Factors Underlying Indivdual Differential Sleepiness in OSA

Factors Underlying Individual Differential Sleepiness in OSA T.E. Weaver, PhD, RN 1-3 , G. Maislin, MS, MA 2,3 , I. Bleckman, BA 2,3 , F. Pack, RN 2,3 , H. Van Dongen, PhD 5 , D. Dinges, PhD 4 , A.I. Pack, MBChB, PhD 2-3 1 Biobehavioral and Health Sciences Division, University of Pennsylvania School of Nursing; 2 Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine; 3 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania School of Medicine; 4 Department of Psychiatry, University of Pennsylvania School of Medicine - Philadelphia/US; 5 Washington State University - Spokane, WA/US, Table 1: Proportion of Sleepy & Non-sleepy Participants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Not all patients with obstructive sleep apnea (OSA) manifest excessive daytime sleepiness, the primary characteristic of this disorder. The purpose of this study was to explore potential factors underlying individual differences in daytime sleepiness in newly diagnosed patients with OSA. Method: Participants performed 1 wk of actigraphy/diary, then laboratory testing: multiple sleep latency test (MSLT), psychomotor vigilance task (PVT), Epworth Sleepiness Scale (ESS), neurobehavioral testing, and anthropometric testing. Sleepiness defined as ESS ≥11 and ≥ 2 lapses on PVT. Participants who were discordant on these measures were excluded. Enrolled participants completed 7 days of home sleep study (Embletta), actigraphy, and diary. Results: Of the 337 participants, 32% were classified as sleepy, 27% not sleepy and 42% discordant. Mean age of the sleepy group was 47.7 ± 8.9 and 47.2 ± 8.6 (N.S.) for the non-sleepy cohort with an apnea-hypoxia index of 33.3 ± 33 and 26.9 ± 24.5 (N.S.), respectively. The sleepy group had significantly (p<0.05) higher body mass index (40 vs. 36), less alcohol consumption per wk (2 vs. 4 drinks/wk), less than a high school education (45 vs. 30%), fewer males (30 vs. 46%), and more African Americans (71 vs. 42%). Baseline polysomnography showed that they had a greater number of periodic limb movements (2 vs.9/hr sleep). They used more thyroid (7 vs 29%), breathing sprays (27 vs. 12%), and sleeping medications (15 vs. 4 %). On actigraphy, the sleepy group significantly spent more time awake, decreased mean sleep time, increased mean nocturnal activity, increased mean length of wake bouts, increased total activity during sleep, and less lux exposure/day. Contrary to our hypothesis, there was no difference in night-to-night variability in the apnea-hypopnea index (AHI) between the groups with the intraclass correlations indicating a high degree of stability in AHI for each group (sleepy = 0.78; non-sleepy = 0.90). Conclusion: There is individual variability in sleepiness in patients with OSA. The reasons for these differences are multifactorial including a biological basis, i.e., genetics, which needs further exploration. Table 2: Demographic Characteristics Table 3: AHI Intraclass Correlations Figures : Sleepiness & Daily Functioning FOSQ Range 1 (Low)– 4 (High Functioning) SF36 Score: 100 = Best Functioning Funding Source National Heart Lung and Blood Institute ,[object Object],[object Object],[object Object],Background Abstract ,[object Object],[object Object],[object Object],[object Object],Methods Results There is individual variability in sleepiness in patients with OSA. The reasons for these differences are multifactorial including a biological basis, i.e., genetics, which needs further exploration. Conclusions PVT Lapses ≥ 2 Epworth Sleepiness Scale Score ≥ 11 Yes No Total Yes 107 AHI = 33 ± 31 45 152 No 95 90 AHI = 27 ± 25 * 185 Total 112 135 Characteristic Sleepy (N = 107) Non-Sleepy (N = 90) P Value Effect Size >0.35 Clinically Important Body Mass Index 40 ± 12 36 ± 10 0.01 0.38 Alcohol/week-Total 2.0 ± 4 4.0 ± 8 0.04 0.30 Gender (Male) 30% 46% 0.03 N/A Race 71% African American 42% African American > 0.001 N/A Education ≤ 45% High School ≤ 30% High School 0.001 N/A Variable All p<0.05 Sleepy N = 53 Non-sleepy N = 33 Apnea-Hypopnea Index 0.78 0.90 Apnea Index 0.77 0.66 Hypopnea Index 0.61 0.71 Minimum Oxygen Desaturation 0.84 0.92 Total Sleep Minutes 0.40 0.27

Factors Underlying Indivdual Differential Sleepiness in OSA

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Factors Underlying Indivdual Differential Sleepiness in OSA