Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 1;41(2):zsx199.
doi: 10.1093/sleep/zsx199.

Determinants of sleepiness in obstructive sleep apnea

Bharati Prasad  1   2   3 , Alana D Steffen  3   4 , Hans P A Van Dongen  5 , Francis M Pack  6 , Inna Strakovsky  7 , Bethany Staley  6 , David F Dinges  6   8 , Greg Maislin  6 , Allan I Pack  6 , Terri E Weaver  3   9
Affiliations

Determinants of sleepiness in obstructive sleep apnea

Bharati Prasad et al. Sleep. .

Abstract

Study objectives: Significant interindividual variability in sleepiness is observed in clinical populations with obstructive sleep apnea (OSA). This phenomenon is only partially explained by the apnea-hypopnea index (AHI). Understanding factors that lead to sleepiness is critical to effective management of patients with OSA. We examined demographic and other factors associated with sleepiness in OSA.

Methods: Prospective study of 283 patients with newly diagnosed OSA by polysomnography (AHI ≥ 5 per hour). Subjective sleepiness (Epworth Sleep Scale [ESS] ≥ 11) and objective sleepiness (psychomotor vigilance task [PVT] mean lapse ≥ 2) were assessed.

Results: Participants were classified into four groups (1: sleepy by ESS and PVT, 2: sleepy by PVT only, 3: sleepy by ESS only, and 4: nonsleepy reference group) and compared by generalized logit model. Shorter daily sleep duration by actigraphy and less morningness were associated with higher risk of sleepiness (Odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.33-0.82 and OR = 0.89, CI 0.80-0.98, respectively). African-American race was associated with sleepiness (group 1, OR = 8.8, CI 2.8-27.3; group 2, OR = 16.6, CI 3.3-83.6; and group 3, OR = 3.3, CI 1.0-10.1). IL-6 level was higher in groups 1 and 3 (OR = 1.9, CI 1.0-3.4 and OR 2.0, CI 1.1-3.7, respectively).

Conclusions: African-American race, short sleep duration, chronotype, and increased proinflammatory cytokine IL-6 level were associated with sleepiness in OSA. These findings will inform future investigations determining mechanisms of sleepiness in OSA.

Keywords: OSA; OSA-clinical assessment; cytokines; home sleep apnea testing; sleepiness; vigilance.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study recruitment and procedures. $ AHI = apnea–hypopnea index, ¥ ESS = Epworth sleepiness scale, PVT = psychomotor vigilance test, MSLT = Multiple Sleep Latency Tests, Ω Group 1 = PVT lapse ≥ 2 and ESS ≥ 11, Group 2 = PVT lapse ≥ 2 and ESS < 11, Group 3 = PVT lapse < 2 and ESS ≥ 11, Group 4 = PVT lapse < 2 and ESS < 11.
See this image and copyright information in PMC

References

    1. Rauscher H, et al. Acceptance of CPAP therapy for sleep apnea. Chest 1991;100(4):1019–1023. - PubMed
    1. Weaver TE, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 2012;186(7):677–683. - PMC - PubMed
    1. Huang JF, et al. The relationship between excessive daytime sleepiness and metabolic syndrome in severe obstructive sleep apnea syndrome. Clin Respir J 2016;10(6):714–721. - PubMed
    1. Guglielmi O, et al. Job stress, burnout, and job satisfaction in sleep apnea patients. Sleep Med 2014;15(9):1025–1030. - PubMed
    1. Ward KL, et al. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med 2013;9(10):1013–1021. - PMC - PubMed