Gouveris H, Deiß A, Hackenberg B, Bahr-Hamm K, Huppertz T, Ludwig K, Matthias C, Simon P
Sleep Medicine and Neurostimulation Center & Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany.
Sleep Medicine and Neurostimulation Center & Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany.
Sleep Med. 2025 May;129:292-296. doi: 10.1016/j.sleep.2025.02.035. Epub 2025 Feb 26.
Previous preliminary evidence suggests insomnia features playing a major causative or confounding role in daytime sleepiness in obstructive sleep apnea (OSA) patients. We investigated further this hypothesis in a larger OSA patient cohort. In a cross-sectional study in a tertiary medical center, consecutive patients presenting with suspected OSA, but without other sleepiness-promoting comorbidities, and tested by in-lab polysomnography (PSG) were evaluated prospectively for excessive daytime sleepiness (EDS) using the Epworth Sleepiness Scale (ESS) and for insomnia using the Insomnia Severity Index (ISI) respectively. Two hundred and thirty patients (63 female; average age: 54,1 y) were included in this OSA treatment-naïve cohort. ISI values correlated best (Spearman's rho = 0,29, p < .001) with the total ESS score than any PSG -associated metric did. Especially ISI item 7- (interference of sleep problems with daily functions, r = 0,33, p < .001) and item 2 - (difficulty staying asleep, r = 0,28, p < .001) and to a lesser degree item 4 - (satisfaction with own current sleep patterns, r = 0,23, p = 0,025) scores showed significant correlations. Notably, no single significant correlation was found between ESS score and any PSG-metric at all. In a multiple regression analysis, the ISI item 7 score emerged as the sole significant independent predictor of the ESS score. We conclude that insomnia may significantly impact patient-reported daytime sleepiness in OSA patients. We suggest that assessment of insomnia symptoms and features (e.g. by means of ISI) should always be performed in OSA patients reporting daytime sleepiness. We propose that these preliminary findings should be validated in larger and diverse cohorts of OSA patients.
先前的初步证据表明，失眠特征在阻塞性睡眠呼吸暂停（OSA）患者的日间嗜睡中起主要的因果或混杂作用。我们在更大的OSA患者队列中进一步研究了这一假设。在一家三级医疗中心进行的一项横断面研究中，对连续出现疑似OSA但无其他促嗜睡合并症且通过实验室多导睡眠图（PSG）检测的患者，分别使用爱泼华嗜睡量表（ESS）对日间过度嗜睡（EDS）进行前瞻性评估，并使用失眠严重程度指数（ISI）对失眠进行评估。该未接受过OSA治疗的队列纳入了230名患者（63名女性；平均年龄：54.1岁）。与任何PSG相关指标相比，ISI值与ESS总分的相关性最佳（斯皮尔曼相关系数ρ = 0.29，p <.001）。特别是ISI第7项（睡眠问题对日常功能的干扰，r = 0.33，p <.001）、第2项（难以入睡，r = 0.28，p <.001）以及程度稍轻的第4项（对自己当前睡眠模式的满意度，r = 0.23，p = 0.025）得分显示出显著相关性。值得注意的是，ESS评分与任何PSG指标之间根本未发现单一的显著相关性。在多元回归分析中，ISI第7项得分成为ESS评分的唯一显著独立预测因素。我们得出结论，失眠可能会显著影响OSA患者报告的日间嗜睡情况。我们建议，对于报告有日间嗜睡的OSA患者，应始终进行失眠症状和特征的评估（例如通过ISI）。我们提出，这些初步发现应在更大且多样化的OSA患者队列中得到验证。
