Author/Authors :
Shao, Chuan Department of Special Procurement Ward - The First Affiliated Hospital of Soochow University, Suzhou, China , Qi, Huan Department of Special Procurement Ward - The First Affiliated Hospital of Soochow University, Suzhou, China , Lang, Ruyi Department of Respiratory Medicine - Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, China , Yu, Biyun Department of Respiratory Medicine - Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, China , Tang, Yaodong Department of Respiratory Medicine - Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, China , Zhang, Lina Department of Preventive Medicine - School of Medicine - Ningbo University, Ningbo, China , Wang, Xun Department of Respiratory and Critical Care Medicine - Wuxi No. 2 People’s Hospital - Nanjing Medical University, China , Wang, Ling Department of Special Procurement Ward - The First Affiliated Hospital of Soochow University, Suzhou, China
Abstract :
Background. The occurrence and severity of excessive daytime sleepiness (EDS) vary considerably among obstructive sleep apnea
(OSA) patients. This study was designed to investigate the characteristics of EDS and identify its contributing factors in OSA
patients. Methods. This was a cross-sectional study from a tertiary medical center in China. A total of 874 consecutive patients with
newly diagnosed OSA were included. Subjective daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The
subjects were assigned to the non-EDS group (582 patients), mild to moderate EDS group (227 patients), and severe EDS group
(65 patients) according to the ESS scores. The clinical features and polysomnographic parameters were acquired and analyzed to
identify the differences between groups and the determinants of EDS. Results. +e age of patients with severe EDS (49.5 ± 11.3) was
slightly greater than that of patients with mild to moderate EDS (44.5 ± 10.2) (p < 0.05) and non-EDS patients (45.2 ± 12.0)
(p < 0.05). Body mass index (BMI) was highest in the severe EDS group (29.1 ± 3.6 kg/m2
) (p < 0.0001), intermediate in the mild to
moderate EDS group (27.9 ± 3.3 kg/m2
), and lower in the non-EDS group (26.8 ± 3.3 kg/m2
). Logistic regression analysis showed
waist circumference, memory loss, work/commute disturbances, and sleep efficiency were independently associated with mild to
moderate EDS, and the microarousal index, apnea-hypopnea index (AHI), and saturation impair time below 90% were independent contributing factors of mild to moderate EDS. Meanwhile, age, neck circumference, gasping/choking, memory loss,
work/commute disturbances, and sleep latency were independently associated with severe EDS, and the AHI and mean SpO2 were
independent contributing factors of severe EDS. Conclusions. OSA patients with various severities of EDS are more obese and have
more comorbid symptoms compared to patients without EDS. Sleep fragmentation, respiratory events, and nocturnal hypoxia
may be predictors of EDS. Comprehensive consideration of demographic, clinical, and polysomnographic factors is required
when evaluating OSA patients.
