The role of large muscle movements on excessive daytime sleepiness in patients with obstructive sleep apnea

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY Sleep and Breathing Pub Date : 2024-09-16 DOI:10.1007/s11325-024-03156-4

Merve Aktan Suzgun, Gulcin Benbir Senel, Derya Karadeniz

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Abstract

Purpose

Obstructive sleep apnea (OSA) is a heterogeneous disorder requiring personalized diagnostic approaches. Restless sleep and excessive daytime sleepiness (EDS) frequently accompany OSA, and are mainly linked to sleep fragmentation secondary to apneas and/or hypopneas. In this study, we aimed to analyze the characteristics of LMMs in OSA and to evaluate interrelationship between LMMs and EDS.

Methods

Untreated-naïve adult OSA patients, with vs. without EDS were prospectively enrolled. Patients with comorbid neurological/psychiatric diagnosis, usage of drugs/substances known to affect sleep and positive airway pressure therapy were excluded. Routine evaluation of video-polysomnography was followed by LMM scoring. LMMs were compared between OSA with vs. without EDS, and correlations of LMMs with ESS scores and macrostructural sleep parameters were analyzed.

Results

Sixty patients were included (median age 43.5 [37.0] years, %78.3 men); 17 had EDS with Epworth Sleepiness Scale (ESS) ≥ 10 (28.3%). Total LMM index in total sleep time (TST) was 7.9 [20.6]. Total LMM index in TST (p = 0.048) and N1 (p = 0.020), and arousal-related LMM index in TST (p = 0.050) and N1 (p = 0.026) were higher in OSA with EDS than those without EDS. ESS scores were positively correlated with total (r = 0.332,p = 0.028) and arousal-related (r = 0.338,p = 0.025) LMM indexes in N1, and abnormal respiratory event-related LMM indexes in N1 (r = 0.440,p = 0.003) and N3 (r = 0.293,p = 0.050) after correction for age, sex, body-mass-index and apnea-hypopnea index.

Conclusion

Our study demonstrated that LMMs were more frequent in OSA with EDS than those without EDS. This may have broad implications for the mechanisms of motor restlessness and residual sleepiness in OSA and warrants larger-scale, long-term follow-up studies.

Clinical trial registration

No clinical trial registration due to the observational design of the study.

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大肌肉运动对阻塞性睡眠呼吸暂停患者白天过度嗜睡的影响

目的阻塞性睡眠呼吸暂停（OSA）是一种异质性疾病，需要个性化的诊断方法。睡眠不安和白天过度嗜睡（EDS）经常伴随着 OSA，主要与继发于呼吸暂停和/或低通气的睡眠片段有关。在这项研究中，我们旨在分析 OSA 中 LMM 的特征，并评估 LMM 与 EDS 之间的相互关系。排除合并神经/精神诊断、使用已知会影响睡眠的药物/物质以及接受过气道正压治疗的患者。在对视频多导睡眠图进行常规评估后，再对 LMM 进行评分。对伴有与不伴有 EDS 的 OSA 患者的 LMM 进行比较，并分析 LMM 与 ESS 评分和宏观睡眠结构参数之间的相关性。结果共纳入 60 名患者（中位年龄 43.5 [37.0] 岁，男性占 78.3%）；17 名患者伴有 EDS，且 Epworth 嗜睡量表（ESS）≥ 10（28.3%）。总睡眠时间（TST）中的 LMM 总指数为 7.9 [20.6]。有 EDS 的 OSA 在 TST（p = 0.048）和 N1（p = 0.020）中的 LMM 总指数，以及在 TST（p = 0.050）和 N1（p = 0.026）中的唤醒相关 LMM 指数均高于无 EDS 的 OSA。ESS评分与N1的总LMM指数（r = 0.332,p = 0.028）和唤醒相关LMM指数（r = 0.338,p = 0.025）以及N1的异常呼吸事件相关LMM指数（r = 0.结论：我们的研究表明，伴 EDS 的 OSA 患者比不伴有 EDS 的 OSA 患者更常出现 LMMs。这可能会对 OSA 运动性不安和残余嗜睡的机制产生广泛影响，因此需要进行更大规模的长期随访研究。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.