Covassin Naima, Lu Dongmei, St Louis Erik K, Chahal Anwar A, Schulte Phillip J, Mansukhani Meghna P, Xie Jiang, Lipford Melissa C, Li Nanfang, Ramar Kannan, Caples Sean M, Gay Peter C, Olson Eric J, Silber Michael H, Li Jingen, Somers Virend K
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
Front Neurosci. 2023 Jun 23;17:1210206. doi: 10.3389/fnins.2023.1210206. eCollection 2023.
Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA.
Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness ( = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality.
In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality.
The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.
日间过度嗜睡（EDS）在阻塞性睡眠呼吸暂停（OSA）中很常见，并且与不良后果有关，尽管这种关联并不一致。此外，EDS的预后影响是否因性别而异尚不清楚。我们旨在评估EDS与OSA男性和女性的慢性病及死亡率之间的关联。
纳入2009年11月至2017年4月在梅奥诊所接受睡眠评估并完成Epworth嗜睡量表（ESS）以评估嗜睡程度的新诊断成年OSA患者（n = 14,823）。多变量调整回归模型用于研究嗜睡（ESS作为二元变量建模，即ESS>10，以及作为连续变量）与慢性病和全因死亡率之间的关系。
在横断面分析中，ESS>10与男性OSA患者患高血压的风险较低独立相关（比值比[OR]，95%置信区间[CI]：0.76，0.69 - 0.83），并且与OSA男性（OR，1.17，95% CI 1.05 - 1.31）和女性（OR 1.26，95% CI 1.10 - 1.45）患糖尿病的风险较高相关。注意到ESS评分与抑郁症和癌症之间存在性别特异性曲线关系。在中位随访6.2（4.5 - 8.1）年后，在调整基线人口统计学、睡眠特征和合并症后，ESS>10的OSA女性与ESS≤10的女性相比，全因死亡的风险比为1.24（95% CI 1.05 - 1.47）。在男性中，嗜睡与死亡率无关。
EDS对OSA发病率和死亡风险的影响因性别而异，仅在女性患者中，嗜睡与过早死亡的更高易感性独立相关。应优先努力降低OSA女性的死亡风险并恢复其日间警觉性。
