More severe hypoxemia is associated with better subjective sleep quality in obstructive sleep apnea

Abstract

BackgroundPerceived sleep quality may play an important role in diagnosis and therapy for obstructive sleep apnea (OSA). However, few studies have assessed factors that are associated with perceived sleep quality in OSA patients. Hypoxemia depresses the central nervous system and attenuates the perceived respiratory load in asthmatic patients. This study aimed to investigate the factors related to perceived sleep quality, focusing on the role of hypoxemia.MethodsPolysomnography studies of 156 OSA patients were reviewed. Traditional polysomnographic parameters, including parameters of oxy-hemoglobin saturation (SpO2), were calculated, and the sleep questionnaire and scales were used. Considering the possible pitfalls of absolute values of SpO2 and individualized responses to hypoxemia, the amplitude of desaturation was further computed as “median SpO2 minus lowest 5 % SpO2 “and “highest 5 % SpO2 minus median 5 % SpO2”. Correlations between these parameters and perceived sleep quality, represented as the Pittsburgh sleep quality index (PSQI), were performed. Multiple linear regression analysis was also conducted to investigate the factors associated with the PSQI.ResultsAlthough the PSQI was not correlated with the apnea-hypopnea index (r = −0.113, p = 0.162) and oxygen desaturation index (r = −0.085, p = 0.291), the PSQI was negatively correlated with “median SpO2 minus lowest 5 % SpO2” (r = −0.161, p = 0.045). After adjusting for age, total sleep time, the periodic limb movements index, tendency of depression, and the lowest 5 % SpO2, the “median SpO2 minus lowest SpO2” was still a significant predictor for a lower PSQI (β = −0.357, p = 0.015).ConclusionsMore severe hypoxemia is associated with better perceived sleep quality among OSA patients. This paradox may be associated with hypoxemia-related impairment of perception. The effect of hypoxemia did not appear to be significant in relatively mild hypoxemia but become significant in severe hypoxemia.” Median SpO2 minus lowest 5 % SpO2” may also be a better predictor of perceived sleep quality than the apnea-hypopnea index because of the disproportionate effects of hypoxemia. Additionally, further studies are necessary to confirm the role of hypoxemia on perceived sleep quality and identify the possible threshold of hypoxemia in OSA patients.

Are lifestyle pattern changes associated to poor subjective sleep quality?: a cross-sectional study by gender among the general Japanese population underwent specified medical check-ups in 2014 and 2015

“…For the interpretation of these results, it is necessary to discuss the association of potential confounders with Poor SSQ. Although several health problems such as sleep apnoea, depression and suicide are associated to poor SSQ, 3–5 and thus are considered to be potential confounders, the present study did not measure these health problems. Therefore, our results could not provide the data for precise interpretation.…”

“…Subjective sleep quality (SSQ) is defined by the satisfaction of one’s overall sleep experience and is composed of sleep depth and restfulness. 1 2 Past studies have reported poor SSQ to be associated with several health problems such as sleep apnoea, 3 depression, 4 suicide, 5 obesity 6 and cardiovascular disease. 7 Sleep disturbance such as low-quality sleep may cause an increase in medical costs in cases where it accompanies other diseases.…”

Self-Reported Sleep Quality With Mandibular Advancement Device or Continuous Positive Airway Pressure: A Randomized Clinical Trial on Patients With Mild and Moderate Obstructive Sleep Apnea

“…However, CPAP treatment also did not reduce PSQI global score below 5.0, showing that the PSQI global score is dependent on more factors than REI. 2,23 The limited reduction of PSQI global score in the CPAP group may be due to low CPAP compliance in the ITT analysis. However, the PP analysis showed that when only including patients who used the MAD or CPAP more than 4 hours, more than 50% of nights, more patients using MAD than using CPAP report improved sleep quality according to the RCI (Table 3).…”

“…15,20 The patient's perceived sleep quality while using CPAP or MAD might be one such factor, but self-reported sleep quality during OSA treatment is not extensively studied. 17,23 Contrary to polysomnographic analysis of sleep quality, which shows sleep efficacy and changes in sleep stages during OSA treatment, 24,25 self-reported sleep quality shows how the patient experiences the effect of OSA treatment on sleep quality. It is currently not clear which OSA treatment is better at improving self-reported sleep quality, or how much improvement could be expected in patients with mild and moderate OSA.…”

Nocturnal Desaturation is Associated With Atrial Fibrillation in Patients With Ischemic Stroke and Obstructive Sleep Apnea

“…The best method by which to score hypopnea events and whether or not AHI is the best parameter to measuring the severity of OSA are debatable. [35][36][37] Currently, the oxygen desaturation threshold (ODT) levels for hypopnea can be 3% or 4% based on different definitions proved by the AASM in 2013. 38 Myllymaa et al studied middle-aged subjects and found that the number of patients with AHI ≥ 15 decreased by approximately 44% when hypopnea was classified according to ODT4% (AASM 2007) instead of ODT3% (AASM 2012).…”