SleepLab - Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil.
Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One. 2020 Aug 27;15(8):e0238083. doi: 10.1371/journal.pone.0238083. eCollection 2020.
Discrepancies between subjective and objective measures of total sleep time (TST) are frequent among insomnia patients, but this issue remains scarcely investigated in obstructive sleep apnea (OSA). We aimed to evaluate if sleep perception is affected by the severity of OSA.
We performed a 3-month cross-sectional study of Brazilian adults undergoing overnight polysomnography (PSG). TST was objectively assessed from PSG and by a self-reported questionnaire (subjective measurement). Sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5.0/h, being its severity classified according to AHI thresholds: 5.0-14.9/h (mild OSA), 15.0-29.9/h (moderate OSA), and ≥ 30.0/h (severe OSA).
Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups (p = 0.014). Mean SPI values significantly decreased as the OSA severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036. Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028). However, insomnia was not considered as an independent variable for the presence of any OSA, moderate/severe OSA, and severe OSA (all p-values > 0.05).
In a clinical referral cohort, SPI significantly decreases with increasing OSA severity, but is not modified by the presence of insomnia symptoms.
在失眠患者中，主观和客观的总睡眠时间（TST）测量之间存在差异，但阻塞性睡眠呼吸暂停（OSA）中这一问题仍鲜有研究。本研究旨在评估睡眠感知是否受 OSA 严重程度的影响。
我们对巴西进行过夜多导睡眠图（PSG）检查的成年人进行了为期 3 个月的横断面研究。TST 由 PSG 和自我报告的问卷（主观测量）客观评估。睡眠感知指数（SPI）定义为主观和客观值的比值。OSA 的诊断基于呼吸暂停/低通气指数（AHI）≥5.0/h，其严重程度根据 AHI 阈值进行分类：5.0-14.9/h（轻度 OSA）、15.0-29.9/h（中度 OSA）和≥30.0/h（重度 OSA）。
共纳入 727 例患者（58.0%为男性）。非 OSA 组和 OSA 组之间的 SPI 存在显著差异（p=0.014）。随着 OSA 严重程度的增加，SPI 的平均数值显著降低：无 OSA（100.1±40.9%）、轻度 OSA（95.1±24.6%）、中度 OSA（93.5±25.2%）和重度 OSA（90.6±28.2%），p=0.036。使用逻辑回归，SPI 增加与 OSA 发生的可能性降低相关（p=0.018），包括中度/重度 OSA（p=0.019）和重度 OSA（p=0.028）。然而，失眠并未被视为存在任何 OSA、中度/重度 OSA 和重度 OSA 的独立变量（所有 p 值>0.05）。
在临床转诊队列中，SPI 随 OSA 严重程度的增加而显著降低，但不受失眠症状存在的影响。
