Predictors of Objective Level of Daytime Sleepiness in Patients with Sleep-Related Breathing Disorders

Roehrs, Timothy; Zorick, Frank; Wittig, Robert M.; Conway, William; Roth, Thomas

doi:10.1378/chest.95.6.1202

Cited by 193 publications

(105 citation statements)

References 10 publications

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“…In line with BENNETT et al [18], this finding suggests that the index of respiratory disturbances may play a primary role in the degree of sleepiness. In contrast, in the present study, sleep fragmentation measures were not related to the waking EEG changes, although apnoea-related sleep fragmentation has been shown to play a role in sleep propensity [19][20][21]. Therefore, in agreement with previous reports [6,[22][23][24], the current results suggest that the severity of nocturnal hypoxaemia, as opposed to sleep fragmentation, could be the primary determinant of impaired alertness, especially in severe OSAHS patients who exhibit numerous and deep sleep oxygen desaturation events.…”

Section: Discussioncontrasting

confidence: 96%

Severity of obstructive sleep apnoea/hypopnoea syndrome and subsequent waking EEG spectral power

Grenèche¹,

Saremi²,

Erhardt³

et al. 2008

Eur Respir J

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It is well known that most patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) suffer sleepiness, although the underlying mechanisms of this relationship remain unclear. The present study examined the relationship between nocturnal variables and the subsequent waking electroencephalogram (EEG), in order to determine if sleepiness was related to OSAHS severity and due to sleep fragmentation or to nocturnal hypoxaemia.In total, 12 moderate-to-severe OSAHS patients underwent a total sleep night followed by a 24-h period of sustained wakefulness where the waking EEG was measured every hour.The results showed that alpha (7.9-12.6 Hz) and beta (12.7-29.2 Hz) activities were strongly related to OSAHS severity, mainly reflected by the apnoea index. Moreover, spectral power in most of the waking EEG components was significantly correlated with nocturnal hypoxaemia indices, namely alpha and beta activity when hypoxaemia becomes severe. However, no correlation was found between the waking EEG and sleep fragmentation parameters.In conclusion, the present results suggest that the difficulty in maintaining an optimal level of alertness, reflected by a higher activity in awake alpha and beta bands (7.9-29.2 Hz) in obstructive sleep apnoea/hypopnoea syndrome, was better explained by: 1) the apnoea as opposed to the hypopnoea index; and 2) nocturnal hypoxaemia as opposed to sleep fragmentation.

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Section: Discussioncontrasting

confidence: 96%

Severity of obstructive sleep apnoea/hypopnoea syndrome and subsequent waking EEG spectral power

Grenèche¹,

Saremi²,

Erhardt³

et al. 2008

Eur Respir J

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“…4). frequent apnoeas (Wittig et al 1984). However, since most of It was frequently noted that limb movements were the subjects were snorers with daytime somnolence, some accompanied by changes in the EEG which did not meet the unexplained arousals may be related to abnormal respiratory criteria for arousal.…”

Section: Periodic Limb Movement Disordermentioning

confidence: 99%

Evaluation of activity‐based techniques to identify transient arousal in respiratory sleep disorders

Drinnan

Murray

White

et al. 1996

Journal of Sleep Research

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SUMMARY Daytime sleepiness and impaired cognitive function can be a consequence of recurrent transient arousal from sleep. Arousal is often associated with abrupt changes in the electroencephalogram (EEG), and such changes can be used as an index of sleep disturbance, but EEG analysis is laborious and requires trained observers. Possible alternative indices of arousal not reliant on EEG analysis were investigated. Recordings were made from 36 sleeping subjects who were being investigated for sleep-related breathing disorders. In each study awakenings and transient arousals according to EEG criteria were compared with activity in five potential indirect indicators of arousal: wrist movement, ankle movement, left and right tibial electromyogram, and phase change in ribcage-abdominal movement. The mean values of sensitivity to arousal ranged from only 25 to 45%. However, their high positive predictive accuracies (PPAs, 68 to 92%) indicated that activity, when present, was usually associated with arousal. Sensitivity to awakenings was higher (71-87%), though PPAs were lower (42 to 63%). For the indicator based on ribcage-abdominal phase, the number of periods of activity showed a significant relation to the number of arousals (r=0.70, P<0.001).It can be concluded that phase changes in chest/abdomen movement are a useful indicator of arousal associated with obstructive apnoea and related conditions. Limb activity has much lower sensitivity for transient arousal, but may be of value in indicating periods of wakefulness.

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“…PLMs with arousals (Table 4). With CPAP therapy these five Increased daytime vigilance is associated with a restoration patients demonstrated a median of 14.5 (10.2, 26.7) PLM of physiological sleep quality and less sleep fragmentation associated arousals/h TIB, and 3 months postoperatively a (Guilleminault et al 1988;Roehrs et al 1989;Martin et al median of 17.2 (16.4, 26.4) PLM arousals/h TIB. 1996), both with CPAP and after surgical treatment by MMO.…”

mentioning

confidence: 99%

“…In patients with fragmented Germany). sleep, daytime vigilance is reduced (Stepanski et al 1984; Apnoeas were scored by definition (Guilleminault et al Roehrs et al 1989). Continuous positive airway pressure 1976).…”

mentioning

confidence: 99%

Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy

Conradt

Hochban

Heitmann

et al. 1998

Journal of Sleep Research

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SUMMARY Impaired vigilance is a frequent daytime complaint of patients with obstructive sleep apnoea (OSA). To date, continuous positive airway pressure (CPAP) is a well established therapy for OSA. Nevertheless, in patients with certain craniofacial characteristics, maxillomandibular advancement osteotomy (MMO) is a promising surgical treatment. Twenty-four male patients with OSA (pretreatment respiratory disturbance index (RDI) 59.3 SD±24.1 events/h) participated in this investigation. The mean age was 42.7±10.7 years and the mean body mass index was 26.7±2.9 kg/ m 2 . According to cephalometric evaluation, all patients had a narrow posterior airway space, more or less due to severe maxillary and mandibular retrognathia. All patients except two were treated first with CPAP for at least 3 months and afterwards by MMO. Two patients only tolerated a CPAP trial for 2 nights. Polysomnographic investigation and daytime vigilance were assessed before therapy, with CPAP therapy and 3 months after surgical treatment. Patients' reports of impaired daytime performance were confirmed by a pretreatment vigilance test using a 90-min, fourchoice reaction-time test. The test was repeated with effective CPAP therapy and postoperatively. Daytime vigilance was increased with CPAP and after surgical treatment in a similar manner. Respiratory and polysomnographic patterns clearly improved, both with CPAP and after surgery, and showed significant changes compared to the pretreatment investigation. The RDI decreased significantly, both with CPAP (5.3±6.0) and postoperatively (5.6±9.6 events/h). The percentages of non-rapid eye movement Stage 1 (NREM 1) sleep showed a marked decrease (with CPAP 8.2±3.6% and after MMO 8.2±4.4% vs. 13.3±7.4% before treatment), whereas percentages of slow wave sleep increased significantly from 8.0±6.1% before therapy to 18.2±12.8 with CPAP and 14.4±7.3% after MMO. The number of awakenings per hour time in bed (TIB) was significantly reduced after surgery (2.8±1.3), compared to both preoperative investigation (baseline 4.2±2.0 and CPAP 3.4±1.5). Brief arousals per hour TIB were reduced to half with CPAP (19.3±20.0) and after MMO (19.7±13.6), compared to baseline (54.3±20.0). We conclude that the treatment of OSA by MMO in carefully selected cases has positive effects on sleep, respiration and daytime vigilance, which are comparable to CPAP therapy. maxillomandibular advancement, sleep apnoea, surgical treatment, daytime vigilance

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Predictors of Objective Level of Daytime Sleepiness in Patients with Sleep-Related Breathing Disorders

Cited by 193 publications

References 10 publications

Severity of obstructive sleep apnoea/hypopnoea syndrome and subsequent waking EEG spectral power

Severity of obstructive sleep apnoea/hypopnoea syndrome and subsequent waking EEG spectral power

Evaluation of activity‐based techniques to identify transient arousal in respiratory sleep disorders

Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy

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