Dimensions of sleepiness and their correlations with sleep-disordered breathing in mild sleep apnea.
OBJECTIVE
There are many ways of assessing sleepiness, which has many dimensions. In patients presenting a borderline apnea-hypopnea index (AHI, expressed as events/hour of sleep), the mechanisms of excessive daytime sleepiness (EDS) remain only partially understood. In the initial stages of sleep-disordered breathing, the AHI might be related to as-yet-unexplored EDS dimensions.


METHODS
We reviewed the polysomnography results of 331 patients (52% males). The mean age was 40 +/- 13 years, and the mean AHI was 4 +/- 2 (range, 0-9). We assessed ten potential dimensions of sleepiness based on polysomnography results and medical histories.


RESULTS
The AHI in non-rapid eye movement (NREM) stage 1 sleep (AHI-N1), in NREM stage 2 sleep (AHI-N2), and in REM sleep (AHI-REM) were, respectively, 6 +/- 7, 3 +/- 3 and 10 +/- 4. The AHI-N2 correlated significantly with the greatest number of EDS dimensions (5/10), including the Epworth sleepiness scale score (r = 0.216, p < 0.001). Factor analysis, using Cronbach's alpha, reduced the variables to three relevant factors: QUESTIONNAIRE (alpha = 0.7); POLYSOMNOGRAPHY (alpha = 0.68); and COMPLAINTS (alpha = 0.55). We used these factors as dependent variables in a stepwise multiple regression analysis, adjusting for age, gender, and body mass index. The AHI-N1 correlated significantly with POLYSOMNOGRAPHY (beta = -0.173, p = 0.003), and the AHI-N2 correlated significantly with COMPLAINTS (beta = -0.152, p = 0.017). The AHI-REM did not correlate with any factor.


CONCLUSIONS
Our results underscore the multidimensionality of EDS in mild sleep apnea.
Martinez
Denis
D
Department of Internal Medicine, Universidade Federal do Rio Grande do Sul - UFRGS, Federal University of Rio Grande do Sul - CEP 90035-903, Porto Alegre, RS, Brazil. dm@ufrgs.br
Lumertz
Magali Santos
MS
Lenz
Maria do Carmo Sfreddo
Mdo C
D000328:Adult; D015992:Body Mass Index; D006970:Disorders of Excessive Somnolence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology; D012895:Sleep, REM / Q000502:physiology*