Daytime Sleepiness in Patients Diagnosed with Sarcoidosis Compared with the General Population

Background. The aim of this study was to analyze daytime sleepiness in a sample of patients diagnosed with sarcoidosis. Methods. A sample of 1197 German sarcoidosis patients was examined with the Epworth Sleepiness Scale (ESS), the Fatigue Assessment Scale, the Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Short-Form Health Survey (SF-8). The patients’ ESS mean scores were compared with those obtained from a large general population sample. Results. Exactly 50% of the patients reached the criterion (ESS > 10) for excessive daytime sleepiness, compared with only 22.1% in the general population. The effect size for the mean score difference between both samples was d=0.62. The number of affected organs and the number of concomitant diseases proved to be significant independent predictors of daytime sleepiness. Sleepiness was associated with fatigue (r=0.45), anxiety (r=0.23), depression (r=0.28), sleep problems (r=0.23), and detriments in physical (r=−0.29) and mental (r=−0.28) quality of life. Conclusions. The issue of excessive daytime sleepiness should be considered in the management of sarcoidosis

Circulating anandamide and blood pressure in patients with obstructive sleep apnea

Objective: Obstructive sleep apnea chronically increases blood pressure through sympathetic nervous system activation. In animals, hypertension and sympathetic activity are restrained by cannabinoid receptor activation. Therefore, we hypothesized that increased blood pressure in patients with obstructive sleep apnea is associated with increased circulating endocannabinoid concentrations. Methods: Arterial oxygen saturation and apnea/hypopnea episodes were recorded in 29 patients with normal glucose tolerance, 26 patients with type 2 diabetes mellitus, and 21 patients obese subjects without sleep apnea. We determined seated blood pressure, insulin, glucose, and high-sensitive C-reactive protein in the morning, and insulin sensitivity by euglycemic-hyperinsulinemic clamp the next day. Anandamide, the sum of 1-arachidonoylglycerol and 2-arachidonoylglycerol, and oleoylethanolamide were measured in plasma by liquid chromatography-tandem mass spectrometry. Results: Endocannabinoid concentrations in sleep apnea patients were increased compared to obese individuals without disordered nocturnal breathing. Correction for variables of obesity and insulin resistance almost completely abrogated this difference in endocannabinoids. Anandamide strongly correlated with blood pressure in sleep apnea patients (r = 0.60 for SBP and r = 0.58 for DBP, P < 0.001). In multivariate regression analysis, anandamide was a stronger determinant of blood pressure than sleep apnea severity, obesity, insulin resistance, and inflammation. Conclusion: Obstructive sleep apnea patients show positive correlations between blood pressure and venous anandamide concentrations independent of confounding factors. Our data suggest a previously not recognized role of the endocannabinoid system for blood pressure regulation in patients with high risk for hypertension and cardiovascular disease