Sleep remains disturbed in patients with obstructive sleep apnea treated with positive airway pressure: a three-month cohort study using continuous actigraphy.
Some patients with obstructive sleep apnea (OSA) remain sleepy despite positive airway pressure (PAP) therapy. The mechanisms by which this occurs are unclear but could include persistently disturbed sleep. The goal of this study was to explore the relationships between subjective sleepiness and actigraphic measures of sleep during the first three months of PAP treatment.



We enrolled 80 patients with OSA and 50 comparison subjects prior to treatment and observed them through three months of PAP therapy. PAP adherence and presence of residual respiratory events were determined from PAP machine downloads. Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and actigraphic data were collected before and at monthly intervals after starting PAP.



Patients with OSA were sleepier and showed a greater degree of sleep disruption by actigraphy at the baseline. After three months of PAP, only ESS and number of awakenings (AWAKE#) normalized, while wake after sleep onset and sleep efficiency remained worse in patients with OSA. FOSQ was improved in patients with OSA but never reached the same level as that of comparison subjects. ESS and FOSQ improved slowly over the study period.



As a group, patients with OSA show actigraphic evidence of persistently disturbed sleep and sleepiness-related impairments in day-to-day function after three months of PAP therapy. Improvements in sleepiness evolve over months with more severely affected patients responding quicker. Persistent sleep disruption may partially explain residual sleepiness in some PAP-adherent OSA patients.
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Department of Veterans Affairs Health Care System, Iowa City, Iowa, USA. Electronic address: jon-tippin@uiowa.edu.
Jon
J
Tippin
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Nazan
N
Aksan
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
Jeffrey
J
Dawson
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Steven W
SW
Anderson
Department of Neurology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Matthew
M
Rizzo
D056044:Actigraphy / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires; D014851:Wakefulness
Actigraphy; Obstructive sleep apnea; Positive airway pressure; Residual sleepiness