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. 2019 Aug 15;15(8):1135-1142.
doi: 10.5664/jcsm.7806.

Severity of Desaturations Reflects OSA-Related Daytime Sleepiness Better Than AHI

Samu Kainulainen  1 , Juha Töyräs  2 , Arie Oksenberg  3 , Henri Korkalainen  4 , Sandra Sefa  5 , Antti Kulkas  6 , Timo Leppänen  4
Affiliations

Severity of Desaturations Reflects OSA-Related Daytime Sleepiness Better Than AHI

Samu Kainulainen et al. J Clin Sleep Med. .

Abstract

Study objectives: The aim was to investigate how the severity of apneas, hypopneas, and related desaturations is associated with obstructive sleep apnea (OSA)-related daytime sleepiness.

Methods: Multiple Sleep Latency Tests and polysomnographic recordings of 362 patients with OSA were retrospectively analyzed and novel diagnostic parameters (eg, obstruction severity and desaturation severity), incorporating severity of apneas, hypopneas, and desaturations, were computed. Conventional statistical analysis and multivariate analyses were utilized to investigate connection of apnea-hypopnea index (AHI), oxygen desaturation index (ODI), conventional hypoxemia parameters, and novel diagnostic parameters with mean daytime sleep latency (MSL).

Results: In the whole population, 10% increase in values of desaturation severity (risk ratio = 2.01, P < .001), obstruction severity (risk ratio = 2.18, P < .001) and time below 90% saturation (t90%) (risk ratio = 2.05, P < .001) induced significantly higher risk of having mean daytime sleep latency ≤ 5 minutes compared to 10% increase in AHI (risk ratio = 1.63, P < .05). In severe OSA, desaturation severity had significantly (P < .02) stronger negative correlation (ρ = -.489, P < .001) with mean daytime sleep latency compared to AHI (ρ = -.402, P < 0.001) and ODI (ρ = -.393, P < .001). Based on general regression model, desaturation severity and male sex were the most significant factors predicting daytime sleep latency.

Conclusions: Severity of sleep-related breathing cessations and desaturations is a stronger contributor to daytime sleepiness than AHI or ODI and therefore should be included in the diagnostics and severity assessment of OSA.

Citation: Kainulainen S, Töyräs J, Oksenberg A, Korkalainen H, Sefa S, Kulkas A, Leppänen T. Severity of desaturations reflects OSA-related daytime sleepiness better than AHI. J Clin Sleep Med. 2019;15(8):1135-1142.

Keywords: MSLT; daytime sleepiness; desaturation severity; diagnostics; obstructive sleep apnea; sleep latency.

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Figures

Figure 1
Figure 1. Simulated relationship between DesSev and mean daytime sleep latency.
General regression model-based visualization of the effect of normalized and scaled DesSev on mean daytime sleep latency in the studied patient population. DesSev = desaturation severity.
Figure 2
Figure 2. Quantile regressions of 10%, 50%, and 90% quantiles for AHI, DesSev, and ObsSev.
Quantile regression-based simulations of the connection between increasing number and severity of breathing cessations and related desaturations. AHI = apnea-hypopnea index, DesSev = desaturation severity, MSL = mean daytime sleep latency, ObsSev = obstruction severity.
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