIVES To assess the relationship between continuous positive airway pressure (CPAP) therapy and cognitive function in patients with mild cognitive impairment (MCI) and obstructive sleep apnea (OSA). METHODS This was a retrospective chart review of patients with MCI and OSA. CPAP compliance was defined as average use of CPAP for at least 4 hours a night. Kaplan-Meier estimates, logrank tests and Cox proportional hazards regression were done to compare the compliance groups in terms of progression to dementia, defined as Clinical Dementia Rating (CDR) of 1 or greater. Linear mixed models were used to assess the relationships between CPAP compliance and neurological cognitive function outcomes over time. RESULTS Ninety-six patients were included with mean age at MCI diagnosis of 70.4 years, mean Apnea Hypopnea Index of 25.9 and mean duration of neurology follow-up of 2.8 years. Forty-two were CPAP compliant, 30 were non-compliant and 24 had no CPAP use. No overall difference among the groups was detected for progression to dementia (p = 0.928, logrank test). Patients with amnestic MCI had better CPAP use (p = 0.016) and shorter progression time to dementia (p = 0.042), but this difference was not significant after adjusting for age, education and race (p = 0.32). CONCLUSIONS CPAP use in MCI patients with OSA was not associated with delay in progression to dementia or cognitive decline. © 2020 American Academy of Sleep Medicine.STUDY OBJECTIVES We aimed to quantify the symptoms of autonomic nervous system (ANS) dysfunction in a large online cohort of patients with IH, and to determine how the severity of these symptoms interacts with sleepiness, fatigue, and quality of life. METHODS One hundred thirty-eight IH patients and 81 age- and sex-matched controls were recruited through the website of the Hypersomnia Foundation, a U.S.-based patient advocacy group. Twenty-four confirmed IH patients were selected by the study investigators as a comparison group. All participants completed a battery of online sleep, autonomic, and quality of life questionnaires including the composite autonomic symptom score-31 (COMPASS-31). RESULTS Online and confirmed patients reported significantly higher COMPASS-31 scores (43.6 [33.6-52.7] & 32.9 [21.7- 46.8] vs. 17.6 [11.7-27.9], p less then 0.001), with the greatest symptom burden in the orthostatic and vasomotor domains. Online and confirmed patients reported more sleepiness (ESS), whereas only online patients reported more fatigue (CFQ). Both the ESS and CFQ positively correlated with COMPASS-31 scores. Patients reported lower quality of life as reflected by lower scores across all domains of the RAND-36, which was negatively correlated with COMPASS-31 scores. CONCLUSIONS Symptoms of ANS dysfunction are common in IH. In addition, ANS symptom burden was positively correlated with sleepiness and negatively correlated with quality of life. © 2020 American Academy of Sleep Medicine.INTRODUCTION In-laboratory titration polysomnography (PSG) is standard to determine optimal therapeutic continuous positive airway pressure (CPAP) in children with obstructive sleep apnea (OSA). The use of auto-titrating CPAP devices (autoCPAP) as an alternative to CPAP titration has not been well studied in children. We hypothesized that autoCPAP-derived pressures (PMEAN, PPEAKMEAN, P90) would be similar to titration PSG pressure (PPSG). METHODS Retrospective study of children with OSAS initiated on autoCPAP between 2007 and 2017, who used autoCPAP for at least 2 hours per night and who had adequate titration PSG were included in the analysis. AutoCPAP-derived pressures were obtained from usage downloads and compared to PPSG. PPSG predictive factors were analyzed by median regression. Non-parametric methods were used for analysis. RESULTS Of 110 children initiated on autoCPAP, 44 satisfied inclusion criteria. Age (median (IQR)) was 13.01 (9.98, 16.72) years, 63.6% were obese. PPSG median[IQR] was 8[7-11] cmH2O, mean autoCPAP-derived pressure (PMEAN) 6.2[5.6-7.6] cmH2O, peak mean pressure (PPEAKMEAN) 9.4[7.7-11.1] cmH2O, and average device pressure ≤ 90% of the time (P90) 8.1[7.2-9.7] cmH2O. AutoCPAP-derived pressures correlated with PPSG (p less then 0.05). PMEAN was lower than the other three pressures (p less then 0.0002). Median regression analysis demonstrated that after adjusting for patient characteristics such as age, sex, obesity status, autoCPAP-derived pressures remained significant predictors of PPSG (p less then 0.05). There were no significant interactions between these patient characteristics and autoCPAP-derived pressures. CONCLUSIONS This study demonstrates that autoCPAP-derived pressures correlate with the titration PSG derived pressures. These results indicate that autoCPAP can be used in the pediatric population and can determine pressures that are close to the titration pressures. © 2020 American Academy of Sleep Medicine.