Increased nocturnal arterial pulsation frequencies of obstructive sleep apnoea patients is associated with an increased number of lapses in a psychomotor vigilance task

Abstract

ObjectivesBesides hypoxemia severity, heart rate variability has been linked to cognitive decline in obstructive sleep apnea (OSA) patients. Thus, our aim was to examine whether the frequency domain features of nocturnal photoplethysmogram (PPG) can be linked to poor performance in psychomotor vigilance task (PVT).MethodsPPG signals from 567 suspected OSA patients, extracted from Type 1 diagnostic polysomnography, and corresponding results of PVT were retrospectively examined. The frequency content of complete PPGs was determined, and analyses were conducted separately for men (n=327) and women (n=240). Patients were grouped to PVT performance-quartiles based on the number of lapses (reaction times ≥500 ms) and within-test variation in reaction times. The best (Q1) and worst-performing (Q4) quartiles were compared due the lack of clinical thresholds in PVT.ResultsWe found the increase in arterial pulsation frequency (APF) in both men and women was associated with a higher number of lapses. Higher APF was also associated with higher within-test variation in men, but not in women. Median APF (β=0.27, p=0.01), time spent under 90% saturation (β=0.05, p<0.01) female sex (β=1.29, p<0.01), older age (β=0.03, p<0.01), and subjective sleepiness (β=0.07, p<0.01) were significant predictors of belonging to lapses Q4. Only female sex (β=0.75, p<0.01) and depression (β=0.91, p<0.02) were significant predictors of belonging to Q4 based on the within-test variation.ConclusionsIn conclusion, increased APF in PPG provides a possible PSG-indicator for deteriorated vigilance especially in male OSA patients. This finding highlights the connection between cardiorespiratory regulation, vigilance, and OSA. However, our results indicate substantial sex-dependent differences that warrants further prospective studies.

The Sleep Revolution project: the concept and objectives

“…We will accomplish this by developing personalised SDB diagnostic parameters that predict future adverse health consequences and determine treatment needs in a patient‐specific manner. This includes an in‐depth assessment of the duration of respiratory events, the pattern of hypoxic burden during sleep, the level of sleep fragmentation, as well as the sympathetic and cardiovascular response to SDB events (Azarbarzin et al, 2019; Kainulainen, Duce, et al, 2020; Kainulainen, Töyräs, et al, 2020; Korkalainen et al, 2021; Kulkas et al, 2013; Muraja‐Murro et al, 2013, 2014).…”

“…We will accomplish this by developing personalised SDB diagnostic parameters that predict future adverse health consequences and determine treatment needs in a patient-specific manner. This includes an in-depth assessment of the duration of respiratory events, the pattern of hypoxic burden during sleep, the level of sleep fragmentation, as well as the sympathetic and cardiovascular response to SDB events (Azarbarzin et al, 2019;Kainulainen, Duce, et al, 2020;Korkalainen et al, 2021;Kulkas et al, 2013;Muraja-Murro et al, 2013. Also, overtreatment of patients, who benefit less from the intervention, can be better avoided by employing these more sophisticated diagnostic parameters valid in all three dimensions "A" (respiratory events), "E" (acute systemic effect), and "O" (chronic end-organ impact) (Pevernagie et al, 2020;Randerath et al, 2018).…”