Ambulatory circadian monitoring in sleep disordered breathing patients and CPAP treatment

Antonio Martinez-Nicolas,Marc Guaita,Juan Antonio Madrid,Josep M Montserrat,Joan Santamaría,María Angeles Rol

doi:10.1038/s41598-021-94315-0

Abstract

Our aim was to evaluate the circadian rhythm of motor activity, body position and integrated variable TAP (composed by wrist Temperature, motor Activity and body Position) in Sleep Disordered Breathing (SDB), its relation to SDB severity and the effect of continuous positive airway pressure (CPAP) on these circadian rhythms. To do this, we monitored motor activity and body position rhythms of 78 SDB patients (53.3 ± 1.2 years old, 26.9% women) and 32 healthy subjects (51.4 ± 3.2 years old, 43.8% women) for 1 week. On the last day of that week, SDB patients underwent a polysomnography followed by a Maintenance of Wakefulness Test, Multiple Sleep Latency Test and Sustained Attention to Response Task protocol. A subgroup of 18 moderate to severe SDB patients was treated with CPAP and monitored again after 3 months under treatment. A non-parametrical analysis was performed to characterize the circadian patterns to assess differences between groups and associations between sleep and circadian parameters. Circadian variables were altered in SDB, exhibiting a direct relationship to SDB severity. The motor activity pattern showed a clear improvement with CPAP treatment. Thus, circadian ambulatory monitoring, including the integrated variable TAP, could be used to evaluate the circadian alterations caused by SDB and activity pattern to monitor the effect of CPAP treatment.

Highlights

Our aim was to evaluate the circadian rhythm of motor activity, body position and integrated variable TAP in Sleep Disordered Breathing (SDB), its relation to SDB severity and the effect of continuous positive airway pressure (CPAP) on these circadian rhythms
PSG revealed a complete resolution of SDB in all patients and improved excessive daytime sleepiness measured by Epworth Sleepiness Scale (ESS), Barcelona Sleepiness Index (BSI) sleepiness index, Multiple Sleep Latency Test (MSLT)-SL, Maintenance of Wakefulness Test (MWT)-SL and MWT-E
Our results highlight that SDB impairs rest-activity, body position and TAP variable circadian rhythms in accordance to SDB severity, whereas CPAP treatment improves motor activity pattern

Summary

Introduction

Our aim was to evaluate the circadian rhythm of motor activity, body position and integrated variable TAP (composed by wrist Temperature, motor Activity and body Position) in Sleep Disordered Breathing (SDB), its relation to SDB severity and the effect of continuous positive airway pressure (CPAP) on these circadian rhythms. The chronodisruptive effect of SDB is supported by both the circadian system alteration at several levels, such as thermoregulation or the sleep–wake cycle itself[5,6,7,8], and the circadian restoration of sleep, blood pressure, thermoregulation, immune response or haemostatic system by Continuous Positive Airway Pressure (CPAP)[5,6,9,10,11,12,13]. The main purpose of this study was to evaluate the circadian rhythm of motor activity, body position and the integrated TAP variable in order to determine how these rhythms are affected by sleep disordered breathing severity and continuous positive airway pressure treatment, and in consequence Ambulatory Circadian Monitoring (ACM) could constitute a screening tool for this disorder as well as CPAP efficacy under free-living conditions

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Conclusion