Bouloukaki Izolde, Vouis Theofilos, Velidakis Antonios, Moniaki Violeta, Mavroudi Eleni, Stathakis George, Fanaridis Michail, Schiza Sophia
Department of Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71500 Heraklion, Greece.
Healthcare (Basel). 2025 Feb 22;13(5):478. doi: 10.3390/healthcare13050478.
Factors underlying excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) are not fully understood. We investigated whether polysomnography (PSG) parameters differed between non-sleepy and sleepy (based on the Epworth Sleepiness Scale (ESS)) OSA patients with the same disease severity, which may play a role in the presence of EDS. A total of 1307 patients, without cardiovascular, metabolic, respiratory, or inflammatory comorbidities, diagnosed with OSA (apnea-hypopnea index (AHI) ≥ 5 per hour of sleep) with type 1 PSG were included. Based on the AHI, patients were classified into mild- (AHI 5-14.9, n = 236), moderate- (AHI 15-29.9, n = 367), and severe-OSA (AHI ≥ 30, n = 704) groups. These groups were further divided into two subgroups based on the ESS, the most convenient and widely used tool to assess excessive daytime sleepiness: sleepy (ESS > 10) and non-sleepy (ESS ≤ 10). PSG data were compared between groups, and multivariable logistic regression was used to identify differences after adjustment for confounders. For the entire population, male sex, younger age, obesity, depression, increased wakefulness after sleep onset (WASO), the arousal index, shorter sleep latency, and all indices of OSA severity (AHI, oxygen desaturation index, mean and lowest resting room air pulse oximetry (SpO), and sleep time with oxygen saturation < 90% (TST90)) were significantly associated with EDS. The arousal index consistently showed a strong association with EDS across all OSA severity groups. Moderate-OSA sleepy patients were younger, with shorter sleep latency and increased indices of OSA severity, excluding the AHI. Severe-OSA sleepy patients were younger, males, and obese; had depression, decreased slow-wave sleep (SWS) and sleep latency, and increased WASO; and presented an increase in all indices of OSA severity. Our results suggest that male sex, younger age, obesity, the presence of depression, WASO, lower sleep efficiency, the arousal index, and all indices of OSA severity may account for the presence or absence of EDS in OSA patients and could be useful for exploring the underlying pathophysiological mechanisms for precision medicine.
阻塞性睡眠呼吸暂停（OSA）患者白天过度嗜睡（EDS）的潜在因素尚未完全明确。我们研究了具有相同疾病严重程度的非嗜睡和嗜睡（基于爱泼华嗜睡量表（ESS））的OSA患者之间多导睡眠图（PSG）参数是否存在差异，这可能在EDS的发生中起作用。纳入了1307例诊断为OSA（呼吸暂停低通气指数（AHI）≥每小时睡眠5次）且进行了1型PSG检查、无心血管、代谢、呼吸或炎症合并症的患者。根据AHI，患者被分为轻度（AHI 5 - 14.9，n = 236）、中度（AHI 15 - 29.9，n = 367）和重度OSA（AHI≥30，n = 704）组。基于ESS（评估白天过度嗜睡最便捷且广泛使用的工具），这些组进一步分为两个亚组：嗜睡（ESS > 10）和非嗜睡（ESS≤10）。对各组之间的PSG数据进行比较，并使用多变量逻辑回归来确定在调整混杂因素后的差异。对于整个人群，男性、年轻、肥胖、抑郁、睡眠起始后觉醒时间（WASO）增加、觉醒指数、较短的睡眠潜伏期以及所有OSA严重程度指标（AHI、氧饱和度下降指数、平均和最低静息室内空气脉搏血氧饱和度（SpO）以及血氧饱和度<90%的睡眠时间（TST90））均与EDS显著相关。在所有OSA严重程度组中，觉醒指数始终与EDS密切相关。中度OSA嗜睡患者更年轻，睡眠潜伏期更短，且除AHI外的OSA严重程度指标增加。重度OSA嗜睡患者更年轻、为男性且肥胖；有抑郁、慢波睡眠（SWS）和睡眠潜伏期减少、WASO增加；并且所有OSA严重程度指标均增加。我们的结果表明，男性、年轻、肥胖、抑郁的存在、WASO、较低的睡眠效率、觉醒指数以及所有OSA严重程度指标可能解释了OSA患者中EDS的存在与否，并且可能有助于探索精准医学的潜在病理生理机制。
