Influencing Factors of Daytime Sleepiness in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Its Correlation with Pulse Oxygen Decline Rate.

Fengying Zhang,Meiling Xiang,Fangfang Wang,Wenping Duan,Xijiang Wu,Tingting Huang

doi:10.1155/2021/6345734

Abstract

Objective To explore the influencing factors of daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the correlation between daytime sleepiness and pulse oxygen decline rate in patients with severe OSAHS. Methods From January 2018 to April 2021, 246 consecutive patients with OSAHS diagnosed by polysomnography (PSG) in our hospital were selected. All patients were grouped according to the minimum nocturnal oxygen saturation and apnea hypopnea index (AHI). There were 33 cases in the no sleep hypoxia group, 34 cases in the mild hypoxia group, 119 cases in the moderate hypoxia group, and 60 cases in the severe hypoxia group. There were 30 cases in the simple snoring group, 55 cases in the mild OSAHS group, 48 cases in the moderate OSAHS group, and 113 cases in the severe OSAHS group. The Epworth Sleepiness Scale (ESS) scores of each group were compared. All patients were grouped according to ESS score. Those with score ≥9 were included in the lethargy group (n = 118), and those with score ≤10 were included in the no lethargy group (n = 128). Univariate and multivariate logistic regression analyses were used to explore the influencing factors of daytime sleepiness in OSAHS patients. Pearson correlation analysis showed the correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS. Results The ESS score of the severe hypoxia group > the moderate hypoxia group > the mild hypoxia group > the no sleep hypoxia group. There was significant difference among the groups (F = 19.700, P < 0.0001). There were significant differences between the severe hypoxia group and other groups and between the moderate hypoxia group and the no sleep hypoxia group and the mild hypoxia group (P < 0.05). The ESS score of the severe OSAHS group > the moderate OSAHS group > the mild OSAHS group > the simple snoring group. There was significant difference among the groups (F = 19.000, P < 0.0001). There were significant differences between the severe OSAHS group and other groups and between the moderate OSAHS group and the simple snoring group (P < 0.05). Univariate analysis showed that BMI, neck circumference, snoring degree, total apnea hypopnea time, AHI, micro arousal index (MAI), oxygen saturation (CT90%), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) were the influencing factors of daytime sleepiness in OSAHS patients (P < 0.05). Multiple logistic regression analysis showed that AHI and CT90% were independent risk factors for daytime sleepiness in OSAHS patients (P < 0.05). Pearson correlation analysis showed that there was a positive correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS (r = 0.765, P < 0.0001). Conclusion OSAHS patients may be accompanied by daytime sleepiness in varying degrees, which may be independently related to AHI and CT90%. The degree of daytime sleepiness in patients with severe OSAHS may be closely related to the decline rate of pulse oxygen, which should be paid great attention in clinic.

Highlights

Adult obstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep disordered breathing disease in which patients are in a state of hypopnea or have apnea more than 30 times during continuous 7 h night sleep, or patients are in a state of hypopnea or have apnea more than 5 times/h [1]. e main clinical manifestations of this disease are excessive sleepiness, decreased memory and attention, even cognitive dysfunction or behavioral abnormalities in the daytime, irregular snoring and loud snoring, apnea, frequent hypoxemia caused by hypopnea, wakefulness, and sleep disorders during sleep at night [2, 3]. e affected patients vary widely, with single or multiple symptoms, or no symptoms at all
Recent studies have shown that longterm chronic hypoxia is an important mechanism leading to daytime sleepiness, and repeated intermittent hypoxemia at night is the main determinant of daytime sleepiness in OSAHS patients, and for some OSAHS patients with severe obstructive apnea, arterial oxygen saturation is low when they are awake, daytime sleepiness with higher performance [9, 10]
Nocturnal minimum oxygen saturation and apnea hypopnea index (AHI) are two important indexes to evaluate the severity of OSAHS; Epworth Sleepiness Scale (ESS) is an important tool for self-assessment of daytime sleepiness in patients with OSAHS [17]

Summary

Introduction

Adult obstructive sleep apnea hypopnea syndrome (OSAHS) is a sleep disordered breathing disease in which patients are in a state of hypopnea or have apnea more than 30 times during continuous 7 h night sleep, or patients are in a state of hypopnea or have apnea more than 5 times/h [1]. e main clinical manifestations of this disease are excessive sleepiness, decreased memory and attention, even cognitive dysfunction or behavioral abnormalities in the daytime, irregular snoring and loud snoring, apnea, frequent hypoxemia caused by hypopnea, wakefulness, and sleep disorders during sleep at night [2, 3]. e affected patients vary widely, with single or multiple symptoms, or no symptoms at all. E main clinical manifestations of this disease are excessive sleepiness, decreased memory and attention, even cognitive dysfunction or behavioral abnormalities in the daytime, irregular snoring and loud snoring, apnea, frequent hypoxemia caused by hypopnea, wakefulness, and sleep disorders during sleep at night [2, 3]. Recent studies have shown that longterm chronic hypoxia is an important mechanism leading to daytime sleepiness, and repeated intermittent hypoxemia at night is the main determinant of daytime sleepiness in OSAHS patients, and for some OSAHS patients with severe obstructive apnea, arterial oxygen saturation is low when they are awake, daytime sleepiness with higher performance [9, 10]. It is of great clinical value to study the influencing factors of daytime sleepiness and its correlation with nocturnal hypoxemia in patients with OSAHS, and as a new sleep monitoring index, pulse oxygen decline rate should receive more attention.

Methods

Results

Conclusion