More severe hypoxemia is associated with better subjective sleep quality in obstructive sleep apnea

BMC Pulmonary Medicine

Chung-Yao Hsu³  Feng-Cheng Lin⁵  Sun-Wung Hsieh⁴  Cheng-Fang Hsieh⁶  Sharon Chia-Ju Chen¹  Chen-Wen Yen²  Li-Min Liou⁴  Ching-Kuan Liu³  Chiou-Lian Lai³  Meng-Ni Wu³ 

[1] Department of Medical Imaging and Radiation Sciences, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung 807, Taiwan;Department of Mechanical and Electro-mechanical Engineering, National Sun Yat-Sen University, No. 70 Lienhai Rd., Kaohsiung 80424, Taiwan;Department of Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung 807, Taiwan;Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, No. 482 Shanming Rd., Siaogang Dist., Kaohsiung City 812, Taiwan;Department of Health, Pingtung Hospital, No. 270, Ziyou Rd., Pingtung City 900, Pingtung County, Taiwan;Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan

关键词: Sleep quality;    Perception;    Obstructive sleep apnea;    Hypoxemia;    Continuous positive airway pressure;    Compliance;   

Others  :  1228325
DOI  :  10.1186/s12890-015-0112-1

 received in 2014-11-15, accepted in 2015-09-28,  发布年份 2015

【 摘 要 】

Background

Perceived sleep quality may play an important role in diagnosis and therapy for obstructive sleep apnea (OSA). However, few studies have assessed factors that are associated with perceived sleep quality in OSA patients. Hypoxemia depresses the central nervous system and attenuates the perceived respiratory load in asthmatic patients. This study aimed to investigate the factors related to perceived sleep quality, focusing on the role of hypoxemia.

Methods

Polysomnography studies of 156 OSA patients were reviewed. Traditional polysomnographic parameters, including parameters of oxy-hemoglobin saturation (SpO2), were calculated, and the sleep questionnaire and scales were used. Considering the possible pitfalls of absolute values of SpO2 and individualized responses to hypoxemia, the amplitude of desaturation was further computed as “median SpO2 minus lowest 5 % SpO2 “and “highest 5 % SpO2 minus median 5 % SpO2”. Correlations between these parameters and perceived sleep quality, represented as the Pittsburgh sleep quality index (PSQI), were performed. Multiple linear regression analysis was also conducted to investigate the factors associated with the PSQI.

Results

Although the PSQI was not correlated with the apnea-hypopnea index (r = −0.113, p = 0.162) and oxygen desaturation index (r = −0.085, p = 0.291), the PSQI was negatively correlated with “median SpO2 minus lowest 5 % SpO2” (r = −0.161, p = 0.045). After adjusting for age, total sleep time, the periodic limb movements index, tendency of depression, and the lowest 5 % SpO2, the “median SpO2 minus lowest SpO2” was still a significant predictor for a lower PSQI (β = −0.357, p = 0.015).

Conclusions

More severe hypoxemia is associated with better perceived sleep quality among OSA patients. This paradox may be associated with hypoxemia-related impairment of perception. The effect of hypoxemia did not appear to be significant in relatively mild hypoxemia but become significant in severe hypoxemia.” Median SpO2 minus lowest 5 % SpO2” may also be a better predictor of perceived sleep quality than the apnea-hypopnea index because of the disproportionate effects of hypoxemia. Additionally, further studies are necessary to confirm the role of hypoxemia on perceived sleep quality and identify the possible threshold of hypoxemia in OSA patients.

【 授权许可】

   
2015 Wu et al.

【 参考文献 】

• [1]Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328:1230-5.
• [2]Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013; 177:1006-14.
• [3]Barbe F, Duran-Cantolla J, Sanchez-de-la-Torre M, Martinez-Alonso M, Carmona C, Barcelo A et al.. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012; 307:2161-8.
• [4]Bawden FC, Oliveira CA, Caramelli P. Impact of obstructive sleep apnea on cognitive performance. Arq Neuropsiquiatr. 2011; 69:585-9.
• [5]Brown DL, Chervin RD, Hickenbottom SL, Langa KM, Morgenstern LB. Screening for obstructive sleep apnea in stroke patients: a cost-effectiveness analysis. Stroke. 2005; 36:1291-3.
• [6]Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997; 20:608-13.
• [7]Wang Y, Gao W, Sun M, Chen B. Adherence to CPAP in patients with obstructive sleep apnea in a Chinese population. Respir Care. 2012; 57:238-43.
• [8]Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011; 15:343-56.
• [9]Richards D, Bartlett DJ, Wong K, Malouff J, Grunstein RR. Increased adherence to CPAP with a group cognitive behavioral treatment intervention: a randomized trial. Sleep. 2007; 30:635-40.
• [10]Malanda UL, Reulen JP, Saris WH, van Marken Lichtenbelt WD. Hypoxia induces no change in cutaneous thresholds for warmth and cold sensation. Eur J Appl Physiol. 2008; 104:375-81.
• [11]Fowler B, Prlic H. A comparison of visual and auditory reaction time and P300 latency thresholds to acute hypoxia. Aviat Space Environ Med. 1995; 66:645-50.
• [12]Neubauer JA, Melton JE, Edelman NH. Modulation of respiration during brain hypoxia. J Appl Physiol. 1990; 68:441-51.
• [13]Eckert DJ, Catcheside PG, Smith JH, Frith PA, McEvoy RD. Hypoxia suppresses symptom perception in asthma. Am J Respir Crit Care Med. 2004; 169:1224-30.
• [14]Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28:193-213.
• [15]Carpenter JS, Andrykowski MA. Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res. 1998; 45:5-13.
• [16]Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002; 53:737-40.
• [17]Neu D, Mairesse O, Hoffmann G, Dris A, Lambrecht LJ, Linkowski P et al.. Sleep quality perception in the chronic fatigue syndrome: correlations with sleep efficiency, affective symptoms and intensity of fatigue. Neuropsychobiology. 2007; 56:40-6.
• [18]Happe S, Klosch G, Zeitlhofer J. Perception of dreams and subjective sleep quality in patients with myasthenia gravis. Neuropsychobiology. 2004; 50:21-7.
• [19]Hodgson N, Gitlin LN, Huang J. The influence of sleep disruption and pain perception on indicators of quality of life in individuals living with dementia at home. Geriatr Nurs. 2014; 35:394-8.
• [20]Bei B, Milgrom J, Ericksen J, Trinder J. Subjective perception of sleep, but not its objective quality, is associated with immediate postpartum mood disturbances in healthy women. Sleep. 2010; 33:531-8.
• [21]van Maanen JP, de Vries N. Long-term effectiveness and compliance of positional therapy with the sleep position trainer in the treatment of positional obstructive sleep apnea syndrome. Sleep. 2014; 37:1209-15.
• [22]Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.
• [23]Chen NH, Johns MW, Li HY, Chu CC, Liang SC, Shu YH et al.. Validation of a Chinese version of the Epworth sleepiness scale. Qual Life Res. 2002; 11:817-21.
• [24]Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ et al.. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005; 14:1943-52.
• [25]Liu C, Li N, Ren X, Liu D. Is traditional rural lifestyle a barrier for quality of life assessment? A case study using the Short Form 36 in a rural Chinese population. Qual Life Res. 2010; 19:31-6.
• [26]Li HC, Chung OK, Ho KY. Center for Epidemiologic Studies Depression Scale for Children: psychometric testing of the Chinese version. J Adv Nurs. 2010; 66:2582-91.
• [27]Leung CM, Ho S, Kan CS, Hung CH, Chen CN. Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. Int J Psychosom. 1993; 40:29-34.
• [28]de Chazal P, Heneghan C, McNicholas WT. Multimodal detection of sleep apnoea using electrocardiogram and oximetry signals. Philos Trans A Math Phys Eng Sci. 2009; 367:369-89.
• [29]Yang CM, Han HY, Yang MH, Su WC, Lane T. What subjective experiences determine the perception of falling asleep during sleep onset period? Conscious Cogn. 2010; 19:1084-92.
• [30]Kaufmann C, Wehrle R, Wetter TC, Holsboer F, Auer DP, Pollmacher T et al.. Brain activation and hypothalamic functional connectivity during human non-rapid eye movement sleep: an EEG/fMRI study. Brain. 2006; 129:655-67.
• [31]Macey PM, Henderson LA, Macey KE, Alger JR, Frysinger RC, Woo MA et al.. Brain morphology associated with obstructive sleep apnea. Am J Respir Crit Care Med. 2002; 166:1382-7.
• [32]Ayalon L, Ancoli-Israel S, Aka AA, McKenna BS, Drummond SP. Relationship between obstructive sleep apnea severity and brain activation during a sustained attention task. Sleep. 2009; 32:373-81.
• [33]Joo EY, Tae WS, Han SJ, Cho JW, Hong SB. Reduced cerebral blood flow during wakefulness in obstructive sleep apnea-hypopnea syndrome. Sleep. 2007; 30:1515-20.
• [34]Scarlata S, Pedone C, Curcio G, Cortese L, Chiurco D, Fontana D et al.. Pre-polysomnographic assessment using the Pittsburgh Sleep Quality Index questionnaire is not useful in identifying people at higher risk for obstructive sleep apnea. J Med Screen. 2013; 20:220-6.
• [35]Hira HS, Shukla A, Kaur A, Kapoor S. Serum uric acid and lactate levels among patients with obstructive sleep apnea syndrome: which is a better marker of hypoxemia? Ann Saudi Med. 2012; 32:37-42.
• [36]Krakow B, Melendrez D, Ferreira E, Clark J, Warner TD, Sisley B et al.. Prevalence of insomnia symptoms in patients with sleep-disordered breathing. Chest. 2001; 120:1923-9.
• [37]Krell SB, Kapur VK. Insomnia complaints in patients evaluated for obstructive sleep apnea. Sleep Breath. 2005; 9:104-10.
• [38]Gooneratne NS, Gehrman PR, Nkwuo JE, Bellamy SL, Schutte-Rodin S, Dinges DF et al.. Consequences of comorbid insomnia symptoms and sleep-related breathing disorder in elderly subjects. Arch Intern Med. 2006; 166:1732-8.
• [39]Smith S, Sullivan K, Hopkins W, Douglas J. Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS). Sleep Med. 2004; 5:449-56.