Predictors of Excessive Daytime Sleepiness in Patients with Obstructive Sleep Apnea Syndrome

10.4103/TPSY.TPSY_5_19

Hung-Ta Liao；Tsung-Yi Tsai；Dai-Yueh Lin

Apnea-hypopnea index ； body mass index ； Epworth sleepiness scale ； rapid eye movement latency

台灣精神醫學

33卷1期（2019 / 03 / 01）

27 - 32

英文

Objective: Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS) is a known risk factor for various accidents and can cause poor quality of life. In this study, we intended to study the demographic and clinical characteristics of EDS in patients with OSAS. Methods: This retrospective study gathered data from 283 patients. We classified patients with Epworth Sleepiness Scale (ESS) scores ≥ 10 points as the EDS group and those with an ESS score ＜10 were the non-EDS group. We also compared the results of physiological and polysomnographic examinations to determine if EDS could be used to predict in patients with OSAS. A stratified analysis was also done to study subpopulation-related factors associated with EDS in OSAS patients. Results: Male OSAS patients with EDS had significantly shortened rapid eye movement latency (REML, p ＜ 0.01), significantly greater sleep efficiency (p ＜ 0.05), and significantly higher EES score (p ＜ 0.001), compared to those without EDS. Female OSAS patients with EDS had significantly higher body mass index (BMI) (p ＜ 0.05) and had significantly more EES score (p ＜ 0.001). Female OSAS patients with EDS in childbearing age had significantly higher EES score (p ＜ 0.001) and had significantly higher BMI (p ＜ 0.05). OSAS patients with severe EDS had significantly shortened REML (p ＜ 0.01) and significantly more EES score (p ＜ 0.001). Conclusion: This study showed that there were differences in the characteristics of OSAS patients with and without EDS and they differed in their subgroups. All findings are mostly in line with those in existing literature.

1. Andersen, ML,Bittencourt, LR,AntunesI, B(2006).Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders?.Curr Med Chem,13,3575-3582.
2. Bilyukov, RG,Nikolov, MS,Pencheva, VP(2018).Cognitive impairment and affective disorders in patients with obstructive sleep apnea syndrome.Front Psychiatry,9,357.
3. Bixler, EO,Kales, A,Soldatos, CR(1979).Prevalence of sleep disorders in the Los Angeles metropolitan area.Am J Psychiatry,136,1257-1262.
4. Canapari, CA,Hoppin, AG,Kinane, TB(201).Relationship between sleep apnea, fat distribution, and insulin resistance in obese children.J Clin Sleep Med,7,268-273.
5. Chen, NH,Johns, MW,Li, HY(2002).Validation of a Chinese version of the Epworth sleepiness scale.Qual Life Res,11,817-821.
6. George, CF,Boudreau, AC,Smiley, A(1996).Simulated driving performance in patients with obstructive sleep apnea.Am J Respir Crit Care Med,154,175-181.
7. George, CF,Boudreau, AC,Smiley, A(1996).Comparison of simulated driving performance in narcolepsy and sleep apnea patients.Sleep,19,711-717.
8. Hoffstein, V,Mateika, S(1992).Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea.Eur Respir J,5,377-381.
9. Iranzo, A(2010).Excessive daytime sleepiness in OSA.Eur Respir Mon,50,17-30.
10. Johns, MW(1991).A new method for measuring daytime sleepiness: the Epworth sleepiness scale.Sleep,14,540-545.
11. Johns, MW(2000).Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth Sleepiness Scale: failure of the MSLT as a gold standard.J Sleep Res,9,5-11.
12. Kao, CC,Huang, CJ,Wang, MY(2008).Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population.Qual Life Res,17,1073-1080.
13. Le Bon, O,Staner, L,Hoffmann, G(2001).Shorter REM latency associated with more sleep cycles of a shorter duration in healthy humans.Psychiatry Res,104,75-83.
14. Lee, SJ,Kang, HW,Lee, LH(2012).The relationship between the Epworth sleepiness scale and polysomnographic parameters in obstructive sleep apnea patients.Eur Arch Otorhinolaryngol,269,1143-1147.
15. Lee, W,Nagubadi, S,Kryger, MH(2008).Epidemiology of obstructive sleep apnea: a population-based perspective.Expert Rev Respir Med,2,349-364.
16. Manber, R,Armitage, R(1999).Sex, steroids, and sleep: a review.Sleep,22,540-555.
17. Martins, AB,Tufik, S,Moura, SM(2007).Physiopathology of obstructive sleep apnea-hypopnea syndrome.J Bras Pneumol,33,93-100.
18. Mignot, E,Young, T,Lin, L(1998).Reduction of REM sleep latency associated with HLA-DQB1*0602 in normal adults.Lancet,351,727.
19. Mirrakhimov, AE,Sooronbaev, T,Mirrakhimov, EM(2013).Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature.BMC Pulm Med,13,10.
20. Pack, AI(2006).Advances in sleep-disordered breathing.Am J Respir Crit Care Med,173,7-15.
21. Romero-Corral, A,Caples, SM,Lopez-Jimenez, F,Somers, VK(2010).Interactions between obesity and obstructive sleep apnea: implications for treatment.Chest,137,711-719.
22. Roure, N,Gomez, S,Mediano, O(2008).Daytime sleepiness and polysomnography in obstructive sleep apnea patients.Sleep Med,9,727-731.
23. Seneviratne, U,Puvanendran, K(2004).Excessive daytime sleepiness in obstructive sleep apnea: prevalence, severity, and predictors.Sleep Med,5,339-343.
24. Sun, Y,Ning, Y,Huang, L(2012).Polysomnographic characteristics of daytime sleepiness in obstructive sleep apnea syndrome.Sleep Breath,16,375-381.
25. Ulfberg, J,Carter, N,Edling, C(2000).Sleep-disordered breathing and occupational accidents.Scand J Work Environ Health,26,237-242.
26. Unal, Y,Ozturk, DA,Tosun, K.Association between obstructive sleep apnea syndrome and waist-to-height ratio.Sleep Breath.
27. Vgontzas, AN(2008).Vgontzas ANExcessive daytime sleepiness in sleep apnea: it is not just apnea hypopnea index.Sleep Med,9,712-714.
28. Vgontzas, AN(2008).VgontzasDoes obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance?.Arch Physiol Biochem,114,211-223.
29. Wimms, A,Woehrle, H,Ketheeswaran, S(2016).Obstructive sleep apnea in women: specific issues and interventions.Biomed Res Int,2016,1764837.
30. Ye, L(2011).Factors influencing daytime sleepiness in Chinese patients with obstructive sleep apnea.Behav Sleep Med,9,117-127.
31. Young, T,Shahar, E,Nieto, FJ(2002).Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study.Arch Intern Med,162,893-900.
32. Zhong, ZQ,Tao, Y,Zhang, ZP(2011).Relationship between excessive daytime sleepiness and oxygen saturation in obstructive sleep apnea-hypopnea syndrome.Zhonghua Yi Xue Za Zhi,91,40-43.