Evaluation Parameter of Excessive Daytime Sleepiness for Obstructive Sleep Apnea Patients

Background and Objective Obstructive sleep apnea (OSA) is a sleep-related breathing disorder caused by repetitive obstruction of the upper airway. Repetitive obstruction of the upper airway causes impaired gaseous exchange, resulting hypoxia, hypercapnia, and frequent arousals of sleep architecture. Polysomnography (PSG) is a gold standard for diagnosing OSA. Excessive daytime sleepiness (EDS) is a common accompanying daytime symptoms in OSA patients. Since EDS can cause unexpected events such as traffic accident or poor performance in workplace, it is regarded as a significant public health problem. Therefore, accurate assessment and prediction of this symptom is important. The Epworth Sleepiness Scale (ESS) and multiple sleep latency test are most commonly used to evaluate EDS, but their efficacies are controversial. The purpose of this study is to find the parameter to evaluate and predict the EDS for OSA patients.Methods We retrospectively reviewed the medical records of 88 OSA patients. Patients were divided into two groups according to the presence of EDS. We analyzed the clinical records, questionnaire scores, and PSG data to find the difference between two groups.Results ESS was 10.64 ± 4.28 in EDS patients and 8.63 ± 4.86 in non-EDS patients. ESS showed a statistically significant difference between two groups (p = 0.044). Also, the percentage of 1st stage non-REM sleep in total sleep time (N1%) was 25.09 ± 15.24 in EDS patients and 18.97 ± 10.30 in non-EDS patients and showed a statistically significant difference between groups (p = 0.033). Patients’ weight was 81.59 ± 20.52 in EDS patients and 74.14 ± 12.63 in non-EDS patients and showed a statistically significant difference between groups (p = 0.046).Conclusions ESS, N1% and patients’ weight were significant parameter which is related with the presence of EDS for OSA patients. These parameters will be useful in evaluating the presence of EDS for OSA patients. Also, in patients diagnosed with sleep disorder with high N1%, EDS must be accurately evaluated as well.

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Patogenesis dan diagnosis gangguan napas saat tidur dengan Drug Induce Sleep Endoscopy (DISE)

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v47i2.229 ◽

2018 ◽

Vol 47 (2) ◽

pp. 193

Author(s):

Elvie Zulka Kautzia Rachmawati ◽

Wresty Arief ◽

Susyana Tamin ◽

Rahmanofa Yunizaf ◽

Fauziah Fardizza

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Upper Airway ◽

Sleep Endoscopy ◽

Drug Induced ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep ◽

Muller’S Maneuver

Latar belakang: Obstructive sleep apnea (OSA) ialah penyakit kronis yang terjadi akibat episode intermiten sumbatan jalan napas komplit atau sebagian saat tidur. OSA dapat menimbulkan komplikasi seperti hipertensi, diabetes melitus, stroke dan excessive daytime sleepiness yang dapat berakibat fatal. OSA merupakan bagian dari gangguan napas saat tidur. Tujuan: Mengindentifikasi letak atau level dan konfigurasi sumbatan pada saat tidur. Tinjauan pustaka: Cara untuk mendiagnosis OSA adalah nasofaringolaringoskopi dengan Muller`s maneuver, pemeriksaan polisomnography (PSG), dan drug induce sleep endoscopy (DISE). Pemeriksaan PSG merupakan standar baku emas untuk mendapakan nilai apnea-hipopnea index (AHI) yang menentukan derajat OSA. Pemeriksaan untuk mengidentifikasi lokasi sumbatan jalan napas yang menyebabkan peningkatan resistensi aliran udara adalah Muller`s maneuver dan DISE. Pada pemeriksaan DISE, digunakan propofol atau midazolam secara intravena untuk menstimulasi keadaan sumbatan pada saat tidur, dilanjutkan dengan pemeriksaan nasofaringolaringoskopi. Kesimpulan: Pemeriksaan ini merupakan cara yang sangat terpercaya untuk menentukan level sumbatan pada keadaan tidur, sehingga jenis tindakan operasi yang dilakukan menjadi lebih tepat. Kata kunci: Drug induced sleep endoscopy, midazolam, propofol, manuver Muller’s, obstructive sleep apnea, polisomnografi ABSTRACT Background: Obstructive sleep apnea (OSA) is a common chronic disorder caused by intermittent episodes of complete or partial upper airway obstruction during sleep. It may lead to complications such as hypertension, diabetes mellitus, stroke, as well as excessive daytime sleepiness which can be fatal. OSA is a part of sleep disorder breathing. Purpose: To identify the sites or the levels of obstruction and its configuration. Literature review: Muller’s maneuver upon nasopharyngoscopy, polysomnography (PSG), and drug-induced sleep endoscopy (DISE) are the modalities for diagnosing OSA. Polysomnography is the gold standard examination for OSA, one of the variables; the apnea-hipopnea index (AHI) is used to determine the presence and severity of OSA. Muller’s maneuver and DISE are the examination to identify the sites responsible for increase in airflow resistance. DISE technique uses intravena injection of propofol or midazolam to produce obstruction in a “natural sleep” condition followed by nasopharyngolaryngoscopy examination. Conclusion: DISE is considered as a very reliable means to define the level of obstruction during sleeping, thus could help to determine appropriate surgery. Keywords: Drug induced sleep endoscopy, midazolam, propofol, Muller’s maneuver, obstructive sleep apnea, polisomnography

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Excessive daytime sleepiness, metabolic syndrome, and obstructive sleep apnea: two independent large cross-sectional studies and one interventional study

Respiratory Research ◽

10.1186/s12931-019-1248-y ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Xinyi Li ◽

Hengye Huang ◽

Huajun Xu ◽

Yue Shi ◽

Yingjun Qian ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Large Scale ◽

Upper Airway ◽

Health Screening ◽

Upper Airway Surgery ◽

Airway Surgery ◽

Obstructive Sleep

Abstract Background Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) were considered to contribute to MetS. This study was performed to assess the association between MetS and EDS in two independent large-scale populations, and in subjects who underwent upper-airway surgery. Methods A total of 6312 patients without self-reported depression and 3578 suspected OSA patients were consecutively recruited, during health screening examinations and from our sleep center, respectively. A total of 57 subjects with OSA who underwent upper-airway surgery were also included. Demographic, anthropometric, biochemical, and polysomnographic data were obtained. Results In the health screening examination group, 233 (9.23%) women and 350 (10.93%) men had complaints of EDS. A total of 229 (7.04%) women and 1182 (36.88%) men met the criteria for MetS. In the OSA group, 147 (21.18%) women and 1058 (36.69%) men reported EDS. In addition, 93 (13.4%) women and 1368 (47.43%) men reported MetS. In the health screening examination group, EDS did not contribute significantly to MetS (OR = 1.125, 95% CI: 0.907–1.395; p = 0.283). In the OSA group, EDS significantly contributed to MetS (OR = 1.249, 95% CI: 1.063–1.468; p = 0.007); however, the results were not significant after adjusting for sleep variables (OR = 1.071, 95% CI: 0.905–1.268; p = 0.423). Upper-airway surgery did not affect cardio-metabolic variables in OSA patients with or without EDS. Conclusions EDS was not associated with MetS in two independent large-scale cohorts. In addition, upper-airway surgery did not affect components of MetS in OSA patients with and without EDS.

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Study of TAK-925 in Participants With Obstructive Sleep Apnea (OSA) Who Are Experiencing Excessive Daytime Sleepiness (EDS) Despite Current or Prior Use of a Primary OSA Therapy

Case Medical Research ◽

10.31525/ct1-nct04091425 ◽

2019 ◽

Author(s):

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Obstructive Sleep ◽

Prior Use

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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Pitolisant versus placebo for excessive daytime sleepiness in narcolepsy and obstructive sleep apnea: A meta-analysis from randomized controlled trials

Pharmacological Research ◽

10.1016/j.phrs.2021.105522 ◽

2021 ◽

Vol 167 ◽

pp. 105522

Author(s):

Jiahe Wang ◽

Xiang Li ◽

Siyuan Yang ◽

Tianyi Wang ◽

Zhongmou Xu ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Randomized Controlled Trials ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Obstructive Sleep

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Risk of obstructive sleep apnea, excessive daytime sleepiness and depressive symptoms in a Nigerian elderly population

Sleep Science ◽

10.1016/j.slsci.2016.05.005 ◽

2016 ◽

Vol 9 (2) ◽

pp. 106-111 ◽

Cited By ~ 3

Author(s):

Michael B. Fawale ◽

Olanrewaju Ibigbami ◽

Ishaq Ismail ◽

Adekunle F. Mustapha ◽

Morenikeji A. Komolafe ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Depressive Symptoms ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Elderly Population ◽

Obstructive Sleep

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The role of home sleep testing for evaluation of patients with excessive daytime sleepiness: focus on obstructive sleep apnea and narcolepsy

Sleep Medicine ◽

10.1016/j.sleep.2019.01.014 ◽

2019 ◽

Vol 56 ◽

pp. 80-89 ◽

Cited By ~ 3

Author(s):

Russell Rosenberg ◽

Max Hirshkowitz ◽

David M. Rapoport ◽

Meir Kryger

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Home Sleep Testing ◽

Obstructive Sleep

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Improved follow-up by peripheral arterial tonometry in CPAP-treated patients with obstructive sleep apnea and persistent excessive daytime sleepiness

Sleep And Breathing ◽

10.1007/s11325-018-1668-9 ◽

2018 ◽

Vol 22 (4) ◽

pp. 1153-1160 ◽

Cited By ~ 2

Author(s):

C. Schöbel ◽

S. Knorre ◽

M. Glos ◽

C. Garcia ◽

I. Fietze ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Peripheral Arterial Tonometry ◽

Arterial Tonometry ◽

Obstructive Sleep ◽

Peripheral Arterial

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Association of TNF-α (-308G/A) Gene Polymorphism with Circulating TNF-α Levels and Excessive Daytime Sleepiness in Adults with Coronary Artery Disease and Concomitant Obstructive Sleep Apnea

Journal of Clinical Medicine ◽

10.3390/jcm10153413 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3413

Author(s):

Afrouz Behboudi ◽

Tilia Thelander ◽

Duygu Yazici ◽

Yeliz Celik ◽

Tülay Yucel-Lindberg ◽

...

Keyword(s):

Coronary Artery Disease ◽

Obstructive Sleep Apnea ◽

Coronary Artery ◽

Sleep Apnea ◽

Gene Polymorphism ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Obstructive Sleep ◽

Tnf Α ◽

Artery Disease

Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), in which inflammatory activity has a crucial role. The manifestation of OSA varies significantly between individuals in clinical cohorts; not all adults with OSA demonstrate the same set of symptoms; i.e., excessive daytime sleepiness (EDS) and/or increased levels of inflammatory biomarkers. The further exploration of the molecular basis of these differences is therefore essential for a better understanding of the OSA phenotypes in cardiac patients. In this current secondary analysis of the Randomized Intervention with Continuous Positive Airway Pressure in CAD and OSA (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), we aimed to address the association of tumor necrosis factor alpha (TNF-α)-308G/A gene polymorphism with circulating TNF-α levels and EDS among 326 participants. CAD patients with OSA (apnea–hypopnea-index (AHI) ≥ 15 events/h; n = 256) were categorized as having EDS (n = 100) or no-EDS (n = 156) based on the Epworth Sleepiness Scale score with a cut-off of 10. CAD patients with no-OSA (AHI < 5 events/h; n = 70) were included as a control group. The results demonstrated no significant differences regarding the distribution of the TNF-α alleles and genotypes between CAD patients with vs. without OSA. In a multivariate analysis, the oxygen desaturation index and TNF-α genotypes from GG to GA and GA to AA as well as the TNF-α-308A allele carriage were significantly associated with the circulating TNF-α levels. Moreover, the TNF-α-308A allele was associated with a decreased risk for EDS (odds ratio 0.64, 95% confidence interval 0.41–0.99; p = 0.043) independent of age, sex, obesity, OSA severity and the circulating TNF-α levels. We conclude that the TNF-α-308A allele appears to modulate circulatory TNF-α levels and mitigate EDS in adults with CAD and concomitant OSA.

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