Center of Sleep Disorders, Medical School of Athens University, Dept of Critical Care and Pulmonary Services, Evangelismos Hospital, Greece.
Eur Respir J. 2009 Sep;34(3):687-93. doi: 10.1183/09031936.00124708. Epub 2009 Apr 8.
Some patients with obstructive sleep apnoea syndrome (OSAS; respiratory distress index (RDI) of >5 events.h(-1)) experience residual excessive daytime subjective sleepiness (Epworth Sleepiness Scale (ESS) score of >10), despite adequate use of continuous positive airway pressure (CPAP) therapy. The aim of the present study was to identify clinical and polysomnographic predictors of this sleepiness. Clinical and polysomnographic variables and ESS score were evaluated in 208 OSAS patients with an ESS score of >10 before (initial assessment) and after > or =6 months of adequate (> or =4 h.day(-1)) CPAP use. Following CPAP treatment, 114 (55%) patients showed an abnormal ESS score (>10; CPAP nonresponders), whereas 94 (45%) showed a normal ESS score (<11; CPAP responders). Of the CPAP responders, none had a history of depression, whereas the converse was true for 38.8% of CPAP nonresponders. In addition, multivariate logistic regression analysis revealed that the independent predictors of residual excessive daytime sleepiness following CPAP therapy were a history of diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment. In conclusion, predictors of residual excessive sleepiness in adequately CPAP-treated OSAS were a history of depression, diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment.
一些阻塞性睡眠呼吸暂停综合征（OSAS；呼吸窘迫指数（RDI）>5 次/小时）患者尽管充分使用持续气道正压通气（CPAP）治疗，但仍存在残余日间过度嗜睡（Epworth 嗜睡量表（ESS）评分>10）。本研究旨在确定这种嗜睡的临床和多导睡眠图预测因素。对 208 例 ESS 评分>10 的 OSAS 患者进行临床和多导睡眠图变量以及 ESS 评分评估，这些患者在充分（>或=4 小时/天）CPAP 使用>或=6 个月前（初始评估）和之后。在 CPAP 治疗后，114 例（55%）患者 ESS 评分异常（>10；CPAP 无反应者），94 例（45%）患者 ESS 评分正常（<11；CPAP 反应者）。在 CPAP 反应者中，无抑郁史者，而 CPAP 无反应者中则有 38.8%有抑郁史。此外，多变量逻辑回归分析显示，CPAP 治疗后残余日间嗜睡的独立预测因素是糖尿病和心脏病病史，以及初始评估时 ESS 评分较高和 RDI 较低。总之，在接受充分 CPAP 治疗的 OSAS 患者中，残余日间嗜睡的预测因素是抑郁、糖尿病和心脏病病史，以及初始评估时 ESS 评分较高和 RDI 较低。
