Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea

Henriette Koch; Logan Douglas Schneider; Laurel A Finn; Eileen B Leary; Paul E Peppard; Erika Hagen; Helge Bjarup Dissing Sorensen; Poul Jennum; Emmanuel Mignot

doi:10.1093/sleep/zsx152

Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea

Henriette Koch, Logan Douglas Schneider, Laurel A Finn, Eileen B Leary, Paul E Peppard, Erika Hagen, Helge Bjarup Dissing Sorensen, Poul Jennum, Emmanuel Mignot

Research output: Contribution to journal › Journal article › peer-review

36 Citations (Scopus)

Abstract

Study Objectives: To determine whether defining two subtypes of sleep-disordered breathing (SDB) events-with or without hypoxia-results in measures that are more strongly associated with hypertension and sleepiness.

Methods: A total of 1022 participants with 2112 nocturnal polysomnograms from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in two indices-desaturating (hypoxia-breathing disturbance index [H-BDI]) and nondesaturating (nonhypoxia-breathing disturbance index [NH-BDI]) events-regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2981 multiple sleep latency tests from a subset of 865 participants) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥ 140/90 or antihypertensive use.

Results: H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r ≥ 0.89, p ≤ .001 with 3% oxygen-desaturation index [ODI] and apnea hypopnea index with 4% desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR = 1.06, 95% CI = 1.00-1.12, p < .05; H-BDI OR 1.04, 95% CI = 0.98-1.10) and daytime sleepiness (β = 0.20 Epworth Sleepiness Scale [ESS] score, p < .0001; β = -0.20 minutes in MSL on multiple sleep latency test [MSLT], p < .01). Independently, nondesaturating event doubling was associated with more objective sleepiness (β = -0.52 minutes in MSL on MSLT, p < .001), but had less association with subjective sleepiness (β = 0.12 ESS score, p = .10). In longitudinal analyses, baseline nondesaturating events were associated with worsening of H-BDI over a 4-year follow-up, suggesting evolution in severity.

Conclusions: In SDB, nondesaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.

Original language	English
Article number	zsx152
Journal	Sleep
Volume	40
Issue number	11
Number of pages	10
ISSN	0161-8105
DOIs	https://doi.org/10.1093/sleep/zsx152
Publication status	Published - 2017

Keywords

Cohort Studies
Female
Humans
Hypertension/complications
Hypoxia
Male
Middle Aged
Polysomnography
Prevalence
Respiration
Sleep Apnea Syndromes/physiopathology
Sleep Stages
Wisconsin

Access to Document

10.1093/sleep/zsx152

Cite this

Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea. / Koch, Henriette; Schneider, Logan Douglas; Finn, Laurel A; Leary, Eileen B; Peppard, Paul E; Hagen, Erika; Sorensen, Helge Bjarup Dissing; Jennum, Poul; Mignot, Emmanuel.

In: Sleep, Vol. 40, No. 11, zsx152, 2017.

Research output: Contribution to journal › Journal article › peer-review

@article{c79775a5f0864c478b94f378e76bed81,

title = "Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea",

abstract = "Study Objectives: To determine whether defining two subtypes of sleep-disordered breathing (SDB) events-with or without hypoxia-results in measures that are more strongly associated with hypertension and sleepiness.Methods: A total of 1022 participants with 2112 nocturnal polysomnograms from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in two indices-desaturating (hypoxia-breathing disturbance index [H-BDI]) and nondesaturating (nonhypoxia-breathing disturbance index [NH-BDI]) events-regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2981 multiple sleep latency tests from a subset of 865 participants) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥ 140/90 or antihypertensive use.Results: H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r ≥ 0.89, p ≤ .001 with 3% oxygen-desaturation index [ODI] and apnea hypopnea index with 4% desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR = 1.06, 95% CI = 1.00-1.12, p < .05; H-BDI OR 1.04, 95% CI = 0.98-1.10) and daytime sleepiness (β = 0.20 Epworth Sleepiness Scale [ESS] score, p < .0001; β = -0.20 minutes in MSL on multiple sleep latency test [MSLT], p < .01). Independently, nondesaturating event doubling was associated with more objective sleepiness (β = -0.52 minutes in MSL on MSLT, p < .001), but had less association with subjective sleepiness (β = 0.12 ESS score, p = .10). In longitudinal analyses, baseline nondesaturating events were associated with worsening of H-BDI over a 4-year follow-up, suggesting evolution in severity.Conclusions: In SDB, nondesaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.",

keywords = "Cohort Studies, Female, Humans, Hypertension/complications, Hypoxia, Male, Middle Aged, Polysomnography, Prevalence, Respiration, Sleep Apnea Syndromes/physiopathology, Sleep Stages, Wisconsin",

author = "Henriette Koch and Schneider, {Logan Douglas} and Finn, {Laurel A} and Leary, {Eileen B} and Peppard, {Paul E} and Erika Hagen and Sorensen, {Helge Bjarup Dissing} and Poul Jennum and Emmanuel Mignot",

note = "{\textcopyright} Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail [email protected].",

year = "2017",

doi = "10.1093/sleep/zsx152",

language = "English",

volume = "40",

journal = "Sleep (Online)",

issn = "0161-8105",

publisher = "Oxford University Press",

number = "11",

}

TY - JOUR

T1 - Breathing Disturbances Without Hypoxia Are Associated With Objective Sleepiness in Sleep Apnea

AU - Koch, Henriette

AU - Schneider, Logan Douglas

AU - Finn, Laurel A

AU - Leary, Eileen B

AU - Peppard, Paul E

AU - Hagen, Erika

AU - Sorensen, Helge Bjarup Dissing

AU - Jennum, Poul

AU - Mignot, Emmanuel

PY - 2017

Y1 - 2017

N2 - Study Objectives: To determine whether defining two subtypes of sleep-disordered breathing (SDB) events-with or without hypoxia-results in measures that are more strongly associated with hypertension and sleepiness.Methods: A total of 1022 participants with 2112 nocturnal polysomnograms from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in two indices-desaturating (hypoxia-breathing disturbance index [H-BDI]) and nondesaturating (nonhypoxia-breathing disturbance index [NH-BDI]) events-regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2981 multiple sleep latency tests from a subset of 865 participants) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥ 140/90 or antihypertensive use.Results: H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r ≥ 0.89, p ≤ .001 with 3% oxygen-desaturation index [ODI] and apnea hypopnea index with 4% desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR = 1.06, 95% CI = 1.00-1.12, p < .05; H-BDI OR 1.04, 95% CI = 0.98-1.10) and daytime sleepiness (β = 0.20 Epworth Sleepiness Scale [ESS] score, p < .0001; β = -0.20 minutes in MSL on multiple sleep latency test [MSLT], p < .01). Independently, nondesaturating event doubling was associated with more objective sleepiness (β = -0.52 minutes in MSL on MSLT, p < .001), but had less association with subjective sleepiness (β = 0.12 ESS score, p = .10). In longitudinal analyses, baseline nondesaturating events were associated with worsening of H-BDI over a 4-year follow-up, suggesting evolution in severity.Conclusions: In SDB, nondesaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.

AB - Study Objectives: To determine whether defining two subtypes of sleep-disordered breathing (SDB) events-with or without hypoxia-results in measures that are more strongly associated with hypertension and sleepiness.Methods: A total of 1022 participants with 2112 nocturnal polysomnograms from the Wisconsin Sleep Cohort were analyzed with our automated algorithm, developed to detect breathing disturbances and desaturations. Breathing events were time-locked to desaturations, resulting in two indices-desaturating (hypoxia-breathing disturbance index [H-BDI]) and nondesaturating (nonhypoxia-breathing disturbance index [NH-BDI]) events-regardless of arousals. Measures of subjective (Epworth Sleepiness Scale) and objective (2981 multiple sleep latency tests from a subset of 865 participants) sleepiness were analyzed, in addition to clinically relevant clinicodemographic variables. Hypertension was defined as BP ≥ 140/90 or antihypertensive use.Results: H-BDI, but not NH-BDI, correlated strongly with SDB severity indices that included hypoxia (r ≥ 0.89, p ≤ .001 with 3% oxygen-desaturation index [ODI] and apnea hypopnea index with 4% desaturations). A doubling of desaturation-associated events was associated with hypertension prevalence, which was significant for ODI but not H-BDI (3% ODI OR = 1.06, 95% CI = 1.00-1.12, p < .05; H-BDI OR 1.04, 95% CI = 0.98-1.10) and daytime sleepiness (β = 0.20 Epworth Sleepiness Scale [ESS] score, p < .0001; β = -0.20 minutes in MSL on multiple sleep latency test [MSLT], p < .01). Independently, nondesaturating event doubling was associated with more objective sleepiness (β = -0.52 minutes in MSL on MSLT, p < .001), but had less association with subjective sleepiness (β = 0.12 ESS score, p = .10). In longitudinal analyses, baseline nondesaturating events were associated with worsening of H-BDI over a 4-year follow-up, suggesting evolution in severity.Conclusions: In SDB, nondesaturating events are independently associated with objective daytime sleepiness, beyond the effect of desaturating events.

KW - Cohort Studies

KW - Female

KW - Humans

KW - Hypertension/complications

KW - Hypoxia

KW - Male

KW - Middle Aged

KW - Polysomnography

KW - Prevalence

KW - Respiration

KW - Sleep Apnea Syndromes/physiopathology

KW - Sleep Stages

KW - Wisconsin

U2 - 10.1093/sleep/zsx152

DO - 10.1093/sleep/zsx152

M3 - Journal article

C2 - 29029253

VL - 40

JO - Sleep (Online)

JF - Sleep (Online)

SN - 0161-8105

IS - 11

M1 - zsx152

ER -