Younes Magdy, Giannouli Eleni
Sleep Disorders Centre, Misericordia Health Centre, University of Manitoba, Winnipeg, Canada.
J Clin Sleep Med. 2020 Mar 15;16(3):389-399. doi: 10.5664/jcsm.8214. Epub 2020 Jan 14.
It is uncertain whether obstructive apnea (OSA) or periodic limb movements (PLMs) contribute to excessive wake time (EWT) when EWT and these disorders coexist. We hypothesized that such EWT is an independent disorder related to central regulation of sleep depth. Accordingly, we compared sleep depth in patients with EWT and OSA/PLMs (EWT+P) with patients with EWT and no OSA/PLMs (EWT-NP) and patients with a normal wake time.
A total of 267 participants were divided into five groups: (1) EWT+P: n = 100 (wake time > 20% total recording time; TRT) with OSA (apnea-hypopnea index 5-110 events/h) and/or PLMs (PLM index 10-151 events/h); (2) EWT-NP: n = 49 (wake time > 20%TRT), no associated pathology; (3) normal wake time (NWT)+P: n = 54 (wake time < 20%TRT, with OSA/PLMs); (4) NWT-NP: n = 26; (5) Healthy participants: n = 38 (no sleep complaints, NWT and no OSA/PLMs). Sleep depth was evaluated by the odds ratio product (ORP; 0 = deep sleep, 2.5 = fully alert). We also measured ORP in the 9 seconds immediately following arousals (ORP-9) to distinguish between peripheral and central mechanisms of light sleep.
ORP during sleep was higher (lighter sleep) in both EWT groups than in the three NWT groups (P < 1E-11) with no difference between those with and those without OSA/PLMs. ORP-9 was also significantly higher in the EWT groups than in the NWT groups (P < 1E-19), also with no difference between those with and without OSA/PLMs, indicating that the lighter sleep was of central origin. There were highly significant correlations between wake time and ORP-9 across all groups (P < 1E-35).
EWT associated with OSA/PLMs is independent of OSA/PLMs and related to abnormal central regulation of sleep depth.
当过度觉醒时间（EWT）与阻塞性睡眠呼吸暂停（OSA）或周期性肢体运动（PLMs）共存时，尚不确定OSA或PLMs是否会导致EWT。我们假设这种EWT是一种与睡眠深度的中枢调节相关的独立疾病。因此，我们比较了患有EWT和OSA/PLMs（EWT + P）的患者、患有EWT但无OSA/PLMs（EWT - NP）的患者以及觉醒时间正常的患者的睡眠深度。
总共267名参与者被分为五组：（1）EWT + P：n = 100（觉醒时间>总记录时间的20%；TRT），伴有OSA（呼吸暂停低通气指数为5 - 110次/小时）和/或PLMs（PLM指数为10 - 151次/小时）；（2）EWT - NP：n = 49（觉醒时间>20%TRT），无相关病理情况；（3）正常觉醒时间（NWT）+ P：n = 54（觉醒时间<20%TRT，伴有OSA/PLMs）；（4）NWT - NP：n = 26；（5）健康参与者：n = 38（无睡眠主诉，NWT且无OSA/PLMs）。通过优势比乘积（ORP；0 = 深度睡眠，2.5 = 完全清醒）评估睡眠深度。我们还测量了觉醒后紧接着的9秒内的ORP（ORP - 9），以区分浅睡眠的外周机制和中枢机制。
两个EWT组睡眠期间的ORP均高于三个NWT组（P < 1E - 11），有OSA/PLMs组和无OSA/PLMs组之间无差异。EWT组的ORP - 9也显著高于NWT组（P < 1E - 19），有OSA/PLMs组和无OSA/PLMs组之间同样无差异，表明浅睡眠源于中枢。所有组的觉醒时间与ORP - 9之间存在高度显著的相关性（P < 1E - 35）。
与OSA/PLMs相关的EWT独立于OSA/PLMs，且与睡眠深度的中枢调节异常有关。
