Breathing disturbances without hypoxia are associated with objective sleepiness in sleep apnea.

Breathing disturbances without hypoxia are associated with objective sleepiness in sleep apnea.

Sleep. 2017 Sep 26;:

Authors: Koch H, Schneider LD, Finn LA, Leary EB, Peppard PE, Hagen E, Sorensen HBD, Jennum P, Mignot E

Abstract
Study Objectives: Determine if defining two subtypes of sleep-disordered breathing (SDB) events - with or without hypoxia - results in measures that are more strongly associated with hypertension and sleepiness.
Methods: A total of 1,022 subjects with 2,112 nocturnal polysomnograms (PSGs) from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in 2 indices - desaturating (H-BDI) and non-desaturating (NH-BDI) events - regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2,981 multiple sleep latency tests from a subset of 865 subjects) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥140/90 or antihypertensive use.
Results: H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r≥0.89, p≤0.001 with 3% ODI and AHI with 4%-desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR=1.06, 95% CI=1.00-1.12, p<0.05; H-BDI OR 1.04, 95% CI=0.98-1.10) and daytime sleepiness (β=0.20 ESS score, p<0.0001; β=-0.20 min in MSL on MSLT, p<0.01). Independently, non-desaturating event doubling was associated with more objective sleepiness (β=-0.52 min in MSL on MSLT, p<0.001), but had less association with subjective sleepiness (β=0.12 ESS score, p=0.10). In longitudinal analyses, baseline non-desaturating events were associated with worsening of H-BDI over a 4-year follow up, suggesting evolution in severity.
Conclusions: In SDB, non-desaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.

PMID: 29029253 [PubMed - as supplied by publisher]

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