IJCM  Vol.3 No.3 , May 2012
Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment
Abstract: The purpose of this study was to assess factors associated with subjective sleep evaluation, chiefly excessive daytime sleepiness (EDS) in obstructive sleep apnea syndrome (OSAS) adult outpatients under continuous positive airway pressure (CPAP) treatment. One thousand and forty-eight OSAS outpatients (mean age: 51.4% male: 90.5%) who were treated by CPAP were consecutively collected. Age, sex, CPAP compliance (CPAP usage as their device of nights with application-time of at least 4 hours per night objectively; %usage ≥ 4 h/d), and Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) of the patients showing EDS (Japanese version of the Epworth Sleepiness Scale; JESS ≥ 11) were compared cross-sectionally with those of the patients who did not show EDS (JESS < 11). Nineteen point two % of all patients showed EDS subjectively. Two hundred one patients were classified to an EDS(+) group and an 847 patients were classified to EDS(–) group. Age and global PSQI-J scores were significantly different between the two groups. Logistic regression showed that EDS was significantly associated with global PSQI-J scores, but not with age. Among PSQI-J components, overall sleep quality, duration of sleep, sleep disturbance, and day dysfunction due to sleepiness were significantly higher in the EDS(+) group. Especially, 19.4% of patient in the EDS(+) group reported actual sleep time during the past month to be less than 5 hours/day. Although functional relationship should be further evaluated, insufficient sleep is the main factor associated with EDS in the OSAS patients under CPAP treatment.
Cite this paper: W. Yamadera, S. Chiba, M. Iwashita, R. Aoki, D. Harada, M. Sato, H. Moriwaki, K. Obuchi, M. Ozone, S. Nishino, H. Itoh and K. Nakayama, "Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment," International Journal of Clinical Medicine, Vol. 3 No. 3, 2012, pp. 194-199. doi: 10.4236/ijcm.2012.33039.

[1]   F. Campos-Rodriguez, N. Pena-Grinan, N. Reyes-Nunez, I. Cruz-Moron, J. Perez-Ronchel, F. Vega-Gallardo and A. Fernandez-Palacin, “Mortality in Obstructive Sleep Apnea-Hypopnea Patients Treated with Positive Airway Pressure,” Chest, Vol. 128, No. 2, 2005, pp. 624-633. doi:10.1378/chest.128.2.624

[2]   J. M. Marin, S. J. Carrizo, E. Vicente and A. G. Agusti, “Long-Term Cardiovasucular Outcomes in Men with Obstructive Sleep Apnea-Hypopnea with or without Treatment with Continuous Positive Airway Pressure: An Observational Study,” Lancet, Vol. 365, No. 9464, 2005, pp. 1046-1053.

[3]   N. B. Kribbs, A. I. Pack, L. R. Kline, P. L. Smith, A. R. Schwartz, N. M. Schubert, S. Redline, J. N. Henry, J. E. Getsy and D. F. Dinges, “Objective Measurement of Patterns of Nasal CPAP Use by Patients with Obstructive Sleep Apnea,” American Journal of Respiratory and Critical Care Medicine, Vol. 147, No. 4, 1993, pp. 887-895.

[4]   M. Orth, S. Kotterba, J. W. Walther, K. Rasche, G. Schultze-Werninghaus and H. W. Duchna, “Long Term Compliance of CPAP-Therapy-Update, Predictors and Interventions,” Pneumologie, Vol. 60, No. 8, 2006, pp. 480-484. doi:10.1055/s-2006-944234

[5]   N. S. Marshall, M. Barnes, N. Travier, A. J. Campbell, R. J. Pierce, R. D. McEvoy, A. M. Neill and P. H. Gander, “Continuous Positive Airway Pressure Reduces Daytime Sleepiness in Mild to Moderate Obstructive Sleep Apnea: A Meta-Analysis,” Thorax, Vol. 61, No. 5, 2006, pp. 430- 434. doi:10.1136/thx.2005.050583

[6]   J. Jing, T. Huang, W. Cui and H. Shen, “Effect on Quality of Life of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome: A Meta- Analysis,” Lung, Vol. 186, No. 3, 2008, pp. 131-144. doi:10.1007/s00408-008-9079-5

[7]   T. Roehrs, M. Carscadon, W. C. Dement and T. Roth, “Day-time Sleepiness and Alertness,” In: M. H. Kryeger, T. Roth and W. C. Dement, Eds., Principles and Practice of Sleep Medicine, 5th Edition, Elsevier Sanders, Philadelphia, 2011, pp. 42-53. doi:10.1016/B978-1-4160-6645-3.00004-9

[8]   D. Hailey, K. Tran, R. Dales, S. Mensinkai and L. Mc-Gahan, “Recommendations and Supporting Evidence in Guideline for Referral of Patients to Sleep Laboratories,” Sleep Medicine Review, Vol. 10, No. 4, 2006, pp. 287-299. doi:10.1016/j.smrv.2005.10.004

[9]   American Academy of Sleep Medicine, “The International Classification of Sleep Disorders 2nd Edition (ICSD-2), Diagnostic and Coding Manual,” American Academy of Sleep Medicine, Westchester, 2005.

[10]   J. Santamaria, A. Iranzo, J. Ma Montserrat and J. Pablo, “Persistent Sleepiness in CPAP Treated Obstructive Sleep Apnea Patients: Evaluation and Treatment,” Sleep Medi- cine Review, Vol. 11, No. 3, 2007, pp. 195-207. doi:10.1016/j.smrv.2007.02.005

[11]   H. M. Engleman, S. E. Martin, I. J. Deary and N. J. Dou- glas, “Effect of Con-tinuous Positive Airway Pressure Treatment on Daytime Function in Sleep Apnea/Hypop- nea Syndrome,” Lancet, Vol. 343, No. 8897, 1994, pp. 572- 575. doi:10.1016/S0140-6736(94)91522-9

[12]   J. L. Perin, J. Krieger, D. Rodenstein, A. Cornette, E. Sforza, P. Del-guste, C. Deschaux, V. Grillier and P. Levy, “Effectiveness Compliance during the First 3 Months of Continuous Positive Airway Pressure: A European Prospective Study of 121 Patients,” American Journal of Respiratory and Critical Care Medicine, Vol. 160, No. 4, 1999, pp. 1124-1129.

[13]   M. Takegami, Y. Suzukamo, T. Wakita, H. Noguchi, K. Chin, H. Kadotani, Y. Inoue, Y. Oka, T. Nakamura, J. Green, M. W. Johns and S. Fukuhara, “Development of a Japanese Version of the Epworth Sleepiness Scale (JESS) Based on Item Response Theory,” Sleep Medicine, Vol. 10, No. 5, 2009, pp. 556-565. doi:10.1016/j.sleep.2008.04.015

[14]   Y. Doi, M. Minowa, M. Uchiyama, M. Okawa, K. Kim, K. Shibui and Y. Kamei, “Psychometric Assessment of Subjective Sleep Quality Using the Japanese Version of the Pittsburgh Sleep Quality Index (PSQI-J) in Psychiatric Disordered and Control Subjects,” Psychiatry Research, Vol. 97, No. 2, 2000, pp. 165-172. doi:10.1016/S0165-1781(00)00232-8

[15]   C. Guilleminault and P. Philip, “Tiredness and Somnolence Despite Initial Treatment of Obstructive Sleep Apnea Syndrome (What to Do When an OSAS Patient Stays Hypersomnolent Despite Treatment),” Sleep, Vol. 19, No. 9S, 1996, pp. 117-122.

[16]   M. K. Reeves-Hoche, R. Meck and C. W. Zwillich, “Nasal CPAP, an Objective Evaluation of Patient Compliance,” American Journal of Respiratory and Critical Care Medicine, Vol. 149, No. 1, 1994, pp. 149-154.

[17]   M. A. Bédard, J. Montplaisir, J. Malo, F. Richer and I. Rouleau, “Persistent Neuropsychological Deficits and Vigilance Impairment in Sleep Apnea Syndrome after Treatment with Continuous Positive Airways Pressure (CPAP),” Journal of Clinical and Experimental Neuropsychology, Vol. 15, No. 2, 1993, pp. 330-341. doi:10.1080/01688639308402567

[18]   T. Kobayashi, E. Morofuji and Y. Watanabe, “Sleeping Time Keeps Decreasing, Male Housework Time Is Increasing. From the 2010 NHK Japanese Time Use Survey,” The NHK Monthly Report on Broadcast Research, 2011, pp. 2-21.

[19]   Y. Doi, M. Minowa and T. Tango, “Impact and Correlates of Poor Sleep Quality in Japanese White-Collar Employees,” Sleep, Vol. 26, No. 4, 2003, pp. 467-471.

[20]   H. P. Van Dongen, G. Maislin, J. M.Mullington and D. F. Dinges, “The Cumulative Cost of Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep Physiology from Chronic Sleep Restriction and To- tal Sleep Deprivation,” Sleep, Vol. 26, No. 2, 2003, pp. 117-126.

[21]   A. Golay, A. Girard, S. Grandin, J. C. Metrailler, M. Vic- trion, P. Lebas, J. Ybarra and T. Rochat, “A New Educa- tional Program for Patients Suffering from Sleep Apnea Syn-drome,” Patient Education and Counseling, Vol. 60, No. 2, 2006, pp. 220-227. doi:10.1016/j.pec.2005.01.007

[22]   J. E. Black and M. Hirshkowitz, “Modafinil for Treatment of Residual Excessive Sleepiness in Nasal Continuous Positive Airway Pressure-Treatment Obstructive Sleep Apnea/Hypopnea Syndrome,” Sleep, Vol. 28, No. 4, 2005, pp. 464-471.

[23]   W. Charles, Atwood Jr., J. Patrick and R. Givelber, “Medical Therapy for Obstructive Sleep Apnea,” In: M. H. Kryeger, T. Roth and W. C. Dement, Eds., Principles and Practice of Sleep Medicine, 5th Edition, Elsevier Sanders, Philadelphia, 2011, pp. 1219-1232