OBSTRÜKTİF UYKU APNE SENDROMLU HASTALARDA GÜNDÜZ AŞIRI UYKULULUK HALİNİ ETKİLEYEN FAKTÖRLER

Bu çalışmanın amacı, obstrüktif uyku apne sendromu (OUAS) olan hastalarda aşırı gündüz uykululuk halini karakterize ederek klinik ve polisomnografik değişkenlerle ilişkisini belirlemektir. Apne hipopne indeksi 5 ve üzeri olan OUAS’lı hastalar (n = 143) çalışmaya dahil edilmiş olup, OUAS’lı hastalardan Epworth uykululuk ölçeği (EUÖ)≥ 10 olanlar gündüz aşırı uykululuğu pozitif kabul edilmiştir (n:73). EUÖ  <10 olanlar gündüz aşırı uykululuğu negatif kabul edilmiştir. (n:70). EUÖ pozitif hastalar, EUÖ negatif hastalar ile karşılaştırıldığında; belirgin şekilde daha yüksek apne hipopne indeksi, gece daha düşük ortalama oksijen satürasyonu ve daha düşük ortalama desatürasyon indeksi gösterdi. EUÖ pozitif hastalarda solunumsal uyarılma indeksi ve ortalama apne süresi daha yüksek olduğu sonucuna ulaşılmıştır. OUAS’lılarda solunumsal uyarılma indeksi, apne hipopne indeksi, ortalama apne süresi ve gece oksijen satürasyonundaki düşmeler GAUH’ni belirlemede önemli rol oynayabilirler.

FACTORS INFLUENCING EXCESSIVE DAYTIME SLEEPINESS in PATIENTS with OBSTRUCTIVE SLEEP APNEA SYNDROME

The aim of this study is to investigate the relationship between clinical and polysomnographic variables by characterizing excessive daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). OSAS patients with apnea hypopnea index 5 and above (n = 143) are included in the study. Epworth Sleepiness Scale (EAP) ≥ 10 patients with OSAS are considered to be positive for daytime sleepiness (n: 73). Those with EEI <10 are considered negative in daytime excessive sleepiness (n: 70). When compared with the Epworth Sleepiness Scala (ESS) negative patients; significantly higher apnea hypopnea index, lower mean oxygen saturation at night, and lower mean desaturation index. Respiratory arousal index and mean apnea duration were higher in ESS positive patients. The respiratory arousal index, apnea hypopnea index, mean apnea duration and night oxygen saturation decrease in OSAS patients may play an important role in determining excessive-daytime sleepiness.

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  • 1. Sateia MJJC. International classification of sleep disorders. 2014;146(5):1387-94.
  • 2. Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TMJS. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. 2004;27(3):453-8.
  • 3. Uehli K, Mehta AJ, Miedinger D, Hug K, Schindler C, Holsboer-Trachsler E, et al. Sleep problems and work injuries: a systematic review and meta-analysis. 2014;18(1):61-73.
  • 4. Mulgrew A, Ryan C, Fleetham J, Cheema R, Fox N, Koehoorn M, et al. The impact of obstructive sleep apnea and daytime sleepiness on work limitation. 2007;9(1):42-53.
  • 5. Garbarino S, Scoditti E, Lanteri P, Conte L, Magnavita N, Toraldo DMJFin. Obstructive sleep apnea with or without excessive daytime sleepiness: clinical and experimental data-driven phenotyping. 2018;9:505.
  • 6. Zhou J, Camacho M, Tang X, Kushida CAJSm. A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. 2016;23:99-108.
  • 7. Prasad B, Steffen AD, Van Dongen HP, Pack FM, Strakovsky I, Staley B, et al. Determinants of sleepiness in obstructive sleep apnea. 2018;41(2):zsx199.
  • 8. Littner MR, Kushida C, Wise M, G. Davila D, Morgenthaler T, Lee-Chiong T, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. 2005;28(1):113-21.
  • 9. Johns MWJs. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. 1991;14(6):540-5.
  • 10. Al-Abri MA, Al-Adawi S, Al-Abri I, Al-Abri F, Dorvlo A, Wesonga R, et al. Daytime sleepiness among young adult Omani car drivers. 2018;18(2):e143.
  • 11. Lanza A, Mariani S, Sommariva M, Campana C, Rubino A, Nichelatti M, et al. Continuous positive airway pressure treatment with nasal pillows in obstructive sleep apnea: long-term effectiveness and adherence. 2018;41:94-9.
  • 12. Patel S, Kon SS, Nolan CM, Barker RE, Simonds AK, Morrell MJ, et al. The Epworth Sleepiness Scale: minimum clinically important difference in obstructive sleep apnea. 2018;197(7):961-3.
  • 13. Thorarinsdottir EH, Bjornsdottir E, Benediktsdottir B, Janson C, Gislason T, Aspelund T, et al. Definition of excessive daytime sleepiness in the general population: Feeling sleepy relates better to sleep‐related symptoms and quality of life than the Epworth Sleepiness Scale score. Results from an epidemiological study. 2019:e12852.
  • 14. Ramar K, Olson EJ. Management of common sleep disorders. American family physician. 2013;88(4):231-8.
  • 15. Chen R, Xiong KP, Lian YX, Huang JY, Zhao MY, Li JX, et al. Daytime sleepiness and its determining factors in Chinese obstructive sleep apnea patients. Sleep & breathing = Schlaf & Atmung. 2011;15(1):129-35.
  • 16. Castiglioni P, Lombardi C, Di Rienzo M, Lugaresi E, Montagna P, Cortelli P, et al. What are the causes of excessive daytime sleepiness in patients with sleep-disordered breathing? The European respiratory journal. 2008;32(2):526-7.
  • 17. Young T, Peppard PE, Gottlieb DJJAjor, medicine cc. Epidemiology of obstructive sleep apnea: a population health perspective. 2002;165(9):1217-39.
  • 18. Veasey SC, Davis CW, Fenik P, Zhan G, Hsu Y-J, Pratico D, et al. Long-term intermittent hypoxia in mice: protracted hypersomnolence with oxidative injury to sleep-wake brain regions. 2004;27(2):194-201.
  • 19. Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. 2013;62(7):610-6.
  • 20. Sun Y, Ning Y, Huang L, Lei F, Li Z, Zhou G, et al. Polysomnographic characteristics of daytime sleepiness in obstructive sleep apnea syndrome. 2012;16(2):375-81.
  • 21. Swanson LM, Arnedt JT, Rosekind MR, Belenky G, Balkin TJ, Drake CJJosr. Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll. 2011;20(3):487-94.
  • 22. Chen Y-C, Chen T-W, Su M-C, Chen C-J, Chen K-D, Liou C-W, et al. Whole genome DNA methylation analysis of obstructive sleep apnea: IL1R2, NPR2, AR, SP140 methylation and clinical phenotype. 2016;39(4):743-55.
  • 23. Castiglioni P, Lombardi C, Cortelli P, Parati GJERJ. Why excessive sleepiness may persist in OSA patients receiving adequate CPAP treatment. 2012;39(1):226-7.
  • 24. Bixler E, Vgontzas A, Lin H-M, Calhoun S, Vela-Bueno A, Kales AJTJoCE, et al. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. 2005;90(8):4510-5.
  • 25. Muraja-Murro A, Nurkkala J, Tiihonen P, Hukkanen T, Tuomilehto H, Kokkarinen J, et al. Total duration of apnea and hypopnea events and average desaturation show significant variation in patients with a similar apnea–hypopnea index. 2012;36(8):393-8.