Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apnea

Bjorvatn, Bjørn; Lehmann, Sverre; Gulati, Shashi; Aurlien, Harald; Pallesen, Ståle; Saxvig, Ingvild West

doi:10.1007/s11325-015-1155-5

Cited by 76 publications

(64 citation statements)

References 31 publications

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“…Only 13% of all of our male participants were classified as excessively sleepy using the Epworth Sleepiness Scale, which is consistent with population estimates from recent international literature 7 but considerably less than the 40% to 58% in patients referred to sleep clinics. 23 Sleepiness does not correlate well with OSA severity 24 and in our study the percentage of men with excessive sleepiness remained similar irrespective of the presence or severity of undiagnosed OSA. However, in the current study, the men with undiagnosed OSA and EDS have the highest likelihood of having depressive symptoms, in comparison with those with either condition alone.…”

Section: Discussioncontrasting

confidence: 56%

“…EDS is considered a cardinal symptom of OSA and is also known to be associated with depression. 23,24 Due to the effect on daytime functioning, EDS is likely to be a factor in self-referral to a general practitioner for (A,B) AHI with or without EDS and (C,D) Epworth Sleepiness Scale scores with differing OSA severities split by type of depression questionnaire. *Presented probabilities are for a non-smoking, married man with median age (59 years) and waist circumference (99.3 cm), not suffering from either financial strain or erectile dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study

Lang

Appleton

Vakulin

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: To determine whether undiagnosed obstructive sleep apnea (OSA) and/or excessive daytime sleepiness are associated with symptomatic depression in Australian men. Methods: Participants were randomly selected, urban community dwelling men aged 40 to 88 years without a prior diagnosis of OSA. Clinically significant depressive symptoms were assessed using the Beck Depression Inventory-1A or Centre for Epidemiological Studies Depression Scale (2007)(2008)(2009)(2010). A random sample of men (n = 788) undertook full at-home unattended polysomnography (Embletta X100, Broomfield, Colorado, United States) and completed the Epworth Sleepiness Scale questionnaire (2010)(2011)(2012). Results: Undiagnosed severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/h) was associated with depressive symptoms (adjusted odds ratio = 1.98; 95% confidence interval [CI] 1.05-3.73; P = .036). However, a significant interaction was observed between obstructive sleep apnea and excessive daytime sleepiness (P = .03) such that individuals with OSA and excessive daytime sleepiness (Epworth Sleepiness Scale score of 10 or higher) exhibited the strongest associations with depression (mild-moderate apnea: adjusted odd ratio = 3.86; 95% CI 1.87-7.95; severe apnea: adjusted odd ratio = 4.82; 95% CI 1. 42-16.35) when compared to individuals without apnea. Conclusions: Depressive symptoms in men were associated with undiagnosed OSA in the community. It is important that clinicians and primary care practitioners consider screening for depression in men with severe OSA and for OSA in men with depression. Screening for depression should also be considered in men with excessive daytime sleepiness regardless of OSA severity.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study

Lang

Appleton

Vakulin

et al. 2017

Journal of Clinical Sleep Medicine

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“…Although some studies have shown a positive correlation between AHI and the severity of depression [30, 53], we have demonstrated similar to Ong et al [29] that subjects with an AHI ≥15/h had a lower self-reported severity of depression than subjects with AHI <15/h, and that the self-reported severity of depression is not a risk factor for moderate to severe OSA. In addition, Bjorvatn et al [54] have shown that the prevalence of insomnia decreased when the severity of OSA increased, which enables better understanding of our results. Indeed, in our study, we have shown that both the lower severity of insomnia (only in univariate analysis) and the lower complaint of maintenance insomnia are associated with a greater risk of moderate to severe OSA.…”

Section: Discussionmentioning

confidence: 54%

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects

et al. 2017

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BackgroundSeveral studies have investigated the prevalence and risk factors of insomnia in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of insomnia sufferers.MethodsData from 1311 insomnia sufferers who were recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as the cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.ResultsThe prevalence of moderate to severe obstructive sleep apnea syndrome in our sample of insomnia sufferers was 13.88%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower maintenance insomnia complaint, presence of metabolic syndrome, age ≥ 50 & <65 years, age ≥ 65 years, BMI ≥ 25 & <30 kg/m2, BMI >30 kg/m2, and CRP >7 mg/L were significant risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.ConclusionModerate to severe obstructive sleep apnea syndrome is a common pathology in insomnia sufferers. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.

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“…Up to sixty percent of OSA patients can be excessively sleepy [30] and report higher rates of impaired concentration, mood lability, and other neurocognitive difficulties [31]. Epidemiologic studies demonstrate that excessive daytime sleepiness (EDS) modifies the relationship between AHI and incidence of hypertension [32], glucose metabolism [33], and mortality [34].…”

Section: Potential Clinically Relevant Osa Phenotypesmentioning

confidence: 99%

Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches

Zinchuk

Gentry

Concato

et al. 2017

Sleep Medicine Reviews

251

153

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Summmary Obstructive sleep apnea (OSA) is a complex and heterogeneous disorder and the apnea hypopnea index alone can not capture the diverse spectrum of the condition. Enhanced phenotyping can improve prognostication, patient selection for clinical trials, understanding of mechanisms, and personalized treatments. In OSA, multiple condition characteristics have been termed “phenotypes.” To help classify patients into relevant prognostic and therapeutic categories, an OSA phenotype can be operationally defined as: “A category of patients with OSA distinguished from others by a single or combination of disease features, in relation to clinically meaningful attributes (symptoms, response to therapy, health outcomes, quality of life).” We review approaches to clinical phenotyping in OSA, citing examples of increasing analytic complexity. Although clinical feature based OSA phenotypes with significant prognostic and treatment implications have been identified (e.g., excessive daytime sleepiness OSA), many current categorizations lack association with meaningful outcomes. Recent work focused on pathophysiologic risk factors for OSA (e.g., arousal threshold, craniofacial morphology, chemoreflex sensitivity) appears to capture heterogeneity in OSA, but requires clinical validation. Lastly, we discuss the use of machine learning as a promising phenotyping strategy that can integrate multiple types of data (genomic, molecular, cellular, clinical) to identify unique, meaningful OSA phenotypes.

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Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apnea

Abstract: Both excessive sleepiness and insomnia were seen in high proportions of the patients referred on suspicion of OSA. Excessive sleepiness was higher whereas insomnia was lower with greater OSA severity.

Cited by 76 publications

References 31 publications

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects

Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches

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