Abstract
Discrepancies between subjective and objective measures of total sleep time (TST) are frequent among insomnia patients, but this issue remains scarcely investigated in obstructive sleep apnea (OSA). We aimed to evaluate if sleep perception is affected by the severity of OSA. We performed a 3-month cross-sectional study of Brazilian adults undergoing overnight polysomnography (PSG). TST was objectively assessed from PSG and by a self-reported questionnaire (subjective measurement). Sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5.0/h, being its severity classified according to AHI thresholds: 5.0-14.9/h (mild OSA), 15.0-29.9/h (moderate OSA), and ≥ 30.0/h (severe OSA). Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups (p = 0.014). Mean SPI values significantly decreased as the OSA severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036. Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028). However, insomnia was not considered as an independent variable for the presence of any OSA, moderate/severe OSA, and severe OSA (all p-values > 0.05). In a clinical referral cohort, SPI significantly decreases with increasing OSA severity, but is not modified by the presence of insomnia symptoms.
Highlights
Obstructive sleep apnea (OSA) is an extremely prevalent disorder [1], characterized by repetitive complete or partial airflow limitation due to increases in upper airway resistance during sleep, leading to intermittent hypoxemia and sleep fragmentation [2]
Mean Sleep perception index (SPI) values significantly decreased as the obstructive sleep apnea (OSA) severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036
Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028)
Summary
Obstructive sleep apnea (OSA) is an extremely prevalent disorder [1], characterized by repetitive complete or partial airflow limitation due to increases in upper airway resistance during sleep, leading to intermittent hypoxemia and sleep fragmentation [2] These hallmark characteristics of OSA are associated with cardiovascular, metabolic, and neurocognitive morbidities [2,3,4,5]. In adult individuals, portable home tests have quickly emerged as an alternative and effective method for the diagnosis of OSA, in light of their reduced cost and wider availability when compared to full polysomnography (PSG) [8] Another highly prevalent sleep disorder is chronic insomnia, and according to the definition used, insomnia rates can reach up to about 50% [9,10,11]. Patients suffering from insomnia are more likely to use sleep medications, in addition to reporting more fragmented sleep and fewer total hours of sleep than those without a diagnosis of insomnia [9,10,11]
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