Clinical and Polysomnographic Features Associated with Poor Sleep Quality in Patients with Obstructive Sleep Apnea

Abstract

Background and Objectives: Poor sleep quality in patients with obstructive sleep apnea (OSA) may be associated with different clinical and polysomnographic features. The aim of this study was to identify features associated with poor sleep quality in OSA patients. Materials and Methods: This was a cross-sectional study enrolling patients with OSA confirmed by polysomnography (PSG). In addition to gathering clinical data, patients were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Clinical Global Impression Scale. Univariate and multivariable analyses were performed to identify factors associated with an increased risk of poor sleep quality in this population. Results: Among 505 enrolled patients (mean age of 57.1 years, 69.7% male) poor quality of sleep (PSQI score ≥ 5) was confirmed in 68.9% of them. Multivariable analysis revealed the following factors associated with poor sleep quality: chronic heart failure (OR 3.111; 95% CI, 1.083–8.941, p = 0.035), male sex (OR 0.396; 95% CI, 0.199–0.787, p = 0.008), total ESS score (OR 1.193; 95% CI, 1.124–1.266, p < 0.001), minimal saturation during sleep (OR 1.034; 95% CI, 1.002–1.066, p = 0.036), and N3 percentage of total sleep time (OR 1.110; 95% CI, 1.027–1.200, p = 0.009). Conclusions: Our study suggests that both the female sex and coexistence of heart failure are independent risk factors for poor sleep quality. Moreover, we hypothesize that nocturnal hypoxia may lead to a misperception of sleep quality and may explain the counterintuitive association between a higher proportion of deep sleep and poor sleep quality.

Assessment of Cerebral Hypoxemia and Its Impact on Cognitive and Psychological Functions in Patients With Obstructive Sleep Apnea Syndrome

“…OSA patients showed significant increases in the ESS and the PSQI compared to the control group. These findings aligned with Kania et al [33], who found a strong relationship between sleepiness and sleep quality. Additionally, Buysse et al [34] confirmed that OSA was linked to sleep fragmentation caused by recurring arousal from apneas, resulting in excessive daytime sleepiness and inadequate sleep quality.…”

Comorbidity of Sleep Disorders, Mental Illness, and Migraine or Headaches

“…The comorbid relationship between sleep apnea and hypersomnia is high. While sleep apnea may be directly influencing hypersomnia, it is possible that other factors contributing to sleep apnea are also contributing to hypersomnia [55].…”

Patient-Reported Outcome Measurements in Patients with COPD-Obstructive Sleep Apnea Overlap Syndrome: Time for Action?

“…The cutoff for abnormal sleep is >5, and worse sleep quality is associated with higher scores [75]. The PSQI has been used in patients with OSA giving data on poor sleep quality related to cardiovascular comorbidities, daytime sleepiness, and nocturnal desaturation [76]. In a study including patients with COPD, PSQI scores were worse in patients with lower diffusion capacity [77], while higher scores correlated to exacerbation frequency [78] and increased symptoms according to CAT [79].…”

“…QoL impairment due to physical or emotional problems [49,50] 3 [49] Moderate-good correlations of all components to disease severity and symptoms (CAT) [59,60] Lower scores compared to general population [ ≥5 [75] Lower scores in patients with reduced DL CO [77] Higher scores correlated to exacerbation frequency [78] and increased symptoms (CAT) [79] Higher scores associated with CVD comorbidities, daytime sleepiness (ESS) and nocturnal desaturation [76] No difference in sleep quality compared to COPD only [80] SAQLI QoL in terms of daily functioning, social interaction, emotional functioning and symptoms [81] N/A Improvements in daily functioning component after high-intensity NIV therapy in stable hypercapnic COPD [83] Impaired QoL compared to controls [25]. Long-term improvements after CPAP treatment in severe and moderate OSA [82] N/A N/A for BDI (5 for BDI-II) [103] Associations with symptom severity [92], poor HRQoL [93] and exacerbation frequency [94] Increased levels of anxiety and depression compared to controls [91] N/A HADS Levels of anxiety and depression in a general medical population [95] 1.5 in COPD [104], 8 in OSA [96] Diagnostic of depression [98] Associations with disease severity [99] and exacerbation frequency [100].…”