睡眠阶段连续性与疑似阻塞性睡眠呼吸暂停患者的客观日间嗜睡有关。

Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea.

机构信息

School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia.

Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.

出版信息

J Clin Sleep Med. 2024 Oct 1;20(10):1595-1606. doi: 10.5664/jcsm.11198.

DOI:10.5664/jcsm.11198

PMID:38722264

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11446124/

Abstract

STUDY OBJECTIVES

Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea is poorly explained by standard clinical sleep architecture metrics. We hypothesized that reduced sleep stage continuity mediates this connection independently from standard sleep architecture metrics.

METHODS

A total of 1,907 patients with suspected obstructive sleep apnea with daytime sleepiness complaints underwent in-lab diagnostic polysomnography and next-day Multiple Sleep Latency Test. Sleep architecture was evaluated with novel sleep-stage continuity quantifications (mean sleep stage duration and probability of remaining in each sleep stage), and conventional metrics (total non-rapid eye movement stages 1, 2, 3 (N1, N2, N3) and rapid eye movement times; and sleep onset latency). Multivariate analyses were utilized to identify variables associated with moderate EDS (5 ≤ mean daytime sleep latency ≤ 10 minutes) and severe EDS (mean daytime sleep latency < 5 minutes).

RESULTS

Compared to those without EDS, participants with severe EDS had lower N3 sleep continuity (mean N3 period duration 10.4 vs 13.7 minutes, < .05), less N3 time (53.8 vs 76.5 minutes, < .05), greater total sleep time (374.0 vs 352.5 minutes, < .05), and greater N2 time (227.5 vs 186.8 minutes, < .05). After adjusting for standard sleep architecture metrics using multivariate logistic regression, decreased mean wake and N3 period duration, and the decreased probability of remaining in N2 and N3 sleep remained significantly associated with severe EDS, while the decreased probability of remaining in wake and N2 sleep were associated with moderate EDS.

CONCLUSIONS

Patients with obstructive sleep apnea and EDS experience lower sleep continuity, noticeable especially during N3 sleep and wake. Sleep-stage continuity quantifications assist in characterizing the sleep architecture and are associated with objective daytime sleepiness highlighting the need for more detailed evaluations of sleep quality.

CITATION

Chen X, Leppänen T, Kainulainen S, et al. Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea. . 2024;20(10):1595-1606.

摘要

研究目的

阻塞性睡眠呼吸暂停患者的日间嗜睡（EDS）用标准临床睡眠结构指标无法很好地解释。我们假设睡眠阶段连续性的降低独立于标准睡眠结构指标来介导这种联系。

方法

共有 1907 名有日间嗜睡主诉的疑似阻塞性睡眠呼吸暂停患者接受了实验室诊断性多导睡眠图和次日多次睡眠潜伏期试验。采用新的睡眠阶段连续性定量评估方法（平均睡眠阶段持续时间和每个睡眠阶段的保持概率）和传统指标（总非快速眼动阶段 1、2、3（N1、N2、N3）和快速眼动时间；以及睡眠潜伏期）评估睡眠结构。利用多元分析来确定与中度 EDS（5≤平均日间睡眠潜伏期≤10 分钟）和重度 EDS（平均日间睡眠潜伏期<5 分钟）相关的变量。

结果

与无 EDS 的参与者相比，重度 EDS 参与者的 N3 睡眠连续性较低（平均 N3 期持续时间为 10.4 分钟与 13.7 分钟， <.05），N3 时间较短（53.8 分钟与 76.5 分钟， <.05），总睡眠时间较长（374.0 分钟与 352.5 分钟， <.05），N2 时间较长（227.5 分钟与 186.8 分钟， <.05）。使用多元逻辑回归调整标准睡眠结构指标后，平均清醒和 N3 期持续时间减少，以及 N2 和 N3 睡眠保持概率降低与重度 EDS 仍显著相关，而清醒和 N2 睡眠保持概率降低与中度 EDS 相关。

结论

阻塞性睡眠呼吸暂停伴 EDS 的患者睡眠连续性较低，尤其是在 N3 睡眠和清醒期间更为明显。睡眠阶段连续性定量评估有助于描述睡眠结构，并与客观日间嗜睡相关，突出了对睡眠质量进行更详细评估的必要性。

引文

Chen X, Leppänen T, Kainulainen S, et al. Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea.. 2024;20(10):1595-1606.