Determinants of daytime sleepiness in obstructive sleep apnea

To investigate determinants of daytime sleepiness in obstructive sleep apnea syndrome (OSAS), we studied 100 unselected OSAS patients by nocturnal polygraphic recording and the Multiple Sleep Latency Test (MSLT). Data obtained were submitted to three types of analysis. Respiratory disturbance index, oxygen saturation indices, body mass index, and total nocturnal sleep time did not significantly correlate with daytime sleepiness, as measured by the MSLT. Analysis of subgroups based on weight and degree of alertness also showed a nonsignificant correlation with daytime sleepiness. The best predictor of the excessive daytime sleepiness (EDS) frequently found in OSAS patients was the nocturnal polygraphic recording of the sleep disturbances and sleep structure anomalies that reflect the brain's overall dysfunction in OSAS. Understanding why an electroencephalogram arousal response occurs during sleep in association with abnormal breathing and how this response can become blunted may help us to better predict the development of EDS.     

Inflammatory proteins in patients with obstructive sleep apnea with and without daytime sleepiness

Excessive daytime sleepiness (EDS) is one of the most frequent symptoms in patients with obstructive sleep apnea syndrome (OSAS). However, not all patients with OSAS manifest EDS. The aim of this study was to assess whether differential circulatory levels of inflammatory mediators would account for differences in somnolence among patients with OSAS. Patients were prospectively recruited from referral patient cohort to the university hospital sleep center. A total of 50 consecutive patients with OSAS undergoing overnight polysomnography with or without EDS and 20 controls were evaluated. EDS was assessed using the Epworth sleepiness scale (ESS) and the multiple sleep latency test after overnight polysomnography. EDS was defined when the ESS was >10 and the mean sleep latency <10 min. Fasting blood was drawn in the morning after polysomnography. Circulating levels of tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), 8-isoprostaglandin F2α (8-iso-PGF2α), and P-selectin were measured with commercially available high sensitivity kits. Although patients with OSAS have elevated levels of ICAM-1, IL-6, and TNFα, there were no statistically significant differences in any of the inflammatory mediators between patients with EDS and without EDS. Emergence of EDS in the context of OSA does not appear to result from the selective increase of any particular somnogenic substance, i.e., TNFα, IL-6, ICAM-1, 8-iso-PGF2α, and P-selectin in the context of sleep-disordered breathing. The work was performed in Hospital Universitario Son Dureta and Kosair Children’s Hospital Research Institute.     

Correlation of daytime sleepiness with urine metabolites in patients with obstructive sleep apnea

Purpose

The apnea–hypopnea index (AHI) is closely related with the severity of daytime sleepiness, but excessive daytime sleepiness (EDS) is not presented on all patients with obstructive sleep apnea (OSA). It is unclear why daytime sleepiness is not always present in OSA patients even if their sleep is disrupted from the perspective of polysomnographic findings. This study aimed to analyze the correlation between sleepiness and urine metabolites of neurotransmitters involved in the arousal system.

Methods

On the basis of AHI in polysomnography, 49 consecutive OSA patients were included. According to their Epworth sleepiness scale (ESS), 23 non-sleepy patients (ESS <11) and 26 sleepy patients (ESS ≥11) were included. Urine samples were collected before and after polysomnography and analyzed by gas chromatography–mass spectrometry with selective ion monitoring. Six metabolites of dopamine, norepinephrine and serotonin were analyzed.

Results

The dopamine metabolites, homovanillic acid (r?=?0.366, P?=?0.017) and 3,4-dihydroxyphenylacetic acid (DOPAC; r?=?0.584, P?P?=?0.032).

Conclusion

Urine dopamine metabolites may identify sleepy patients with OSA. In particular, the overnight change of urine DOPAC may indicate OSA patients with EDS.     

Factors associated with excessive daytime sleepiness in patients with severe obstructive sleep apnea

Purpose

Although excessive daytime sleepiness (EDS) is one of the key symptoms of obstructive sleep apnea (OSA), associations between OSA and EDS have been inconsistent, even in patients with severe OSA. To that end, our goal was to investigate factors associated with EDS based on the Epworth Sleepiness Scale (ESS) score in a large clinical population with severe OSA (apnea–hypopnea index ≥30).

Methods

This cross-sectional study included 1,126 consecutive adult patients referred for their first in-laboratory polysomnogram for suspicion of OSA. All patients completed a routine questionnaire including demographics, race, co-morbidities, sleep history, ESS, short-form quality of life questionnaire-12 (SF-12), the Center for Epidemiologic Studies Depression scale, and medications used. Severe OSA was diagnosed in 498 patients. After excluding patients taking narcotics, hypnotics, benzodiazepines, antidepressants, or those with diagnosis of depression, 355 patients remained in the final analytic cohort. Patients were divided into quartiles based on the ESS and comparisons were made between the lowest quartile (ESS?≤?6; n?=?105) and highest quartile (ESS?≥?13; n?=?97).

Results

Compared to the ESS?≤?6 group, patients in the ESS?≥?13 group had a significantly higher 3 % oxygen desaturation index and a significantly lower oxygen saturation nadir during sleep (p?<?0.05). Moreover, patients with severe OSA in the highest quartile of ESS had higher depressive symptomatology.

Conclusions

In patients with severe OSA, intermittent hypoxemia and depressive symptoms are important contributing factors to EDS.     

Insomnia subtypes and their relationships to daytime sleepiness in patients with obstructive sleep apnea

BACKGROUND: Insomnia and obstructive sleep apnea syndrome (OSA) are the two most common sleep disorders. Studies showed that insomnia complaints were prevalent in OSA. Relatively little is known about the causes of insomnia in OSA and whether etiological factors differ for insomnia subtypes. We hypothesized that sleep onset problem was mainly due to hyperarousal and sleep maintenance difficulty was primarily related to sleep-disordered breathing. OBJECTIVES: To determine the prevalence of insomnia subtypes in OSA, compare subjects with sleep onset insomnia, sleep maintenance insomnia and no insomnia symptom, and study the relationship of insomnia subtypes to daytime sleepiness. METHODS: We analyzed intake questionnaires and polysomnography and Multiple Sleep Latency Test results of 157 OSA patients. RESULTS: Forty-two percent of the sample had at least one problematic insomnia symptom. The prevalence of sleep onset insomnia, sleep maintenance insomnia and insomnia with early awakening was 6, 26 and 19%, respectively. Patients with sleep onset insomnia had significantly lower apnea-hypopnea (AHI) and arousal indices. There were significant inverse relationships between sleep onset insomnia and measures of daytime sleepiness. On the contrary, subjects with repeated wakening had more severe subjective sleepiness. Results were similar in patients with AHI >or=5 or >or=15. CONCLUSIONS: Insomnia symptoms were common in OSA patients. Insomnia subtypes related differently to measures of daytime sleepiness. Our findings suggest that OSA patients with sleep onset insomnia may be in a state of hyperarousal. It is clinically relevant to examine insomnia subtypes, which may influence the treatment decision in sleep-disordered breathing.     

Polysomnographic characteristics of daytime sleepiness in obstructive sleep apnea syndrome

Purpose  

The study is intended to explore the nocturnal sleep determinants for excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS).     

Association between serum neopterin, obesity and daytime sleepiness in patients with obstructive sleep apnea

OBJECTIVE: Obesity and obstructive sleep apnea (OSA) and systemic inflammation may interact through biochemical pathways. Neopterin (NP) is a monocyte/macrophage activation marker produced by macrophages in response to interferon-gamma secreted by activated T-lymphocytes. This study examines the association between NP, obesity and OSA. PATIENTS AND METHODS: The study included 22 newly diagnosed OSA (+) patients and 18 OSA (-) patients. Subjects with history of coronary artery disease, transplant patients, history of alcohol and drug abuse, history of HIV and any other significant medical illnesses such as active infections, autoimmune disease, malignancy, liver disease, pulmonary disease (COPD, asthma,...), neuromuscular disease, patients on immunomodulating therapy or HMG-CoA reductase inhibitors were excluded. RESULTS: There were no significant differences in age, body mass index (BMI), and smoking habits of the OSA (+) patients and OSA (-) patients. Serum NP levels did not show any significant difference between the OSA (+) patients and OSA (-) patients, however, NP levels were positively correlated with BMI (r=0.320, p=0.044). There was no significant correlation between NP and any of the polysomnographic parameters. The result of stepwise regression analyses (r(2)=0.320, p<0.001) showed that high serum NP levels (p=0.004) and apnea-hypopnea index (AHI) were a risk factor for elevated Epworth sleepiness score, independent of BMI. CONCLUSION: We suggest that serum NP levels correlate with BMI. There was a significant relationship between serum NP levels and excessive daytime sleepiness in OSA patients.     

低氧血症与 OSAHS 患者嗜睡的关系分析简

目的 分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者低氧血症与白天嗜睡的关系.方法 选取我院就诊的150例OSAHS患者为研究对象,根据嗜睡评分进行分组,比较嗜睡组与非嗜睡组的一般情况及夜间多导睡眠监测参数,并将各数据参数进行相关性分析.结果 嗜睡组与非嗜睡组相比,嗜睡评分、睡眠呼吸暂停通气指数、氧减指数显著高于非嗜睡组（P〈0.05）,最低血氧饱和度显著低于非嗜睡组（P〈0.05）.多元回归提示日间嗜睡评分仅与氧减指数相关.结论 OSAHS患者日间嗜睡与氧减指数密切相关,夜间低氧血症是OSAHS患者出现日间嗜睡的主要原因.     

Gender differences in the sleep variables contributing to excessive daytime sleepiness among patients with obstructive sleep apnea

Sleep and Breathing - Excessive daytime sleepiness (EDS) is a main symptom in patients with obstructive sleep apnea (OSA); however, patients with OSA&nbsp;have significant variability in their...     

Residual excessive daytime sleepiness in patients with obstructive sleep apnea treated with positive airway pressure therapy

Sleep and Breathing - Patients with obstructive sleep apnea (OSA) commonly report residual excessive daytime sleepiness (EDS) despite treatment with positive airway pressure (PAP). The present...     

白日嗜睡对阻塞性睡眠呼吸暂停低通气患者认知障碍的影响

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者认知障碍的影响因素.方法 选择2018年1月至2019年12月于南京市第一医院呼吸科睡眠中心经多导睡眠监测诊断为OSAHS的患者175例,其中重度OSAHS患者96例,轻中度OSAHS患者79例.根据Epworth嗜睡量表(ESS)评分及嗜睡症状将患者分为OSA...     

睡眠片段对慢性阻塞性肺疾病和阻塞型睡眠呼吸暂停低通气患者日间嗜睡的意义

睡眠片段与白天嗜睡间的关系一直是研究的热点，也取得了较大的进展。本文将近年来慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）和阻塞型睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）的研究进展中关于睡眠片段的文献做一综述。     

Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea.

Patients with obstructive sleep apnea/hypopnea syndrome can experience residual daytime sleepiness despite regular use of nasal continuous positive airway pressure therapy. This randomized, double-blind, placebo-controlled, parallel group study assessed the efficacy and safety of modafinil for the treatment of residual daytime sleepiness in such patients. Patients received modafinil (n = 77) (200 mg/d, Week 1; 400 mg/d, Weeks 2 to 4) or matching placebo (n = 80) once daily for 4 wk. Modafinil significantly improved daytime sleepiness, with significantly greater mean changes from baseline in Epworth Sleepiness Scale scores at Weeks 1 and 4 (p < 0.001) and in multiple sleep latency times (MSLT) at Week 4 (p < 0.05). The percentage of patients with normalized daytime sleepiness (Epworth score < 10) was significantly higher with modafinil (51%) than with placebo (27%) (p < 0.01), but not for MSLT (> 10 min; 29% versus 25%). Headache (modafinil, 23%; placebo, 11%; p = 0.044) and nervousness (modafinil, 12%; placebo, 3%; p = 0.024) were the most common adverse events. During modafinil or placebo treatment, the mean duration of nCPAP use was 6.2 h/night, with no significant change from baseline observed between groups. Modafinil may be a useful adjunct treatment for the management of residual daytime sleepiness in patients with obstructive sleep apnea/hypopnea syndrome who are regular users of nasal continuous positive airway pressure therapy.     

阻塞性睡眠呼吸暂停综合征的嗜睡及残余嗜睡

嗜睡是阻塞性睡眠呼吸暂停综合征（OSAS）的常见症状。人们普遍期望对OSAS的有效治疗可以清除或改善白天过度嗜睡,但仍有一些接受治疗的OSAS患者在觉醒时有嗜睡,称为残余嗜睡。对OSAS患者残余嗜睡的进一步诊治取决于发生残余嗜睡的原因。最近,已获得来自临床实验的数据,为对残余嗜睡的OSAS患者进行评估和处理提供了方向。     

Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses

Sleep and Breathing - Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs)....     

The interaction between hypertension and obstructive sleep apnea on subjective daytime sleepiness

Hypertension is one of the most common chronic cardiovascular diseases in adults while obstructive sleep apnea (OSA) is the most common type of sleep apnea. It was recently reported that the mean Epworth Sleepiness Scale (ESS) score, measuring subjective daytime sleepiness, was significantly higher in non‐hypertensive subjects than the hypertensive counterparts with moderate to severe obstructive sleep apnea. In the current study, the authors investigated the interaction between hypertension and OSA on daytime sleepiness among 280 subjects recruited from a sleep study. OSA was evaluated with the Apnea‐Hypopnea Index (AHI), and daytime sleepiness was measured with the ESS. Significantly higher mean ESS scores were found for subjects without than those with hypertension (11.3 vs 9.4, P = 0.003) but only a marginally significant difference was discerned for the ESS scores between subjects with AHI ≥15/h and AHI <15/h (P = 0.075). A significant interaction between hypertension and OSA status on daytime sleepiness was observed from the analysis of variance (P = 0.02). The adjusted mean ESS score for the group of normotensive subjects with moderate to severe OSA (13.11) was significantly higher than the other three groups, namely, normotensive subjects with mild OSA (9.35), hypertensive subjects with mild OSA (9.70), and hypertensive subjects with moderate to severe OSA to (9.43). In conclusion, subjective daytime sleepiness of normotensive subjects with moderate to severe OSA was significantly more severe than other subjects.     

Hypoxemia vs sleep fragmentation as cause of excessive daytime sleepiness in obstructive sleep apnea

To determine the effects of intermittent hypoxemia on daytime sleepiness in the clinical setting of obstructive sleep apnea syndrome, we enrolled seven patients in a prospective, randomized, crossover study. We had two experimental conditions with NCPAP treatment as follow: (1) to correct apneas, sleep fragmentation, and hypoxemia; and (2) to correct apneas and sleep fragmentation and at the same time, induce intermittent hypoxemia. The outcome variable, daytime sleepiness, was measured objectively with the multiple sleep latency test following completion of baseline and each treatment condition. Compared with sleep latencies in the untreated condition, both experimental treatment arms prolonged sleep latencies (p less than 0.05). We found no statistically significant differences between mean MSLT scores obtained after NCPAP treatment under hypoxemic and nonhypoxemic conditions. In summary, two nights of intermittent nocturnal hypoxemia during NCPAP treatment for OSAS did not diminish the objective improvement in daytime somnolence seen with NCPAP treatment in the absence of nocturnal hypoxemia. Results lend further support to the hypothesis relating excessive daytime sleepiness to sleep fragmentation.     

Improved follow-up by peripheral arterial tonometry in CPAP-treated patients with obstructive sleep apnea and persistent excessive daytime sleepiness

Sleep and Breathing - OSA-patients with persistent excessive daytime sleepiness (EDS) despite CPAP treatment are challenging in daily clinical life. To rule out residual sleep-disordered breathing...     

Influence of excessive daytime sleepiness and sleep quality on anxiety and depression in patients with obstructive sleep apnea hypopnea syndrome.

<正>Objective To explore the factors that contribute to the anxiety and depression in obstructive sleep apnea hypopnea syndrome (OSAHS) patients in terms of excessive daytime sleepiness (EDS) and sleep quality. Methods A total of 196 OSAHS patients,including 103 severe     

Relationship between serum substance P levels and daytime sleepiness in obstructive sleep apnea syndrome

OBJECTIVE: We hypothesized that intermittent hypoxia might influence serum substance P levels, and that this effect might in turn contribute in excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Fifty-five patients with newly diagnosed OSAS and 15 age-matched nonapneic control subjects were enrolled in this study. Full polysomnography was performed in all patients. Single blood samples were drawn between 8:00 am and 9:00 am after the sleep study. Substance P levels were analyzed with a competitive enzyme immunoassay (substance P EIA kit; Cayman Chemical; Ann Arbor, MI). RESULTS: There were no significant differences in age, gender, body mass index, smoking habit, and snoring between the two groups. Serum substance P levels in the OSAS group were significantly lower than that in the control group (p < 0.0001). Serum substance P levels were positively correlated with rapid eye movement sleep (r = 0.330, p = 0.049) and slow-wave sleep (r = 0.324, p = 0.049) phases. Serum substance P levels were negatively correlated with Epworth sleepiness scale score (r = - 0.253, p = 0.048), number of total apneas during the night (r = - 0.247, p = 0.036), number of respiratory events during the night (r = - 0.266, p = 0.024), apnea-hypopnea index (r = - 0.287, p = 0.015), respiratory arousal index (r = - 0.267, p = 0.026), time spent in apnea and hypopnea (r = - 0.307, p = 0.01), average oxygen desaturation (r = - 0.265, p = 0.026), and oxygen desaturation index (r = - 0.254, p = 0.031). CONCLUSION: We concluded that EDS seen in some of the OSAS patients might be associated with various pathophysiologic mechanisms including substance P levels.