Gottlieb D J, Yao Q, Redline S, Ali T, Mahowald M W
Department of Medicine, Boston University School of Medicine and VA Boston Healthcare System, Boston, Massachusetts, USA.
Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1512-7. doi: 10.1164/ajrccm.162.4.9911073.
Obstructive apneas and hypopneas during sleep are a well recognized cause of excessive daytime sleepiness. Snoring is also associated with excess sleepiness, although it is not known whether this reflects an independent effect of snoring or whether snoring is simply a marker for obstructive sleep apnea. To further explore the relation of snoring to sleepiness, we conducted a cross-sectional cohort study of community-dwelling adults participating in the Sleep Heart Health Study. The study sample comprises 2,737 men and 3,040 women with a mean age of 64 (SD 11) yr. Sleepiness was quantified using the Epworth Sleepiness Scale (ESS). Snoring history was obtained via a self-completion questionnaire. The respiratory disturbance index (RDI), defined as the number of apneas plus hypopneas per hour of sleep, was measured during in-home polysomnography. The ESS score increased progressively with increasing RDI, from a mean of 7.1 (4.2) in subjects with RDI < 1.5 to 8.8 (4.8) in subjects with RDI >/= 15 (p < 0.001). A progressive increase in ESS score was also seen across five categories of snoring frequency, from 6.4 (4.2) in current nonsnorers to 9.3 (4.8) in subjects who snored six to seven nights per week (p < 0.001). The prevalence of excessive daytime sleepiness, defined as an ESS score >/= 11, increased from 15% in never-snorers to 39% in those who snored six to seven nights per week. The relation of snoring to sleepiness was seen at all levels of RDI, with no significant change in the relation of snoring to ESS score after adjustment for RDI in multivariate models. The effects of snoring and RDI on sleepiness were little affected by adjustment for age, sex, race, body mass index, or questionnaire evidence of insufficient sleep time or nocturnal leg jerks or cramps. We conclude that both snoring and RDI are independently associated with excess sleepiness in community-dwelling, middle-aged and older adults.
睡眠期间的阻塞性呼吸暂停和呼吸不足是导致日间过度嗜睡的一个公认原因。打鼾也与过度嗜睡有关，不过尚不清楚这是反映了打鼾的独立影响，还是打鼾仅仅是阻塞性睡眠呼吸暂停的一个标志。为了进一步探究打鼾与嗜睡之间的关系，我们对参与睡眠心脏健康研究的社区成年居民进行了一项横断面队列研究。研究样本包括2737名男性和3040名女性，平均年龄为64（标准差11）岁。使用爱泼华嗜睡量表（ESS）对嗜睡程度进行量化。通过自填问卷获取打鼾史。呼吸紊乱指数（RDI）定义为每小时睡眠中呼吸暂停加呼吸不足的次数，在家庭多导睡眠图监测期间进行测量。ESS评分随着RDI的增加而逐渐升高，RDI<1.5的受试者平均评分为7.1（4.2），RDI≥15的受试者平均评分为8.8（4.8）（p<0.001）。在打鼾频率的五个类别中，ESS评分也呈逐渐升高趋势，从不打鼾者的6.4（4.2）升高到每周打鼾6至7晚的受试者的9.3（4.8）（p<0.001）。定义为ESS评分≥11的日间过度嗜睡患病率从从不打鼾者的15%升至每周打鼾6至7晚者的39%。在所有RDI水平上均可见打鼾与嗜睡之间的关系，在多变量模型中对RDI进行校正后，打鼾与ESS评分之间的关系无显著变化。年龄、性别、种族、体重指数，或睡眠时间不足、夜间腿部抽搐或痉挛的问卷证据进行校正后，打鼾和RDI对嗜睡的影响几乎未受影响。我们得出结论，在社区居住的中老年人中，打鼾和RDI均与过度嗜睡独立相关。
