Unique sleep‐stage transitions determined by obstructive sleep apnea severity, age and gender

Abstract

Summary In obstructive sleep apnea, patients’ sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 209), moderate (n = 222) and severe (n = 272) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two‐step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two‐step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep‐states for power‐laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake‐state durations followed a power‐law distribution, while sleep‐state durations were characterized by an exponential distribution. Sleep‐stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort (n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea‐related clinical outcomes like arterial hypertension and daytime sleepiness.

Effect of Continuous Positive Airway Pressure on Chronic Cough in Patients with Obstructive Sleep Apnea and Concomitant Gastroesophageal Reflux

“…GERD-Q consists of six questions: heartburn, reflux, epigastric pain, nausea, sleep disorder, and anti- Third, previous studies have found a sex difference in the incidence of OSA. 47,48 However, sex did not affect the therapeutic effect of cough in patients with OSA and concomitant GER in present study. It suggested that sex could affect the incidence of OSA, but CPAP therapy was equally important for cough in male and female patients with OSA and concomitant GER.…”

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

“…In this review, the studies represented 28 countries including Argentina, Australia, Belgium, Brazil, Bulgaria, Cameroon, China, Czech Republic, Finland, France, Germany, Greece, India, Iran, Italy, Ireland, Japan, Korea, Lebanon, New Zealand, Poland, Romania, Spain, Saudi Arabia, Slovakia, Taiwan, Turkey, and the United States. A multicenter study, conducted by Wächter et al, 2020 [ 51 ], represented 11 sleep centers in 8 European countries.…”

“…Another cross-sectional study involving 2740 adults in Korea [ 50 ] identified the “high risk” individuals as being older aged and having a BMI ≥ 25 kg/m 2 for OSA. Several other studies that involved large samples included a cross-sectional study ( n = 2208) in Japan addressing the association between hypertension and OSA [ 42 ], a multicenter study ( n = 1877) in Europe looking for the effects of OSA severity and other comorbidities on sleep pattern [ 51 ], a prospective cohort study ( n = 1825) in Korea determining the association between hypertension with OSA in patients with high levels of homocysteine in the blood [ 36 ], and a cross-sectional study ( n = 1272) in Belgium determining the prevalence of hypertension with insomnia [ 32 ].…”

“… Score = 4; high; study design, sample size, sample selection and data analyses, each scored 1. Wächter et al, 2020 [ 51 ] 11 Sleep centers in 8 European countries Multicenter retrospective cohort study 1877 (OSA patients and healthy controls) Hypertension; obesity Effects of OSA severity and potential confounders on sleep architecture were small, but transition patterns still linked sleep fragmentation directly to OSA-related clinical outcomes such as arterial hypertension and daytime sleepiness. Score = 4; high; study design, sample size, sample selection and data analyses, each scored 1.…”

A Short-Time Insomnia Detection System Based on Sleep EOG With RCMSE Analysis

“…The associate editor coordinating the review of this manuscript and approving it for publication was Rajeeb Dey . but has persisted for less than three months, it is considered short-term insomnia [3]. To diagnose insomnia, the physician may first execute a physical exam to look for signs of medical problems that may be related to insomnia and ask some sleep-related questions, such as sleep-wake pattern and daytime sleepiness.…”