Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
J Sleep Res. 2022 Dec;31(6):e13690. doi: 10.1111/jsr.13690. Epub 2022 Jul 22.
Excessive daytime sleepiness (EDS) is a hallmark symptom in obstructive sleep apnea (OSA). It is commonly eliminated by obstructive sleep apnea therapy and constitutes a major treatment indication. This study aimed to identify determinants of excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS) scores in the large, representative national obstructive sleep apnea patient cohort of the Swedish Sleep Apnea Registry (SESAR, www.sesar.se). Data from 34,684 patients with obstructive sleep apnea recruited at 23 sites (33% females, mean age 55.7 ± 13.7 years, BMI 30.2 ± 6.3 kg/m , AHI 29.1 ± 22.3, and ODI 24.9 ± 21.4 events/h) had a mean ESS score in the mild to moderate excessive daytime sleepiness range (9.7 ± 4.9). The proportion of patients with excessive daytime sleepiness was 41.4% in men and 44.6% in women. Independent predictors of excessive daytime sleepiness included gender, age, and hypoxic markers (high ODI and low mean saturation). Univariate and multivariate analyses were used to identify significant predictors for the ESS score and for excessive daytime sleepiness (ESS ≥10) amongst anthropometric factors, sleep apnea frequency (apnea-hypopnea index (AHI)), markers of intermittent hypoxia (oxygen desaturation index (ODI), mean saturation (mSaO )), as well as prevalent comorbidities. Depression was associated with higher ESS scores and hypertension/atrial fibrillation with lower scores. The oxygen desaturation index provided a stronger predictor of excessive daytime sleepiness than the apnea-hypopnea index. The severity of obstructive sleep apnea, captured as the apnea-hypopnea index, was only weakly associated with daytime sleepiness in this representative obstructive sleep apnea patient cohort. Age had different effects in men and women.The impact of obstructive sleep apnea in a wider patient related perspective needs to be determined after the inclusion of factors other than the apnea-hypopnea index.
日间嗜睡（EDS）是阻塞性睡眠呼吸暂停（OSA）的标志性症状。它通常通过阻塞性睡眠呼吸暂停治疗消除，是主要的治疗指征。本研究旨在通过瑞典睡眠呼吸暂停登记处（SESAR，www.sesar.se）的大型、代表性全国阻塞性睡眠呼吸暂停患者队列中的Epworth 睡眠量表（ESS）评分，确定日间嗜睡的决定因素。该队列包括 34684 名在 23 个地点招募的阻塞性睡眠呼吸暂停患者（33%为女性，平均年龄 55.7±13.7 岁，BMI 30.2±6.3 kg/m 2 ，AHI 29.1±22.3，ODI 24.9±21.4 事件/小时），其 ESS 评分处于轻度至中度日间嗜睡范围（9.7±4.9）。男性患者中，日间嗜睡的比例为 41.4%，女性为 44.6%。日间嗜睡的独立预测因素包括性别、年龄和低氧标志物（高 ODI 和低平均饱和度）。单变量和多变量分析用于识别 ESS 评分和日间嗜睡（ESS≥10）的显著预测因素，包括人体测量因素、睡眠呼吸暂停频率（呼吸暂停低通气指数（AHI））、间歇性低氧标志物（氧减饱和指数（ODI））、平均饱和度（mSaO ））以及常见合并症。抑郁与 ESS 评分升高有关，高血压/心房颤动与 ESS 评分降低有关。与 AHI 相比，氧减饱和指数对日间嗜睡的预测作用更强。在这个具有代表性的阻塞性睡眠呼吸暂停患者队列中，阻塞性睡眠呼吸暂停的严重程度，以呼吸暂停低通气指数表示，与日间嗜睡仅呈弱相关。年龄对男性和女性的影响不同。需要在纳入除 AHI 以外的因素后，确定阻塞性睡眠呼吸暂停在更广泛的患者相关方面的影响。
